**4. Method**

The purpose of this paper is to present the cumulated results of an excessive literature review, looking at propositions for and examples of health risk messages disseminated during previous epidemics and pandemics, as well as during COVID-19. Hence, this review will only include articles from the field of risk communication and health communication which were released between 2000 and 2020, even though parallels to messages addressing ongoing pandemics, such as HIV/AIDS and Cholera, can be found.

We used keywords such as risk, health risk, risk communication, health communication, epidemic, pandemic and a combination thereof to compose our sample. With this scope in mind, we conducted a search using national library databases. We covered the major journals in strategic communication, risk communication, and health communication, such as *The Journal of Risk Research, Environmental Research, The Journal of Business Research, The Journal of Public Relations Research, Public Relations Review, The European Journal of Communication, Public Health, Health Communication, The Journal of Health Communication, Health Education and Behavior, The Journal of Allergy and Clinical Immunology, The Journal of Communication in Healthcare, The Journal of Health Management, The American Journal of Public Health, The Journal of Urban Health* and *Public Understanding of Science.* From these sources, we limited our selection to articles dealing with any type of health crisis, including Zika, Ebola, H1N1, the avian influenza and COVID-19. We screened them to a list of 115 pertinent references on health risk communication and message design, which constituted our sample.

With the above considerations we have now summed up some recommendations for designing health risk messages. For government officials, it is now of great interest to learn more about how health risk messages can be designed to benefit not only their own agenda, but also whole populations affected by crisis situations. After reviewing relevant (and recent) literature, it becomes obvious that scholars have devoted their research to studying communication during crisis situations in detail. In the following, several recommendations for designing and drafting health risk messages will be presented.

### **5. Recommendations for designing health risk messages**

#### **5.1 Be open and transparent**

The availability of timely and transparent information allows the public to derive at a realistic assessment of the health threat [3, 4, 54]. Building on previous research, messages disseminated in times of disruption should "[e]mphasize the rationale and importance of adherence to public health measures that some people may consider intrusive (e.g., quarantine)" (US Department of Health and Human Services 2008). Providing a solid reasoning is seen as paramount, given that in recent years, individuals trust in the validity of scientific findings has decreased considerably [55]. Hence, PSAs must address the necessity for specific crisis mitigation strategies and actions.

#### **5.2 Focus on relevant message content**

Experts have determined that ensuring public access to information – and thus engaging in a process of constant communication – is seen as essential in crisis situations [56]. Thereby, different forms of information need to be distinguished: instructing information, preventive information, and reactive information [57]. Instructing information covers three areas: information on the pandemic, the public's primary needs, and precautionary measures [57]. Through preventive information, public opinion regarding the crisis is sensitized, whilst through reactive information,

#### **Figure 1.**

*Austrian PSAs advising grandparents to refrain from visiting their grandchildren (left) and social distancing (right). (Source: https://www.bmkoes.gv.at/).*

the affected population is informed about the crisis progression, and a potential panic and the spread of rumors can be prevented [1]. *For instance, public health campaigns in Austria, Australia and the U.S. (New York) highlighted the necessity to either stay at home, socially distance or wear masks. For instance, the example in Figure 1 emphasizes the necessity to cut back on visits from grandparents or social distancing.*
