'By failing to prepare you are preparing to fail': lessons from the 2009 H1N1 'swine flu' pandemic.

Background: Pandemic influenza has the potential to cause widespread death and destruction. Communications with the public have a vital role in the prevention of pandemic influenza by promoting the effective uptake of behaviours that can delay the spread of infection. This study explored the development and implementation of communications in the pandemic influenza outbreak of H1N1 ('swine flu') in 2009 in three European countries.

Methods: In-depth interviews were conducted with senior policy and communication officials involved in the planning and delivery of communications programmes in England, Italy and Hungary.

Results: The study found a lack of planning and a low value attached to the skills required to produce effective communications. In all case study countries there was a dearth of good quality audience research to inform the development of communications. Little thought had been given to the tone, targeting or channelling of messages. Instead, communications were characterized by a 'one size fits all' and a 'top down', expert-led response. There was also little effort to evaluate the impact of communications, but where this was done, very low levels of public compliance and engagement with key behavioural messages were found.

Conclusions: Policy makers should prioritize investment in the skills and expertise required to achieve desired behaviour changes. Audience research should be conducted throughout the planning cycle to inform national communications strategies. This should include insights to inform the segmentation of public audiences, targeting of messages and consideration of content and emotional tone most likely to achieve desired behavioural outcomes.