Skip to main content

Communicating with the Public Following Radiological Terrorism: Results from a Series of Focus Groups and National Surveys in Britain and Germany

  • Julia M. Pearce (a1), G. James Rubin (a2), Piet Selke (a3), Richard Amlôt (a4), Fiona Mowbray (a4) and M. Brooke Rogers (a1)...

Incidents involving the exposure of large numbers of people to radiological material can have serious consequences for those affected, their community and wider society. In many instances, the psychological effects of these incidents have the greatest impact. People fear radiation and even incidents which result in little or no actual exposure have the potential to cause widespread anxiety and behavior change. The aim of this study was to assess public intentions, beliefs and information needs in the UK and Germany in response to a hidden radiological exposure device. By assessing how the public is likely to react to such events, strategies for more effective crisis and risk communication can be developed and designed to address any knowledge gaps, misperceptions and behavioral responses that are contrary to public health advice.


This study had three stages. The first stage consisted of focus groups which identified perceptions of and reactions to a covert radiological device. The incident was introduced to participants using a series of mock newspaper and broadcast injects to convey the evolving scenario. The outcomes of these focus groups were used to inform national telephone surveys, which quantified intended behaviors and assessed what perceptions were correlated with these behaviors. Focus group and survey results were used to develop video and leaflet communication interventions, which were then evaluated in a second round of focus groups.


In the first two stages, misperceptions about the likelihood and routes of exposure were associated with higher levels of worry and greater likelihood of engaging in behaviors that might be detrimental to ongoing public health efforts. The final focus groups demonstrated that both types of misunderstanding are amenable to change following targeted communication.


Should terrorists succeed in placing a hidden radiological device in a public location, then health agencies may find that it is easier to communicate effectively with the public if they explicitly and clearly discuss the mechanisms through which someone could be affected by the radiation and the known geographical spread of any risk. Messages which explain how the risk from a hidden radiological device “works” should be prepared and tested in advance so that they can be rapidly deployed if the need arises.

PearceJM, RubinGJ, SelkeP, AmlôtR, MowbrayF, RogersMB. Communicating with the Public Following Radiological Terrorism: Results from a Series of Focus Groups and National Surveys in Britain and Germany. Prehosp Disaster Med. 2013;28(2):1-10.

Corresponding author
Correspondence: Julia M. Pearce, PhD Kings College London Department of War Studies Strand Campus Room K7.05 London, WC2R 2LS UK E-mail
Hide All
1.Slovic P. Perception of risk. Science. 1987;236:280-285.
2.Bromet EJ. Lessons learned from radiation disasters. World Psychiatry. 2011;10(2):83-84.
3.Vyner HM. The psychological dimensions of health care for patients exposed to radiation and the other invisible environmental contaminants. Soc Sci Med. 1988;27:1097-1103.
4.Acton JM, Rogers MB, Zimmerman PD. Beyond the dirty bomb: re-thinking radiological terror. Survival. 2007;49(3):151-168.
5.Becker SM. Emergency communication and information issues in terrorist events involving radioactive materials. Biosecurity and Bioterrorism: Biodefense Strategy Practice and Science. 2004;2(3):195-207.
6.Lasker RD. Redefining Readiness: Terrorism Planning Through the Eyes of the Public. New York: New York Academy of Medicine; 2004.
7.Williams MT, Saathoff GB, Guterbock TM, MacIntosh A, Bebel R. Community Shielding in the National Capital Region: A Survey of Citizen Response to Potential Critical Incidents. Charlottesville, Virginia USA: University of Virginia, Critical Incident Analysis Group; 2005.
8.Stone FP. The “Worried Well” Response to CBRN Events: Analysis and Solutions. Alabama: USAF Counterproliferation Center; 2007.
9.Rubin GJ, Amlot R, Wessely S, Greenberg N. Anxiety, distress and anger among British nationals following the Fukushima nuclear accident. Br J Psychiatry. 2012;201:400-407.
10.Lemyre L, Turner MC, Lee JEC, Krewski D. Differential perception of chemical, biological and nuclear terrorism in Canada. Int J Risk Assessment and Management. 2007;7(8):1191-1208.
11.Taylor M, Joung W, Griffin B, et al. The public and a radiological or nuclear emergency event: threat perception, preparedness, and anticipated response - findings from a preliminary study in Sydney, Australia. Aus J Emerg Manage. 2011;26:31-39.
12.Glik D, Harrison K, Davoudi M, Riopelle D. Public perceptions and risk communications for botulism. Biosecur Bioterror. 2004;2:216-223.
13.Henderson JN, Henderson LC, Raskob GE, Boatright DT. Chemical (VX) terrorist threat: public knowledge, attitudes, and responses. Biosecur Bioterror. 2004;2:224-228.
14.Wray R, Jupka K. What does the public want to know in the event of a terrorist attack using plague? Biosecur Bioterror. 2004;2:208-215.
15.Marshall RJ, Petrone L, Takach MJ, et al. Make a kit, make a plan, stay informed: using social marketing to change the population's emergency preparedness behavior. Social Marketing Quarterly. 2007;13:47-64.
16.Gibson S, Lemyre L, Clement M, Markon MPL, Lee JEC. Terrorism threats and preparedness in Canada: The perspective of the Canadian public. Biosecur Bioterror. 2007;5:134-144.
17.Santos SL, Helmer DA, Fotiades J, Copeland L, Simon JD. Developing a bioterrorism preparedness campaign for veterans: using focus groups to inform materials development. Health Promot Pract. 2007;8:31-40.
18.Rinchiuso-Hasselmann A, Starr DT, McKay RL, Medina E, Raphael M. Public compliance with mass prophylaxis guidance. Biosecur Bioterror. 2010;8:255-263.
19.Chesser A, Ablah E, Hawley SR, et al. Preparedness needs assessment in a rural State: themes derived from public focus groups. Biosecur Bioterror. 2006;4:376-383.
20.Glik DC, Drury A, Cavanaugh C, Shoaf K. What not to say: risk communication for botulism. Biosecur Bioterror. 2008;6:93-107.
21.North CS, Pollio DE, Pfefferbaum B, et al. Concerns of Capitol Hill staff workers after bioterrorism: focus group discussions of authorities’ response. J Nerv Ment Dis. 2005;193:523-527.
22.Clarke CE, Chess C. False alarms, real challenges - one university's communication response to the 2001 anthrax crisis. Biosecur Bioterror. 2006;4:74-83.
23.Stein BD, Tanielian TL, Ryan GW, Rhodes HJ, Young SD, Blanchard JC. A bitter pill to swallow: nonadherence with prophylactic antibiotics during the anthrax attacks and the role of private physicians. Biosecur Bioterror. 2004;2:175-185.
24.Blanchard JC, Haywood Y, Stein BD, Tanielian TL, Stoto M, Lurie N. In their own words: lessons learned from those exposed to anthrax. Am J Public Health. 2005;95:489-495.
25.Miro S, Kaufman SG. Anthrax in New Jersey: a health education experience in bioterrorism response and preparedness. Health Promot Pract. 2005;6:430-436.
26.Quinn SC, Thomas T, Kumar S. The anthrax vaccine and research: reactions from postal workers and public health professionals. Biosecurity Bioterrorism. 2008;6:321-333.
27.Jefferds MD, Laserson K, Fry AM, et al. Adherence to antimicrobial inhalational anthrax prophylaxis among postal workers, Washington D.C., 2001. Emerging Infectious Diseases. 2002;8:1138-1144.
28.Keselman A, Slaughter L, Patel VL. Toward a framework for understanding lay public's comprehension of disaster and bioterrorism information. J Biomed Informatics. 2005;38:331-344.
29.Fischhoff B, Gonzalez RM, Small DA, Lerner JS. Evaluating the success of terror risk communications. Biosecur Bioterror. 2003;1:255-258.
30.Blendon RJ, Desroches CM, Benson JM, Herrmann MJ, Taylor-Clark K, Weldon KJ. The public and the smallpox threat. NEJM. 2003;348:426-432.
31.Marshall KM, Begier EM, Griffith KS, Adams ML, Hadler JL. A population survey of smallpox knowledge, perceptions, and healthcare-seeking behavior surrounding the Iraq invasion--Connecticut 2002-03. Biosecur Bioterror. 2005;3:246-255.
32.SteelFisher G, Blendon R, Ross LJ, et al. Public response to an anthrax attack: reactions to mass prophylaxis in a scenario involving inhalation anthrax from an unidentified source. Biosecur Bioterror. 2011;9:239-250.
33.Rubin GJ, Page L, Morgan O, et al. Public information needs after the poisoning of Alexander Litvinenko with polonium-210 in London: cross sectional telephone survey and qualitative analysis. BMJ. 2007;335:1143-1146.
34.Renn O. Public Responses to the Chernobyl Accident. Journal of Environmental Psychology. 1990;10(2):151-167.
35.Gaskell G, Bauer MW. Towards Public Accountability: Beyond Sampling, Reliability and Validity. In M.W. Bauer and G. Gaskell (eds.), Qualitative Researching with Text, Image and Sound. London: Sage Publications Ltd.; 2007:336-350.
36.Galea S, Tracy M. Participation rates in epidemioligic surveys. Annals of Epidemiology. 2007;17:643-653.
37.Aronson J. A pragmatic view of thematic analysis. The Qualitative Report. 1994;2(1):1-3.
38.Boyatzis RE. Transforming Qualitative Information: Thematic Analysis and Code Development. London: Sage Publications Ltd.; 1998.
39.Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77-101.
40.Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D. The revised Illness Perception Questionnaire (IPQ-R). Psychology & Health. 2002;17(1):1-16.
41.Rogers MB, Amlôt R, Rubin GJ, Wessely S, Krieger K. Mediating the social and psychological impacts of terrorist attacks: The role of risk perception and risk communication. International Review of Psychiatry. 2007;19(3):279-288.
42.Wray RJ, Kreuter MW, Jacobsen H, Clements B, Evans RG. Theoretical perspectives on public communication preparedness for terrorist attacks. Family & Community Health. 2004;27(3):232-241.
43.Rubin GJ, Amlôt R, Carter H, Large S, Wessely S, Page L. Reassuring and managing patients with concerns about swine flu: qualitative interviews with callers to NHS Direct. BMC Public Health. 2010;10:451.
44.Wray RJ, Becker SM, Henderson N, et al. Communicating with the public about emerging health threats: lessons from the pre-event message development project. American Journal of Public Health. 2008;98(12):2214-2222.
45.Pandey A, Patni N, Singh M, Sood M, Singh G. YouTube as a source of information on the H1N1 influenza pandemic. American Journal of Preventive Medicine. 2010;38(3):e1-e3.
46.Morgan DL. Focus Groups as Qualitative Research, 2nd Edition.London: Sage Publications Ltd.; 1997.
47.Sussman S, Burton D, Dent CW, Stacy AW, Flay BR. Use of focus groups in developing an adolescent tobacco use cessation program - collective norm effects. Journal of Applied Social Psychology. 1991;21(21):1772-1782.
48.Bishop GF. The Illusion of Public Opinion: Fact and Artifact in American Public Opinion Polls. Oxford: Rowman & Littlefield.; 2005.
49.O'Cathain A, Knowles E, Nicholl J. Testing survey methodology to measure patients’ experiences and views of the emergency and urgent care system: telephone versus postal survey. BMC Medical Research Methodology. 2010;10:52.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Prehospital and Disaster Medicine
  • ISSN: 1049-023X
  • EISSN: 1945-1938
  • URL: /core/journals/prehospital-and-disaster-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary materials

Pearce Supplementary Material

 Word (27 KB)
27 KB


Altmetric attention score

Full text views

Total number of HTML views: 2
Total number of PDF views: 30 *
Loading metrics...

Abstract views

Total abstract views: 264 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd February 2018. This data will be updated every 24 hours.