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: 49 *
Loading metrics...

Abstract views

Total abstract views: 343 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 18th August 2018. This data will be updated every 24 hours.