Nearly a year into a once-in-a-century pandemic, US leaders continue to struggle to communicate salient coronavirus disease 2019 (COVID-19) information that resonates with the public and builds trust in science. Contributing to this challenge is the nation’s highly politicized response to the pandemic and growing ideological tensions.1
The COVID-19 pandemic has laid bare the challenges of communicating public health messages in a manner that motivates communities to follow lifesaving interventions. While both the World Health Organization and the Centers for Disease Control and Prevention have communications frameworks and toolkits that provide a grounding in crisis communication, neither dives deeply into the importance of language. Language gives meaning to messages that are conveyed and, when used effectively, has the potential to elicit behavior change.
Language has a profound influence on health behaviors and is a key component of science communication.2 Language about HIV prevention for people who inject drugs is a good example. Language that demonizes drug use as a moral failing stigmatizes people who use drugs, thereby inhibiting evidence-based harm-reduction interventions that save lives.3 Similarly, with respect to patient care, evidence shows that inclusive person-centered language is the least prone to stereotyping and stigma.4
Language to Reset the COVID-19 Conversation
To evaluate the language and messaging that government officials in the US have been using to address the COVID-19 pandemic, and to identify more effective language, the de Beaumont Foundation, in partnership with polling expert Frank Luntz, conducted a nationwide online poll of 1100 registered voters (a base sample of 800 plus an oversample of 300 African American individuals) from across the country on November 21 and 22, 2020. Respondents were selected from a convenience panel with weights applied to represent the nation’s demographics, including age, gender, race, education, and income. The poll assessed preferred words and phrases that could influence people to follow public health measures to slow the spread of the COVID-19 pandemic. The results offer insights into the ways health and government leaders can improve the effectiveness of public health messaging in the coming critical months of the pandemic, as well as the people and organizations who are trusted to communicate about COVID-19.
Insights About Language
Among the primary takeaways from the poll, COVID-19 communications are more likely to be effective if they focus on the benefits of success, not just the consequences of failure. People are less likely to follow public health measures based on fear alone.
Among respondents, 47% had a more favorable reaction to a “stay-at-home order” than to a “lockdown” (15%) or “aggressive restrictions” (19%). The phrase “lockdown” may raise concerns because it sounds like jailing people against their will, while staying at home is less threatening.
Referring to policies to combat the pandemic as “fact-based” (46%) or “based on science” (43%) has greater influence than saying they are based on “evidence,” “data,” or “medicine.”
People in the US react more positively when rules and regulations to address COVID-19 are called “protocols” rather than “mandates,” “directives,” “controls,” or “orders.” The language of government control is unlikely to be effective; avoiding such language is less threatening.
More than 4 in 5 respondents preferred “face masks” over “facial coverings.”
The warlike imagery of language that many politicians use about the pandemic—words such as “defeat,” “crush,” “combat,” and “conquer”—does not work well.
Many respondents (42%) believe that the nation’s goal should be to “eliminate” COVID-19. Because this is not currently possible, language should promote public understanding that the goal now is to slow the spread, with an ultimate goal to eliminate and eradicate the virus.
People in the US understand that specific individuals and businesses are exempt from some COVID-19 measures because of their roles in the community. Among respondents, 34% preferred to call workers “essential” rather than “frontline” workers, presumably because not all of these individuals are directly combating COVID-19 (eg, supermarket employees vs nurses).
Regarding vaccine uptake, 10% of respondents reported they “would never take a vaccine for COVID-19.” Among African American respondents, 19% stated they would never take the vaccine, while just 4% said they would take the vaccine “without hesitation” (compared with 16% of all respondents).
Insights About Decision-making and Communications
Just as important as using words that will be well received, effective health communication also requires using the most appropriate messengers to reach target audiences. The majority of people in the US (83%) believe that the nation’s and states’ top public health officials should be the decision-makers identifying solutions to the pandemic. After decisions have been made, respondents say they most trust researchers/scientists (63%) and COVID-19 survivors (50%) to share factual information. The national media and elected officials were among the least trustworthy to be communicating about the pandemic (30% and 20%, respectively).
Integration and Interpretation
People in the US are more responsive to language that personalizes the pandemic and its impact. Personalizing the situation includes recognizing the challenges and relating to them—reminding the public that while many people are exhausted by the pandemic, public health measures are not the enemy, but the road map for a faster and more sustainable recovery.
This public health crisis calls for consistency and clarity in communications from all levels of government. The nation’s political polarization and the disjointed response of elected officials (often along partisan lines) have contributed to confusion and mistrust of scientific information. Inconsistent messaging and the lack of a coordinated communications effort have affected adherence with public health measures and contributed to additional cases and deaths.
Words alone will not overcome the polarization and politicization of the US COVID-19 response, but using more effective words, the right messengers, and consistent messaging at all levels of government can keep people safer and strengthen our resilience and recovery.
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Miller M et al. JAMA Health Forum.
Corresponding Author: Mark Miller, BA, de Beaumont Foundation, 7501 Wisconsin Ave, Ste 1310e, Bethesda, MD 20814 (firstname.lastname@example.org).
Conflict of Interest Disclosures: This research was funded by a grant from the de Beaumont Foundation. No other disclosures were reported.
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Miller M, Castrucci BC. Changing the COVID-19 Conversation: It’s About Language. JAMA Health Forum. 2021;2(2):e210020. doi:10.1001/jamahealthforum.2021.0020