Fish and Shellfish Consumption Advisories Home

The sixth step for developing and implementing a risk communication program for fish and shellfish consumption advisories is to develop and pretest concepts, messages, materials, and activities.

Managers of fish consumption advisory (FCA) programs need to decide the primary Communication Objective as well as the main message of the material.

• Involve Target Audiences
• How to Write the Message
• Message Content: Benefits and Risks of Fish Consumption
• Pretest the Message

Involve Target Audiences

The only way to ensure that the communication will meet the needs of the target audiences is to involve target audience members from the beginning. Early target audience input is needed to learn about their respective issues associated with fish consumption and purpose of the communication, including barriers people have experienced related to their fish consumption, and recommendations to overcome those barriers.

Target audiences may often consist of people whose literacy and/or understanding of English is limited. Therefore, it is important to include people with limited literacy skills in the FCA development process. This ensures the message is understandable to those who cannot read English.

The content of the message and the channels that are used need to be effective and appropriate from the target audience’s perspective. Implementation efforts, too, must be effective and appropriate from the perspective of target audiences, who may be well-positioned to take the lead in implementing an advisory and outreach strategy that has been developed by and for their group. Evaluation may also be best when conducted together with members of the target audience, who may have the ability to help define and measure “success”.

Examples of Methods to Involve Target Audiences

There are numerous participatory, or user-centered design techniques, including focus groups, individual interviews, and usability testing that can be used to involve target audiences.

Using focus groups to help develop the message for different cultures allows the message content to be adapted based on what is heard from those groups. Focus groups can be designed for having conversations with small groups of people, which can allow a more in-depth conversation about what is important to them and what can be done to change the way of communicating with people so that they will understand and follow the advice.

Usability testing refers to a broad range of structured methods to engage users in designing communication materials. Usability tests often involve a tester asking a user to read and navigate a draft document or website, accomplish specific tasks related to it, and to recommend changes to the text, format, and graphics.

How to Write the Message

• Clarity
• Prescriptive and Explanatory Information
• Culture and Language
• Literacy
• Word Choice
• Visual Aids

Clarity

• Ways to be succinct, clear and concise
  • Decide on the key points or “messages” to communicate. What is the bottom line or the take-away message, even if the details are forgotten? A message is usually phrased as a brief (often one-sentence) statement.
  • Limit to 1-3 main messages.
  • Avoid jargon; use easier to understand terms.
  • Translate technical terms into everyday language the target audience can easily understand.
  • Use simple, strong, unambiguous, straightforward/direct language.
  • Use short sentences and short words.
  • Have a clear description of health outcomes.
  • Be direct about uncertainty of information at the beginning of a FCA.
  • When quantitative information is available, it should be presented clearly, with numbers. Using only words like “low,” “medium,” and “high” can mean different things to different people and be confusing. Whole numbers are easier to understand than decimals or fractions.
• Tone
  • Use positive rather than negative messages. For example, “prepare the fish differently” (to be safer) or “eat another type of fish” is preferable to “don’t eat this fish”. The content of the message should either give options or clearly state what to do. Information describing what can be gained by changing health behavior is more persuasive than describing what can be lost.
  • Cajoling tone is preferred to commanding tone.
  • Use active voice and address the user personally in a conversational style.
• Tailoring to the Target Audience
  • Outreach products will often have multiple related messages. Consider which messages to send to each target audience. There may be different messages for different audiences.
  • Speak to the target audience, shape the message to their needs, be sensitive to their situation.
  • To be effective while brief, communicators should know their audience and tailor the message appropriately.
  • Tailor the information to consider what members of the target audience(s) are already likely to know, what else they need to know, and what they are likely to understand. The most effective approach is to provide information that is valuable and interesting to the target audience.
  • Focus on what the user needs to know, especially for actions to take or a call to action.
• Formatting
  • The first few sentences or moments of communication might be the only chance to share key messages. Follow up with more details and contact information because some of the target audience will want that information.
  • Give advice that is immediately essential, dividing information into easy-to-understand parts, using bullets and summaries of important information.
  • Use headings and other formatting techniques to provide a clear and organized structure.
  • Reduce the amount of information shown as much as possible. With more information, people may not know where to focus their attention and know the information should be most important in their decisions. Exclude non-critical information.

Prescriptive and Explanatory Information

• Prescriptive messages are generally issued through a government agency and often include “do this” or “do not do that” types of statements.
• Explanatory messages seek to make the prescriptive information more relevant to specific target audiences. Explanatory messages could include “redirect” information providing links to technical reports or other types of complex information. The explanatory messages should show some degree of simplification. For instance, an explanatory message might be limited to just two or three major themes to avoid overloading the message. While even simplified explanatory messages might be expected to contain some qualitative facts and figures, such messages would often aim to avoid unnecessary jargon and seek ways to relate technical terms to common sense concepts.

Culture and Language

FCA content should be culturally appropriate from the target audience’s perspective. Culturally appropriate messages tend to be more accepted by target audiences. It is helpful when the agency developing the FCA message has site-specific information such as why people fish and how they prepare the fish. There could be vast differences among target audiences as to what is and is not acceptable.

Provide advisories in the language(s) of the target audiences. Many members of some target audiences have limited English proficiency. Some, especially recent immigrants and refugees, may not speak any English. If detailed information is included in a separate document, make sure that is presented in the target audience’s language(s). Back-translate translations to verify the meaning is consistent. In these cases, use the local or common name of the fish in any type of outreach.

Literacy

Design advisories to account for limited literacy or illiteracy in the target audience. Consider computer literacy in the target audience. In addition to basic literacy skills, web-based sources of information pose computer literacy requirements, such as the ability to locate and search sites, spell search terms, and follow threads to related sources.

Some groups have an oral tradition. They may not have a written language or may not be literate in their language to the extent it has been written down. Or they may be resistant to reducing communication to writing, preferring instead to give and receive information orally. Some groups have had less formal education and some of their members may be illiterate. It may be that some advisories should not rely solely on written words, rather they should potentially use spoken words, demonstration, or graphics. This information will become apparent as FCA programs gather information on target audiences.

Word Choice

Proper word choice is critical for communicating the message. Feedback from target audiences will help identify confusing terms and preferred terms.

Examples of Some Confusing Terms for FCAs from a Study

Visual Aids

In addition to including concise and direct text, the greatest emphasis should be on symbols and images, because that is where people will look first. Striking and meaningful visual images and symbols can be very effective. Materials that use a combination of communication methods (e.g., text, graphics, diagrams, photos) are more effective than material with only one of those methods. Printed and electronic media should be culturally appropriate and include racially relevant images of target audiences. Clearly explain any numbers that are presented.

Demonstrations and pictures can help make directions simpler to understand and follow for any literacy level. They can help the target audience understand quantitative information. A reference point for portion sizes is helpful in estimating portion size. For example, an image of an adult hand with a cooked fish fillet overlaid (over the palm) is understandable as a portion size of approximately four ounces. An image of an adult hand holding a smaller portion (less than the size of the palm of the hand) effectively illustrates advice regarding children’s portion sizes. Using these images significantly reduces reliance on potentially confusing terminology such as “meal.” For more information, refer to EPA-FDA Advice about Eating Fish and Shellfish.

• Use a font size of at least 12 (14-16 is better for groups with vision limitations).
• Avoid italics and words in all capital letters.
• Limit bulleted or numbered lists to no more than seven items.
• Use pictures and stories for illustration and break up text in written communication.
• Put text in chunks and use lots of white (clear) space around text.
• Use colors that appeal to the target audiences. Be aware of colors/shades that cause trouble for color-blind people.
• Avoid confusion by not presenting more than one set of advice side-by-side (e.g., consumption limits for sensitive and non-sensitive populations).

• Provide a summary or review of key messages or takeaways.
• Include photographs or illustrations.
• Use typographic cues, e.g., bullets, to emphasize key points.
• Use web links to allow people to point and click on map images and to zoom in to get site-specific information.
• Include image icons of certain types of fish for detailed information on associated risks.

Message Content: Benefits and Risks of Fish Consumption

Presenting the target audience with relevant information on both the benefits and the adverse effects of consuming fish allows its members to make an informed decision about not only eating fish, but also which fish to eat and obtained from which source.

• Benefits of Fish Consumption
• Risk of Consuming Contaminated Fish, Depending on the Contaminant
• Location
• Contaminants
• Consumption Information
• Species
• Fish Preparation and Cooking Information
• Additional Information

Benefits of Fish Consumption

Fish are a healthy and a nutritional source of protein and it is important to eat fish before, during, and after pregnancy. One of the most important advisory messages is: eating fish is good for you and for your baby, that it is important to eat fish, and that it is important to follow advisory recommendations. A communication on the benefits of fish consumption is likely adequate and effective if it presents information about health risks in a balanced way, to enhance acceptance of the message and prevent complete avoidance of eating fish.

Risk of Consuming Contaminated Fish, Depending on the Contaminant

In addition to the benefits of consuming fish, the risk of fish consumption needs to be clearly explained so that target audiences can make informed choices about eating fish. Messages should assert the nature of the risk and the health consequences that can be supported by evidence. Adding conditional language such as “may cause cancer” does not detract from the impact.

Some people respond better when given more detailed information about specific risks to specific populations. There can be a preference for risk information being communicated in a quantitative, rather than qualitative manner. Quantitative expression of risk can be informative and can help form realistic perceptions of risk.

Location

Include the waterbodies that have fish that are the subject of a FCA. FCA managers should coordinate their messages with other government agencies so there is no contradictory information. Detailed site-specific information as well as more generalized items that provide summaries for large regions within a state (e.g., coastal) may be needed.

Contaminants

State the contaminants in fish that are of concern. FCAs should make available information about the nature, extent, and sources of the contamination behind the advisory. At a minimum, they should include contact information for the appropriate agencies, tribal government bodies and/or community groups, so that there is a place to lodge comments, ask questions, or obtain more information.

Consumption Information

In general, fish consumption levels should be related to the idea of a certain number of meals per week as opposed to more technical dosages involving the weight of the fish serving relative to the weight of the person eating the fish and a time period. Within a state, a uniform meal size should be utilized. Portion size should be presented in quantities typically eaten by consumers (six to eight ounces).

Using visual aids can help convey that information. The meal frequency should be easily understood by the target audience. The concept of eating certain species more often, less often, or not at all appears to be readily understood.

FCAs should include how frequently different species of fish can be eaten.

• Recommended number of meals per week
• Recommended number of meals per month
• Recommended number of meals per year
• Meal size advice
• Meal size advice for adults
• Meal size advice for children
• Meal advice based on a person’s body weight
• Advice based on fish length in inches
• Advice based on size of fish caught in pounds
• Meal size advice based on uncooked fish portions
• Meal size advice based on cooked fish portions
• Meal size advice based on both cooked and uncooked fish portions

FCAs should emphasize the benefit of eating at least some low-risk fish (or eating more less-contaminated fish) during pregnancy. A change in this behavior can be brought about by focusing messages on eating healthy fish and describing why it is important to eat healthy fish during pregnancy and even while breastfeeding.

Species

FCAs’ information should include the types of fish that are unsafe to eat, those that should be limited or avoided and the types of fish that provide the most health benefits and the fewest health risks. When viewing the FCA, target audiences search for the fish species that they catch or consume the most. When a specific fish is omitted, the audience may assume that the fish is safe to eat or may assume that the fish should be avoided completely. They may also decide that the entire message is not credible and lacked a scientific basis. In one particular case, where all popular fish species were at least mentioned by name, even without specific advice, study participants felt the advisory was more credible. Alternative fish species that fit cultural imperatives should be recommended for consumption.

The following information should be included if considered relevant and appropriate for the target audiences for the particular contaminant and fish species – fish size, age (juvenile vs. adult), trophic level, tissue (muscle vs. fat).

Store-bought fish can be a significant portion of home-based consumption of fish. Some fish sold commercially contain contaminants (mercury) and should be avoided or intake limited. FCA managers may deem it appropriate to include information on the 2019 EPA-FDA joint national fish consumption advice related to methylmercury which focuses on store-bought fish for the target audiences.

Fish Preparation and Cooking

Fish advisories can provide preparation and cooking advice and methods that reduce exposure to certain contaminants. The message will be different depending on the type of contaminant.

Contaminants that Bioaccumulate in Fatty Tissue

The amount of contaminants in the fat of fish, in a fish meal, can be reduced by properly trimming, skinning, and cooking the catch. Cooking does not destroy contaminants in fish, but heat from cooking melts some of the fat in fish and allows some of the contaminated fat to drip away.

• Fillet the fish
• Remove the skin
• Remove belly fat
• Pan fry (and remove the drippings)
• Deep fry (and remove the drippings)
• Bake, roast, broil, or grill

Examples of messages: Broil, grill, or bake the trimmed, skinned fish on a rack so the fat drips away; do not reuse oil or fat from cooking fish (the drippings) to prepare sauces or gravies.

Contaminants that Bioaccumulate in Muscle

The precautions to address contaminants that bioaccumulate in fatty tissue will not reduce the amount of mercury or other metals in a fish. Mercury is distributed throughout a fish's muscle tissue rather than in the fat and skin. Mercury cannot be eliminated by cooking it differently. The only way to reduce mercury intake is to reduce the amount of contaminated fish eaten.

Additional Information

Where to get additional information, e.g., the scientific evidence supporting the advisory, agency contact information, should be clearly listed in the FCA. In a focus group reviewing fish advisories, the participants wanted to understand, not only the messages, but also the reasoning behind the messages. They pointed out that it was important to tell target audiences how to get additional information. The public should be able to access the scientific evidence supporting the advisory.

A multilayered (or tiered) approach with several types of messages is sometimes needed. Although some might assume their target audiences want simplified information products, target audiences often want more technical detail than found in the ordinary “prescriptive” documents of an FCA.

Pretest the Message

All communications should be tested before use, although it may not be possible in all instances. An iterative testing process is critical. Draft, test, and redraft communications, addressing the critical differences between what people know and what they need to know. Outcomes are more likely to succeed when target audiences are involved in the design, pretesting, and dissemination of the health communication. Interactive testing of outreach materials with the target audience, as well as continuous interaction with people and agencies ultimately responsible for their distribution, is essential because messages and channels can be refined for specific local conditions. Involving the community can be especially effective when cultural values are recognized.

Target audiences may receive a very different message than the one that was meant to be communicated. The possibility of misunderstanding does not go away even with experienced communicators. It is important to keep checking with the target audience to learn whether its members understood what was intended.

For more details and information about pretesting, refer to Pretesting in Pink Book.

Potential Core Messages

In general, the core message of all FCAs falls into one of six categories:

• Making Health Communications Programs Work
• Communicating Risks and Benefits: An Evidence-Based User’s Guide (FDA)
• Awake at the switch: Improving fish consumption advisories for at-risk women  
• Fish Consumption and Environmental Justice (2002) (PDF) (185 pp, 2 MB)
• What We Know about Fish Consumption Advisories: Insights from Experts and the Literature Exitor National Risk Communication Conference Proceedings Document (PDF) (196 pp, 708 K)
• Risk Communication in Action: The Risk Communication Workbook (PDF) (75 pp, 15 MB) (EPA, 2007)
• Evaluating Risk Communication about Fish Consumption Advisories: Efficacy of a Brochure versus a Classroom Lesson in Spanish and English 
• A Community-Based Approach to Disseminate Health Information on the Hazards of Prenatal Mercury Exposure in Brooklyn, NY
• Addressing the Risk: Understanding and Changing Anglers’ Attitudes about the Dangers of Consuming Anacostia River Fish by OpinionWorks of Annapolis, MD (PDF) (20 pp, 21 MB) Exit
• 2014 National Forum on Contaminants in Fish – Proceedings (PDF) (379 pp, 60 MB)  
• Audience Analysis and Pretesting of Michigan Fish Advisory Materials Final Report, Pradeep Sopory, James Cherney, Donna Kashian, Wayne State University, November 11, 2013
• Evaluating Risk Communication: Examining Target Audience Perceptions About Four Presentation Formats for Fish Consumption Health Advisory Information 
• The CDC Clear Communication Index
• Communicating Fish Consumption Advisories in California: What Works, What Doesn’t  
• Risk Communication Advisory Committee (FDA, November 3, 2014)
• Factors Influencing Fish Consumption by Key Audiences in the Great Lakes RegionExit
• A Framework and Information Needs for the Management of the Risks from Consumption of Self-caught Fish, Environmental Research 101 (2006)
• Comparative Analysis of State Fish Consumption Advisories Targeting Sensitive Populations 
• Factors Affecting Fish Consumption among New Mothers Living in Minnesota, Pennsylvania, and Wisconsin 
• Weighing Health Benefit and Health Risk Information when Consuming Sport‐Caught Fish 
• Protocol for a Uniform Great Lakes Sport Fish Consumption Advisory (1993)
• Factors Affecting Fish Consumption among Licensed Anglers Living in the Great Lakes Region (2012) Exit
• Fish Consumption Advisory Interpretation by Key Audiences in the Great Lakes Region

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