Evidence-based communication on climate change and health: Testing videos, text, and maps on climate change and Lyme disease in Manitoba, Canada

counterproductive communication frames; for example, in our study some participants had their skepticism reinforced by materials instead of creating engagement with the topic. Finally, the platform and context within which content is communicated should be taken into consid- eration and material should be adapted accordingly (e.g., have the information available in contexts other than a climate information website for skeptical audiences). Limitations and opportunities A limitation of this study–inherent to focus group methods generally–is the potential for cer- tain people to dominate discussion or influence others’ comments, depending on the social dynamics that emerge in the group. This was considered and steps were taken by the facilita- tion team to ensure that everyone participated as equally as possible. The discussion was also designed to probe for feedback on the materials, which may have led to there being more nega- tive than positive comments. While the study was regionally-specific, perhaps limiting their applicability outside of this area, the results also clearly demonstrated the unique challenges of communicating climate change in an area known for skepticism like the Canadian Prairies [25]. Future research should explore public perceptions of communications materials in differ- ent regions in Canada and with different issue-specific or more general health framings of cli- mate change, to further articulate and inform effective communications on the full range of health impacts of climate change. Conclusion

The intersecting crises of climate change and public health demand communication approaches that bolster public engagement in these issues for urgent and far-reaching action. The findings from this focus group study in central Canada shed light on benefits, challenges, and considerations in communicating about the relationship between climate change and cli- mate-affected Lyme disease, with implications for the use of different mediums and frames within climate communications. The results illustrate the efficacy of the use of video as a cli- mate visual, while another visual material, a series of climate maps, was less effective and less understood across audiences. It was clear that the video successfully translated scientific infor- mation through narrative elements, visual storytelling, and relatable messengers, while the cli- mate maps required prior audience knowledge and ability to engage with more complex scientific information. Based on the results here, we suggest video, and to a lesser extent plain language articles, may be better mediums of communication for audiences with lower levels of knowledge or concern on climate change, which may prime these individuals and communi- ties for subsequently interpreting more complex materials such as climate projection maps. Additionally, the findings underscore the importance of tailoring the communication frame to the specific purpose and audience of the climate and health communications. For example, despite creating materials aimed at inspiring adaptive health behaviours, these inter-

ventions did not resonate with audiences of low climate concern, and thus it may be best to decouple climate and health issues in this case. In the first stage of this research, we developed an exploratory model regarding the relationship between Lyme disease and climate change risk perceptions, which may further assist those interesting in framing and messaging on these topics [32]. Whereas, if the goal is to initiate action on climate change or change public opin- ion on climate change as a health issue, an approach that links climate and health and is tai- lored to the audience levels of climate concern is key. This research is among the first to test audience responses to climate change visualizations in Manitoba, and more research is needed to further test tools such as these from this and other CIWs. It illustrates the importance of user-driven, evidence-based approaches to climate PLOS ONE Evidence-based communication on climate change and health PLOS ONE | https://doi.org/10.1371/journal.pone.0252952 June 10, 2021 13 / 17