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

mentioned that the map of the far future (2051–2080) had no effect on them because it was not relatable. One person mentioned, “. . .by 2080, I’m sorry, I’m not going to be around. How can I relate to that last picture?” Additionally, some people in three of the groups took issue with the use of climate projections, suggesting that they are not accurate or reliable. One person described scientific projections as “guessing”. As another person mentioned, “Well. . .it’s such a huge timeframe and as I said, you look at the history of forecasting weather. . . they’re accu- rate to a degree, but never exact. And so, I look at this and okay, well, yes, they are true to a degree, but how accurate?” A few people across two of the groups simply did not understand the map at all, with one stating “It’s a pretty picture. It looks like it’s getting worse, but we don’t understand why.” There was also mention across three groups (of both high and low climate concern) that the map was “fear mongering” or trying to scare people by making the changes look extreme. One person in Winnipeg even suggested that Lyme disease was being used to incite fear about cli- mate change: “It makes me think more that these [researchers] are just using Lyme disease to scare you about climate change.” A summary of common strengths and criticisms for the three materials are found in Table 2. Criticisms and recommendations were more commonly discussed because of the design of the focus group discussion and moderator’s probes for feedback. Materials comparisons and recommendations

Materials elicited a range of responses. When asked which of the three materials had the most impact or was the most effective, the majority of people in five of the six groups clearly felt that it was the video. Across four groups, people mentioned that they liked the video better because they were audio-visual learners, while others in two groups said it had more of an Table 2. Summary of common strengths (+) and criticisms and recommendations (-) of each material and comparison across materials for low concern (W2, B2, M2), high concern (W1, B1, M1), and all groups. Low climate concern High climate concern All (Low and High concern) Article − Credibility of some sources not trusted − Not enough proof of climate change impacting Lyme − Want more “balance” and more information on other factors influencing Lyme spread − Too simplistic − Too much focus on individual action, not enough on systemic solutions − Want more information on the implications of acting on climate for the spread of Lyme − Want more visuals + Lyme disease statistics (e.g. rate of movement of ticks, reported cases) + Information about tick species and hosts − Unclear language − Want more stories, lived experiences − Want more info on Lyme symptoms Video − Not enough evidence of climate change − Want more info on other contributors of Lyme disease spread + Positive message + Personal story − Lacking key visuals (e.g. pets) − Too long − Lab-based scientists are less interesting − Not enough call to action + Practical visuals (e.g. bullseye rash, tick species) + Animated map (showing spread)

+ Doctor, field researcher, layperson with lived experience were best messengers − Want more information on layperson’s story and long term effects of Lyme Disease − Want more info on different stages and species of ticks Map − Projections not credible − Would be better with the US included to previous disease range + Interesting info on climate + Good at communicating alarm and urgency on climate − Technical language (e.g. “degree days”, “high carbon scenario”) − Confusing gaps in time frame; far future is not relatable − Concept of climate models is unclear − Colours are too alarming − Risk areas overlaid on projections are confusing Across all three materials − Want more information on Lyme disease and less on climate change, separating the issues − Want more information on solutions for climate and Lyme + Most people found video most engaging of the three materials, it created emotional engagement, and connected with the audience − Materials are too long, should be shortened and simplified https://doi.org/10.1371/journal.pone.0252952.t002 PLOS ONE Evidence-based communication on climate change and health PLOS ONE | https://doi.org/10.1371/journal.pone.0252952 June 10, 2021 7 / 17