Mapping risk communication practices in public health emergencies: a scoping review and comparison with Italian regional pandemic plans

BACKGROUND: Effective risk communication is a cornerstone of public health emergency preparedness and response. The COVID-19 pandemic and other recent crises have highlighted both the centrality of communication in sustaining trust and compliance, and the persistent gap between theoretical frameworks and operational practice. METHODS: Within the framework of the CreSP project (Comunicare il Rischio nelle Emergenze per la Sanità Pubblica), we conducted a scoping review to map international evidence on risk communication in public health emergencies, comparing it with Italian regional pandemic preparedness plans. Following PRISMA-ScR guidelines, we searched PubMed, Scopus, and Web of Science (1 January 2019-16 May 2024). Peer-reviewed studies addressing health risk communication in emergencies were included. In parallel, 18 Italian regional pandemic plans were identified and analysed using a structured checklist derived from inductive thematic analyses. RESULTS: Of the 12,479 records identified, 173 studies were included. Most publications originated from high-income countries and focused on COVID-19 pandemic response. Mass communication strategies, especially via social media, predominated, while targeted and participatory approaches were less frequent. The emergency response phase was far more represented than the preparedness or post-emergency phases. Key principles such as timeliness, transparency, and trust were widely discussed across studies, whereas equity, citizen engagement, and infodemic management were less consistently operationalised. Analysis of Italian regional pandemic plans revealed substantial heterogeneity. Although communication was universally acknowledged as important, it was often framed as top-down information dissemination. Structured mechanisms for monitoring, evaluation, citizen participation, and infodemic management were inconsistently addressed. CONCLUSIONS: Although the concept of emergency risk communication is well-developed, its implementation varies across different levels of governance. The misalignment between scientific evidence and institutional frameworks-particularly regarding inclusivity, participatory models, and infodemic management-underscores the need for a more integrated and standardised national approach. Incorporating communication into preparedness infrastructures, supported by measurable indicators and workforce capacity building, is essential to strengthen resilience, equity, and public trust in the event of future emergencies.