Locally tailored public health messages dispel Ebola myths in Sierra Leone

A two-way channel of communication, appointing community leaders as messengers and communication in local dialects were all instrumental in dispelling misconceptions about Ebola virus in Sierra Leone during the West African epidemic, study data showed.

 “One of the main drivers for the West African Ebola epidemic was, especially in the early stages, a mismatch between some of the messages that were being disseminated by the authorities, and the lived reality of people in the community. For example, when people in Sierra Leone were told that ‘Ebola kills!,’ they saw people who survived; and when they were told of the dramatic, sometimes bloody symptoms of Ebola, they wondered why these did not affect all of the Ebola patients that they heard about,” John Kinsman, PhD, associate professor of global health at Umea University, told Infectious Disease News.

A disconnect between what residents saw, Kinsman said, diminished their “already limited trust” in Sierra Leone’s health care system, making people less likely to seek care at an Ebola treatment center. Other public concerns included a perceived lack of respect for the dead by burial teams, fear of ambulances and fear of the use of chlorine as a disinfectant.

 “Much of our focus was on trying to overcome the obstacles that led to many families taking care of Ebola patients themselves or using the services of traditional healers instead of seeking qualified medical care,” Kinsman said.

Government officials formed a consortium with three institutional members in 2014 with the Epidemiology and Global Health Unit of Umea University, Sweden, the Medical Research Centre of Sierra Leone and the Centre for Health and Research Training, also of Sierra Leone. Professionals working for member institutions provided analytical expertise, health promotion skills, backgrounds in medical anthropology and tropical diseases and knowledge of the culture, history and political climate of Sierra Leone. The researchers conducted 16 focus group discussions with a total of 118 participants, along with 24 individual interviews, in the city of Freetown and the rural Bombali District between January and March of 2015. Kinsman and colleagues performed a thematic analysis of data and drafted messages about the epidemic, field testing them and refining them after the field test.

Messages ranged from encouraging trust in the health care system and encouraging use of ambulances to safe burial practices and dispelling the stigma surrounding Ebola workers.

The researchers identified four major principles of message development: use of trusted messengers such as imams and pastors to speak to the community; two-way communication, such as social media posts, radio or television call-in shows and town hall meetings, in addition to broadcasting campaigns or billboards; quality operational services to back up the credibility of public service announcements; and accounting for local factors, such as avoiding the use of colors favored by political parties and producing messages in the local language or dialect.

Kinsman and colleagues noted that an understanding of a community’s perceptions surrounding a public health issue should “lie at the core of attempts to inform the population.”

 “In sum, therefore, systematic, iterative qualitative research should be fully embedded into the message development process from the outset of the response to any future public health emergency, and the communication of those messages should also be conducted on a two-way basis,” Kinsman and colleagues wrote.– by Andy Polhamus