Addressing Fears, Rumors, and Community Resistance through Responsive Engagement

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Pharmacy in Monrovia displaying versions of Ebola is Real posters, October 2014. Photograph by Dan Stowell, CDC

Community resistance was one of the biggest obstacles to stopping Ebola in West Africa. In the early days of the epidemic, the understandable and widespread fear of Ebola was fueled by an epidemic of rumors, faulty information about the disease, and distrust of government.

In any emergency, risk communicators encourage public health professionals to engage with their communities to gain a better understanding of community values, opinions, and beliefs. As the Ebola epidemic response evolved, health promotion teams worked to develop nuanced messages and communication strategies tailored to diverse communities—from densely populated cities to remote, rural villages. Two-way communication between health promotion teams and communities greatly informed the prevention and control strategies put in place. 

The Role of Behavioral Science   

A major challenge of the Ebola response was to change people’s behaviors in order to prevent the spread of the disease. To do so required a deep understanding of the beliefs, attitudes and barriers that impact whether people adopt health behaviors. Behavioral assessments throughout the epidemic looked at knowledge and awareness gaps, reasons for health care failures, and community norms and perceptions. The information gathered around issues such as quarantine or safe burials then helped shaped the outbreak response.

Lee-Kwan, Seung Hee (Interview 1)

Dr. Seung Hee Lee-Kwan

Dr. Seung Hee Lee-Kwan discusses a village's initial fear surrounding chlorine, and how it was addressed.

Freeman, Yolonda

Yolonda Freeman

Yolonda Freeman, health communications specialist in CDC's Division of Emergency Operations, talk about the challenges that stemmed from the stigma associated with Ebola.

Multiple versions of the following poster were distributed in Liberia Early in the epidemic, people questioned whether Ebola was real, or suggested that the government was purposely spreading the disease. The poster assures people that Ebola is real, and describes the symptoms.

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Ebola is Real poster

Big Idea of the Week Campaign

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Sierra Leone Global Times article about the Big Idea of the Week, December 8, 2014

Clear, simple messages were needed to help people change the behaviors that were spreading Ebola. To improve understanding of the most critical messages, Sierra Leone’s National Ebola Response Center (NERC) launched a national campaign in November 2014 called the Big Idea of the Week. This campaign focused discussion on one key issue for an entire week, such as “Safe Burials Save Lives” and “Celebrate Survivors,” coordinated with partners across all forms of media, including radio, television, print news, SMS text messaging, and social media.

CDC was actively involved in designing and rolling out the campaign, including creating the campaign content. Other partners, in addition to the Sierra Leone Ministry of Health, were WHO, UNICEF, and BBC Media Action, and GOAL, among others. 

Jernigan, Daniel

Dr. Daniel Jernigan

Dr. Daniel Jernigan discusses the importance of the campaign in terms of awareness and education in the communities.

Nur, Sophia (Interview 1)

Dr. Sophia Nur

Dr. Sophia Nur, communications expert with CDC's Division of Global Health Protection, remembers her experience helping to implement the Big Idea of the Week campaign.

Safe Burial Pledge

Building upon the Big Idea of the Week, Desmond Williams, a Sierra Leonean-American doctor who works for CDC, took to the airwaves with a chilling and blunt message: "If I die, I want the deaths to stop with me." Williams then said his wish would be for his family to give him a safe, dignified, medical burial. Similar pledges were made by prominent Sierra Leoneans, including the communications director for the Health Ministry, pop stars, and radio DJs.

Evaluating Impact of Prevention Messages

Health promotion teams needed to understand whether their campaigns were working.  Studies such as Knowledge, Attitudes, and Practices (KAP) let them see what people already know, where they got their information—radio, newspapers, neighbors—and what barriers existed to absorbing and using health information. These studies provided crucial insight into the best ways to disseminate information to the public.

Focus 1000, a non-governmental organization based in Freetown committed to improving health outcomes in Sierra Leone, implemented three KAP studies with technical assistance from CDC and UNICEF experts. Data from the second KAP study in October 2014 confirmed suspected links between the outbreak and specific community behaviors.  Focus groups identified one of the barriers to adhering to safe burial practices: a strong dislike for black burial bags used by burial teams. They explained that black bags were associated with paupers’ graves. Changing the color of the bags to white helped overcome resistance to safe burial practices.

Knowledge, Attitudes, and Practices (KAP) Report

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4. Communication and Participation
Addressing Fears, Rumors, and Community Resistance