Development of a set of community-informed Ebola messages for Sierra Leone

PLoS Neglected Tropical Diseases
(Accessed 19 August 2017)

Research Article
Development of a set of community-informed Ebola messages for Sierra Leone
John Kinsman, Kars de Bruijne, Alpha M. Jalloh, Muriel Harris, Hussainatu Abdullah, Titus Boye-Thompson, Osman Sankoh, Abdul K. Jalloh, Heidi Jalloh-Vos
Research Article | published 07 Aug 2017 PLOS Neglected Tropical Diseases
The West African Ebola epidemic of 2013–2016 was by far the largest outbreak of the disease on record. Sierra Leone suffered nearly half of the 28,646 reported cases. This paper presents a set of culturally contextualized Ebola messages that are based on the findings of qualitative interviews and focus group discussions conducted in ‘hotspot’ areas of rural Bombali District and urban Freetown in Sierra Leone, between January and March 2015. An iterative approach was taken in the message development process, whereby (i) data from formative research was subjected to thematic analysis to identify areas of community concern about Ebola and the national response; (ii) draft messages to address these concerns were produced; (iii) the messages were field tested; (iv) the messages were refined; and (v) a final set of messages on 14 topics was disseminated to relevant national and international stakeholders. Each message included details of its rationale, audience, dissemination channels, messengers, and associated operational issues that need to be taken into account. While developing the 14 messages, a set of recommendations emerged that could be adopted in future public health emergencies. These included the importance of embedding systematic, iterative qualitative research fully into the message development process; communication of the subsequent messages through a two-way dialogue with communities, using trusted messengers, and not only through a one-way, top-down communication process; provision of good, parallel operational services; and engagement with senior policy makers and managers as well as people in key operational positions to ensure national ownership of the messages, and to maximize the chance of their being utilised. The methodological approach that we used to develop our messages along with our suggested recommendations constitute a set of tools that could be incorporated into international and national public health emergency preparedness and response plans.
Author summary
The work on which the paper is based was conducted in two Ebola ‘hotspots’ in Sierra Leone (urban Freetown and rural Bombali district) between January and April 2015. Numerous misperceptions about Ebola had developed in the community over the course of 2014, and it was becoming increasingly clear that the largely top-down messaging strategy in use was not as effective as it could have been. Our project aimed to actively include the community in the development of a set of actionable Ebola messages that responded directly to their needs and concerns. While developing our messages on such topics as ambulances, burial teams, and the use of chlorine, we derived a set of recommendations that could also be applicable to control efforts relating to other infectious disease outbreaks. These include the importance of listening to community concerns during an outbreak, communicating on a two-way basis using trusted messengers, and engaging with relevant officials throughout the project in order to maximise the likelihood of the findings being utilised. While our work is based empirically on one disease in one setting, the messaging principles that emerged out of it are to a large degree generic.