Communicating in a Public Health Crisis: The Case of Ebola in West Africa
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The global health system is ill prepared to handle communicable health crises, much less effectively communicate about them, as evidenced by the West African Ebola outbreak. Although some critics have argued that the delay in international response contributed to the fast spread of the disease, others place greater blame on local cultural practices. The current study investigated how risk/crisis communication was produced, deployed, and received. This is particularly critical as the World Health Organization guidance on crisis/risk communication is not based on systematic evidence-based research Again, risk communication on communicable diseases is still relatively new and the body of research lacks both rigorous empirical evidence and evaluation research on event-specific risk communication efforts. Guided by the protection motivation theory and social mobilization theory, and using a comparative case study approach, this study sought to examine how crisis risk communication was undertaken and received in Liberia and Ghana and the implications for health crisis risk communication. Data was collected via interviews with communication and social mobilization team representatives in the two countries, document reviews, surveys of a cross section of inhabitants in Margibi and Shai Osudoku districts, and focus group discussions with purposively selected participants in the two countries. The study finds that expert-led top-bottom communication interventions used at the start of the outbreak were ineffective in getting target audiences to make the recommended behavior changes in Liberia. Messages developed induced fear rather than action. Furthermore, one in five respondents today, cannot identify the main signs and symptoms of Ebola. Again, the more worried people were about Ebola, the more vulnerable they felt. Finally, respondents moved through a cycle from equilibrium to defense to protection and then back to equilibrium as they sought to make sense of the disease and the communication they received about Ebola. It is recommended that risk communication include bottom-up community-led communication approaches and systems that are embedded within community culture and reality and used by community members. Again, the research challenged the assumption in risk perception studies that increasing knowledge and self-efficacy lowers risk perception thus suggesting the need for further studies in this area.