Responsive Engagement with Communities

Posters at Monrovia Pharmacy

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, Seung Hee (Interview 1)

Dr. Seung Hee Lee

Dr. Seung Hee Lee, part of CDC's health communication and promotion team, discusses a village's initial fear surrounding chlorine, and how it was addressed. (Transcript)

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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KAP 2 Final Report
5. Communication and Participation
Responsive Engagement with Communities