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SUMMARY BOX
Risk communication and community engagement (RCCE) is integral to public health emergency preparedness, response and recovery and is imperative in empowering communities to protect themselves from disease outbreaks.
Social behavioural insights significantly affect public health outcomes and thus must be studied to guide RCCE strategies.
These insights, including knowledge, attitudes, perceptions, and sociocultural practices and norms, are redefining RCCE interventions in public health emergencies.
This commentary demonstrates the need to shift from traditional RCCE strategies to more tailored strategies informed by surveys and research.
Aligning communication approaches with community values, norms and cultural context messages can be more persuasive and impactful in promoting desired behaviours.
RCCE should not be undertaken in isolation; both disciplines need to be merged, and experts should work together to identify more tailored means of communicating with communities.
Introduction
In the intricate landscape of public health emergencies, risk communication and community engagement (RCCE) is a vital component of pandemic prevention, preparedness and response (PPPR) and must be guided by social behavioural insights. Risk communication for public health encompasses the various communication skills needed during readiness, response and recuperation stages in a significant public health crisis.1 The goal of RCCE is to promote informed choices, foster positive behavioural shifts and uphold trust.2 A multicountry survey conducted by Adebisi et al demonstrates that community engagement remains central to outbreak prevention and control, further underscoring the vital role of RCCE in public health emergency preparedness and response. We can ensure a more resilient and empowered response by fostering collaboration, enhancing capacities and advocating for sustained funding.3
It is indisputable that adapted social behaviours profoundly influence health and well-being, particularly habits, actions and interactions, significantly affecting public health outcomes.4 5 Risk communication and community engagement are fundamental elements in controlling infectious diseases and play a critical role in public health emergency responses. These strategies are essential for building trust, which is necessary to promote better behaviours among the population. The interconnection between these disciplines lies in their ability to foster trust and collaboration within communities, thereby allowing for tailored communication that enhances public health interventions' effectiveness. The COVID-19 pandemic prompted strategies to modify behaviours to reduce the risk of spreading the virus and safeguard individuals and their communities. The recommended COVID-19 infection prevention and control, public health and social measures were staying at home, practising physical distancing, using hand sanitisers or practising thorough hand washing, receiving COVID-19 vaccinations, mask wearing, school and business measures, modifications of mass gatherings and international travel and trade measures.6 However, the adherence level faced numerous challenges from political and social unrest to religious and cultural influences.
From the onset of the COVID-19 pandemic, social media became a major source of misinformation, contributing significantly to vaccine hesitancy among adolescents and the youth. Risk communication interventions globally focused on using social media to deliver accurate information and counteract misinformation. These behavioural interventions have shown promise in reducing the spread of misinformation, disinformation and changing beliefs. This highlights the potential of social media-based interventions to address vaccine hesitancy by promoting accurate information and fostering critical thinking among users.7
According to reporting on a US Centers for Disease Control and Prevention survey, the mpox (monkeypox) outbreak was mitigated mainly by behavioural changes, especially among members of the lesbian, gay, bisexual, transgender and queer communities in the USA.8 Given that the large majority of mpox cases occurred within communities of male-to-male sexual relations, the study of their behaviours informed the risk communication interventions and channels to promote preventive behaviours and vaccine uptake. Targeted efforts included the use of social media, dating apps and outreach at sex-on-premise and cruising venues.
The 2014–2016 Ebola outbreaks in West Africa underscored the impact of social behaviours,9 particularly safe and dignified burial practices, on the escalation of cases. Specifically, cultural traditions involving the washing of deceased bodies and the practice known as the ‘love touch’, which consists of bathing with rinse water, were associated with 60–80% of Ebola cases in Sierra Leone and Guinea, respectively. Burial practices hold deep personal and cultural significance in African communities. It is crucial to strike a balance between biomedical safety and honouring the cultural, religious and individual needs of grieving families and communities. This involves continually assessing community needs and engaging with bereaved families to ensure safe burial protocols are tailored to their requirements.10
Research into social behaviours
In integrating risk communication with behavioural insights (BI),11 it is imperative to conduct research to understand human behaviour and tailor effective communication strategies. Gender-lensed swift research during emergencies cannot be overemphasised for seamless incorporation into interventions. BI research is essential for understanding behavioural choices, barriers and drivers within a population. This understanding can contribute to addressing ‘pandemic fatigue’12 through informed decision-making and optimised implementation of public health interventions. Figure 1 illustrates how the social-ecological model applies to public health and how an individual’s knowledge, attitude and perceptions determine their behaviours.
The socio-ecological model of behaviour change.
BI is paramount in fostering robust collaborations and advocating for quick and effective communication. Social behaviour change (SBC) insights are vital in customising messages to resonate with diverse audiences, considering age, gender, socioeconomic status and cultural background. Incorporating social data into the wider global data landscape and enhancing SBC indicators for a more people-centred approach is essential.13 For example, the critical issue of vaccine acceptance intervention should be explored through community feedback, active attitude surveys and campaigns leveraging digital media for health outcomes.
Drawing insights from the Africa Centres for Disease Control and Prevention (Africa CDC) Saving Lives and Livelihoods initiative to counter the widespread dissemination of misinformation, disinformation, rumours and myths surrounding COVID-19 and its vaccine, social listening through social media and knowledge attitude and practices surveys was important in cultivating tailored RCCE intervention for generating demand for COVID-19 vaccines.14
A strong commitment to foundational principles is required, emphasising the need to build a fit-for-purpose system centred around RCCE and SBC, pro-gender action, workforce development and active community listening.
Africa CDC Coordination Initiatives
To effectively integrate risk communication and social behavioural change, building on existing expertise while establishing robust coordination mechanisms at all levels is a great approach. Many countries have meticulously documented their experiences, yet this valuable knowledge often remains underused when faced with epidemic threats. To address this gap, there is a pressing need to create a knowledge-sharing platform and foster coordination and exchange of best practices and lessons learnt across various African countries. The importance of technical working groups for RCCE at the national level and the integration of RCCE into the global health strategy cannot be overemphasised. This calls for the inclusivity of diverse partnerships and communities to foster trust building and the necessity for guidelines and sustained focus in RCCE and SBC programmes.
The Africa CDC, alongside other continental and national bodies, can play a pivotal role in encouraging countries to document and disseminate their experiences. The establishment of the Public Health Risk Communication and Community Engagement Community of Practice for Africa in May 2020 served as a cornerstone for addressing the pressing need for a robust system on the continent.15
The initiative seeks to deliver strategic guidance, continuous learning and knowledge exchange that provides strategic leadership pertaining to public health RCCE initiatives across the continent. In advancing this significant public health component in public health at the third International Conference on Public Health in Africa in November 2023, Africa CDC convened a side event aimed at enhancing the continental RCCE and SBC architecture, preparing communities for future pandemics and solidifying the foundation laid during the COVID-19 outbreak. The side event emphasized the need for more significant investment in Risk Communication and Community Engagement (RCCE) and Social and Behaviour Change (SBC) by enhancing leadership and research across the continent. It also highlighted the importance of RCCE workforce development an leveraging technology and artificial intelligence for RCCE to be effective. The African Union media fellows took part to amplify the subject matter experts' messages across various media platforms.
Media and other channels
By leveraging both traditional and digital media channels, communication efforts can extend their reach to broader audiences, especially adolescents and youth, thereby maximising the impact of SBC interventions.16 Aligned with the New Public Health Order for Africa and the Africa CDC Strategic Plan 2023–2027, meaningful engagement of the youth can help realize inventive leadership and significant contributions thus upholding public health across the continent. The Adolescents and Youth Programme within Africa CDC has a pivotal role the youth play in RCCE, which is essential in nurturing a resilient public health infrastructure tailored to address the distinct challenges experienced by the younger populations.
The media plays a critical role in risk communication and the facilitation of SBC. Diverse media channels are instrumental in fostering positive transformations at the individual, family, community, institutional, policy and political levels. Educational media, in particular, serves as a catalyst for change, with edutainment mass media programmes significantly influencing individuals’ attitudes and perceptions, promoting desirable health outcomes. Empowering mass media platforms to enhance local ownership and engagement is essential. Effective platforms and interventions encompass educational media such as television and radio, mobile technologies, interactive internet use and other innovative, non-technological approaches to complement traditional media to raise public awareness about various health issues and gradually influence behaviour change.
Conclusion and recommendation
In the realm of public health emergencies, RCCE and SBC are pivotal in ensuring effective pandemic prevention, preparedness and response (PPPR). These interventions are essential for promoting informed decision-making, fostering positive behavioural shifts and sustaining public trust.
Cultivating culturally relevant, engaging and interactive RCCE approaches is essential to effectively communicating with and addressing the challenges experienced by younger populations, such as vaccine hesitancy and low trust in public health interventions.
Therefore, as public health interventions evolve, so must our strategies. It is imperative to transition from traditional RCCE strategies to more tailored approaches informed by surveys and research. This adaptability ensures our communication efforts resonate with community values, norms and cultural contexts, making our messages more persuasive and impactful, ultimately leading to better health outcomes.
Data availability statement
All data relevant to the study are included in the article.
Ethics statements
Patient consent for publication
Ethics approval
Not applicable.
Footnotes
Handling editor Helen J Surana
X @Dottienjagi, @ndembi12
Contributors DN conceptualised the commentary, conducted literature review and drafted the manuscript. MN provided critical feedback, revised the manuscript for intellectual content and contributed expertise in public health social behaviour change. NN provided critical review and editing of the manuscript, provided guidance on the commentary’s structure and content and offered insights based on extensive experience in public health. All authors reviewed and approved the final version of the commentary.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.