…as COVID-19 is creating a new norm, it behoves development communication professionals and experts to help government, first responders, researchers and scientists, to think and plan ahead on how to promote changes in social norms and the desired health behaviour of the future. A creative health communication approach would be critical for the post-COVID life.
Actions of various individuals, social groups and organisations, either promote or undermine human health. Their knowledge, practices and attitude also contribute to wellbeing, or compromise the quality of life.
From its multifaceted dimensions, the coronavirus disease (COVID-19) raises several behavioural issues, which affect its spread, containment, prevention and recovery. Such behaviours play a major role in those who are infected or not. They also determine how a society can contain its spread. Many of the behaviours are simple and need to be repeated to become regular habits of life. Some may even become part of the ‘new norm’, post-COVID-19.
A Tsunami of Information
Information is critical to health behaviour. As the foundation of attitude and action, it is the first step in positive health behaviour. Public health experts agree that awareness or knowledge about a health issue or a disease plays a critical role in health behaviours. This makes awareness creation the key cornerstone of many health education and behaviour change communication, as lack of knowledge undermines people’s ability to engage in positive health behaviour. However, from empirical evidence and experience, knowledge alone does not translate into action.
Interestingly, there is no shortage of information on the pandemic. A COVID-19 ‘information overload’ is an understatement. The pandemic has generated the super-abundance of information, now known as an ‘infodemic’. It has created an information pandemic in itself, a crisis within a crisis. The entire world is suffering from a deluge of information on the origin, prevention, treatment and effect of the cotonavirus disease. With the rapidity and creativity involved, it would appear that there are Misinformation Making Machines (MMM) pumping torrents of messages on the virus into the planet. The tsunami of information and stories has created another disease: ‘COVID-19 Information Indigestion’. We just hope that the impending mutation into a ‘Coronavirus Mental Disorder’ is not already rearing its head globally.
People just don’t know what to believe, or are just believing everything. With new stories, podcasts, articles, experts’ opinions on daily basis, people are even doubting what they knew before. The superabundance of information also creates a public health concern, which according to the World Health Organisation, needs to be managed. To say the least, the COVID-19 information avalanche has polluted the information ecosystem, causing doubts about the reality of the pandemic.
To address it, we submit that such a contested and convoluted information ecosystem should serve as the starting point of health promotion/education and behaviour change communication. A major implication of this for development communication and health promotion/education is aggressive monitoring of the information environment and responding with appropriate, coordinated and consistent messaging on traditional, non-tradition and digital channels. Similar to crisis communication, its speed and creativity should be faster than the misinformation machine. If not we shall be playing catch up.
This should also be supplemented with a sub-campaign on how to avoid health misinformation and disinformation, which has become critical for COVID-19 and other health issues. Such a campaign is imperative because of the extensive health misinformation available online and across social media platforms.
Lack of Correct Information
Despite the dizzying volume of information, the pandemic is characterised by considerable unawareness and lack of correct information. Coronavirus is a novel disease, implying that it was not there before. As a ‘brand new’ and equally ‘strange disease’, there are many unknowns about it that even foremost researchers and scientists are still trying to know. Thus, as the disease is studied, so would the knowledge about its behaviour expand.
The disease has now spread to all 54 African countries. However our informants’ interviews in urban, peri-urban and rural areas confirm that many people still lack the correct information about the pandemic. From discussions with several segments of the population, and even our own social groups, we have seen extensive ignorance on the origin of the disease, its treatment, its prevention and its impact, principally caused by pervasive misinformation and disinformation. Coupled with these is the absence of the voices of local researchers and scientists in the response to the pandemic across nations.
The main weapon to address unawareness is the dissemination of simple, up-to-date and accurate information. For this group, we need to scale up precise information and messages on the disease. Such information should address their questions, concerns, queries and doubts about the pandemic.
However it is important to bear in mind that such information would have to fight through the current maze of health misinformation and disinformation, hence it must be creative and sharp to break through, and then stick! Such messaging would also consider where each segment of the population is on the ‘knowledge continuum’ for targeted messaging.
A Sea of Unconvinced Population
In some cases, people may be aware or have heard of the disease, but do not believe it exists. This is a situation of the lack of conviction. For these people, it is not for lack of information, or even ignorance, as much as resistance, based on factors such as ‘knowledge’, ‘education’, belief, experience, misinformation or disinformation.
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With COVID-19, the sea of unconvinced population is unusually vast. Four months into the pandemic, many people across Nigeria, and other African countries, are not convinced or are sceptical about the pandemic. Even with the death of some high profile persons in society and in the Diaspora, some still deny the existence of the disease.
From our interaction with journalists, we hear statements like ‘many people don’t believe the disease’ or ‘people are not convinced’. Findings from key informants suggest that many of such people operate in the realm of deep, not peripheral, unbelief, doubt and the lack of conviction.
In some communities in Northern Nigeria, most people think coronavirus is ‘a lie’. While in the villages in the South, many think of it as ‘a ruse’. In the South-East, people are still carrying about their jolly life. And in many communities in the West, Lagos and Ibadan inclusive, it is business as usual for many who are eager to dare the consequences.
Furthermore, media professionals have been fielding an army of uninformed pundits who parade half-baked opinions and theories on the pandemic. In Nigeria, reports from the laboratories is limited to the daily release of a number of cases from her Centre for Disease Control (NCDC). Voices of scientists and researchers are muted, while there is hardly a media report detailing the science of the virus; a step in improving the public understanding of the virus. The cumulative effect is what we are seeing a denial of the pandemic and business as usual mentality.
The sources of the lack of conviction are multifarious, ranging from the global misinformation campaign, delayed and slow dissemination of correct information in various countries and communities, and poor health promotion/education and reporting. Besides, social media has polluted the information ecosystem with wild manifold stories, theories and messages about the virus. Many religious leaders have also pushed the conspiracy narrative, and directly or indirectly, are pressuring government over the containment strategy. It is also reported that some traditional leaders are not convinced about the disease and therefore continue with their community activities, including festivals and local ceremonies. Some go as far as carrying out rituals and sacrifices for the intervention of the gods.
The attitude and statements of national leaders may also have contributed to that lack of conviction or indifference to the situation by different sectors of the population.
The implication for communication and health promotion/education is how to neutralise the effect of the conspiracy theories around COVID-19 and initiate a creative counter-narrative through multiple channels. To be effective, such messaging should be grounded in the context of the narrative but implemented on a large scale for maximum effect. This should not be any of those faint-hearted campaigns that do not achieve results. Rather, it must be a massive health promotion/education and behaviour change intervention, with a high level of message dosage and saturation. This is the only way to neutralise disinformation and begin to promote positive health behaviour.
Prevalence of Low Risk Perception
Another major issue to deal with in the COVID-19 health behaviour is risk perception. This is defined as the level of an individual’s perception of susceptibility to a threat. In a broad sense, risk perception is determined by several factors and leads to a variety of behaviours. There are also different types of risks. Considered as a whole, risk perception is fundamental to health behaviour.
From key informants’ interviews and interaction with various individuals, the pandemic typifies low risk perception among segments of the population. This is a feeling that the disease is for others and not for them. Some people see it as a strange disease, for the rich, for those who have travelled abroad, or for those living in a particular community or country. Such people do not personalise the risk of the disease, as reflected in the apathetic response to the containment strategies. No! We all need to personalise the risk of the virus to be able contain the disease.
Addressing this challenge requires intensive risk communication. This involves a robust tracking of risk perception, level, and the types of risks. It would also entail analysing and integrating such data into messaging and communication interventions. From systematic reviews, interventions that successfully engage and change risks would increase health behaviours.
The Challenge of Adopting New Behaviours and Practices
COVID-19 comes with specific preventive and containment behaviours mainly: Hand washing with soap under running water, social distancing, the wearing of face masks, coughing and sneezing into the elbow to avoid spreading infected droplets, and lockdown to contain the spread of infection. The illness behaviour for those already infected include self-isolation, testing and reporting themselves to an isolation centre.
COVID-19 shows us that health behaviours have significant impact on health outcomes. Simultaneously, it questions the level of preparedness of development communication professionals in engaging with novel and strange health pandemics. It also calls for new ways of social and behaviour change communication.
The main challenge has been in adopting these practices on a large scale. Qualitative data from different African countries show that various population groups have found it difficult to accept and maintain some of the containment strategies. There have even been human rights perspectives in the mix of resistance to the lockdown of populations.
First, some of the preventive strategies, such as social distancing and lockdown are out of sync with African traditional and economic realities. This makes their implementation naturally difficult. Second, illness and sick role behaviour is prone to stigma.
Media reports in Nigeria point to the lack of full observance of the preventative and containment strategies of the disease in Lagos. The behaviour of some celebrities have contravened the health behaviour required under COVID-19. And those who are observing this behaviour appear uncommitted. Social distancing is being delegitimised and compromised. In some cases, it has turned into opportunities for club meeting and ‘old boys’ socialising, or house wives catching up sessions. In markets, public transport, and banks, social distancing is a mirage. It is contrary to African culture.
In Cameroon, churches are still meeting and people don’t understand social distancing, even after the country had over 2,000 cases of the virus. The speaker of parliament, who has now tested positive for coronavirus, refused to self-isolate, and was actually seen interacting with parliamentarians in the days leading to being tested positive.
Communities in Malawi, Zambia, Zimbabwe and others question the essence and principles of social distancing. In South Africa, 73,000 military personnel had to be drafted to enforce some of the containment strategies, while in Kenya police had to enforce the lockdown with force.
Organisations are critical to promoting healthy behaviours, because the health of any organisation depends on the health of its human resource. One institution whose behaviour has seemed to be undermining the overall health behaviour is the faith establishment. While some religious leaders are now complying with government directives, many faith leaders have undermined the public health behaviours of the population. Some are still holding anointing services with their members, in contravention of required health behaviours under COVID-19. Some mosques are holding their services in public, without adhering to social distancing guidelines. The pronouncements of some of their leaders also undermine positive health behaviours.
Efforts to promote adherence to health behaviours and practices call for deep root-cause analysis, extensive social mobilisation, community sensitisation and advocacy with various groups. It also entails understanding the causes of the lack of compliance to health behaviours and finding solutions to them. There is need for all sectors to develop sectoral responses to COVID-19, in line with WHO international guidelines. However, regardless of the reasons for non-adherence or non-compliance, it is certain that such behaviours undermine the health and wellbeing of the population. So while positive health behaviours promote wellbeing, negative behaviours undermine the quality of life.
Some Implications For Development Communication
COVID-19 shows us that health behaviours have significant impact on health outcomes. Simultaneously, it questions the level of preparedness of development communication professionals in engaging with novel and strange health pandemics. It also calls for new ways of social and behaviour change communication.
COVID-19 is a new virus. Though it raises known issues in health behaviour, it has to be fought through a different approach. The virus is virulent, so behaviour change strategy must be commensurate to this. The virus is novel, so must be the tactical approach. The virus is peculiar, so must be our interventions. Evidence is suggesting that coronavirus will be with us for a while. Some practices like the wearing of face mask and social/physical distancing might continue for a long time.
This is why we call for a completely different kind of development communication, which must be intense, coordinated, and adaptive to assure any semblance of victory.
Finally, as COVID-19 is creating a new norm, it behoves development communication professionals and experts to help government, first responders, researchers and scientists, to think and plan ahead on how to promote changes in social norms and the desired health behaviour of the future. A creative health communication approach would be critical for the post-COVID life.
Adebayo Fayoyin is a visiting professor in the Department of Mass Communication, Caleb University, Imota, Lagos, while Akin Jimoh is executive director, Development Communication Network, Lagos.
