Local interpretations of COVID-19 communication and their influence on risk perception and self-efficacy in rural, township and informal settlement communities: a case study in KwaZulu-Natal.

Abstract

Communication during a health crisis is important to ensure that the public is informed and is equipped with correctly affirming behaviours and actions that can ensure their safety. While acknowledging COVID-19 as a global pandemic, the reality is that prevention measures must be implemented in local, geographically, and culturally bounded contexts. The traditional approach to communication during public health emergencies, involving one-way broadcast messages, usually from government to communities, has been criticised for stifling public participation and failing to integrate local knowledge and contexts, thus leading to poor adoption of protective behaviours by communities. This study explores how communities in three different types of localities; township, rural and informal settlement in eThekwini Municipality in South Africa, interpret COVID-19 prevention communication, and how these interpretations influence their perception of risk and self-efficacy to adopt preventive behaviours. Such an understanding can shape the development of a more localised response to COVID-19 prevention, and hopefully, future pandemics. Theoretically the study is grounded within Colins Airhihenbuwa’s PEN-3 Cultural Model for Health Communication, which foregrounds the importance of culturally appropriate and compelling strategies for behaviour change. The PEN-3 Model negates the ‘culture-as-barrier’ bias but instead locates culture as central in determining individual, family and community health by investigating positive, neutral, and negative impacts of culture on health behaviour. Data were collected in two rounds: after the South African 2nd wave of COVID-19 in April and after the 3rd wave in November 2021, with communities in the three identified geo-spatial locations. A total of six virtual WhatsApp groups and six face-to-face community dialogues (55 participants) were conducted to explore local interpretations of COVID-19 prevention messages and how these can form pathways for the development of locally relevant COVID- 19 communication. Unsafe working environments, the public transport industry and attitudes towards the government’s COVID-19 strategy impacted participants’ evaluation of the threat and risk for COVID-19 infection. The cultural identity of communal living and support, embedded in Ubuntu, was challenged through prescriptive government-led pandemic communication, leading to widespread flouting of COVID-19 precautions. Community assets, agency and resources were ignored by the top-down communication approach, contributing further to the widespread lack of adherence to prescribed precautions. The overcrowded and unhygienic informal settlement environment rendered adherence to preventive precautions too hard, demonstrating the structural environment's moderating influence in decisionmaking and subsequent preventive action. Reverence for local community leadership structures over distant national government demonstrated the moderating influence of power dynamics at the community level, which work to enhance mechanisms for transparency and accountability. Patriarchal societal norms influenced men’s responses to pandemic communication, and the role of the family in potentially contributing to positive health outcomes was highlighted. The results point to a need for risk communication and community engagement at a more granular level. The study argues for a participatory communication process that amplifies community voices and reveals context-specific and culturally-informed perceptions that impact on decision-making around COVID-19. This culture-centred exploration ensures that health communication interventions are developed from a positive perspective, that extends beyond highlighting the negatives, but rather focuses on enhancing the positive through a recognition of the positive and unique aspects of a people’s culture. The study recommends the application of a culture-centred theoretical lens to communication during a health crisis, as opposed to the proliferation of individual-focused theories of behaviour change that characterised the COVID- 19 communication landscape, for future pandemic preparedness efforts.