Exploring the localisation of COVID-19 prevention messages in eThekwini communities.

Abstract

The global COVID-19 pandemic disrupted communities and healthcare systems worldwide. In early 2020, the World Health Organisation (WHO) recommended a range of preventive measures aimed at reducing the spread of COVID-19 which included regular handwashing or sanitising, social distancing and the use of face masks. These measures were adopted by governments around the globe including South Africa. However, these strategies were predominantly based on biomedical and behavioural approaches, with limited consideration of the socio-cultural context in which health decisions and preventive actions are taken. Evidence from past and ongoing pandemics, such as Ebola and HIV, demonstrates that excluding local knowledge, cultural norms, and community-based insights in health messaging can limit the effectiveness and uptake of these interventions. Adopting a photovoice methodology embedded within the community-based participatory approach, this study explored the local interpretation, adaptation and reconstruction of the dominant COVID-19 prevention messages that included regular hand washing and sanitising, the use of face masks and social distancing in three eThekwini communities (including Umbumbulu - a rural community, Cato Crest - an informal settlement and Umlazi a township). Participants were recruited purposively in each community. Data was collected in two phases with the first phase taking place between March and April 2021 during the adjusted level 2 lockdown, and the second phase was during the adjusted level 1 lockdown, between October and November 2021. The study adopted a three-staged data collection process which included (1) the introductory sessions with participants to inform them about the study and data collection methods (2) the photovoice data collection stage in which participants went out to their communities to capture photos that reflected their understanding, interpretation and adaptation of the COVID-19 prevention messages within their local contexts and (3) the focus group discussion which included detailed discussions on the photos collected and explored other related themes. Data was analysed thematically. Key findings from this study highlighted that people's understanding and interpretation of COVID-19 prevention messages evolved over time. During the first phase of data collection, people focused on making sense of these messages within their local cultural contexts. Whereas, the second phase found that there was more familiarity with the dominant messaging and localised interpretation of these messages to fit specific contexts. While there were mixed reactions to adopting COVID-19 prevention messages, cultural beliefs and values often conflicted with full compliance, challenging widespread acceptance of these measures within local communities. This study highlighted the importance of integrating community perspectives and contextual nuances in the development of health communication strategies to enhance their effectiveness and sustainability in managing future pandemics. These insights can guide the design of culturally grounded public health interventions and strengthen future pandemic communication strategies to ensure greater trust, uptake, and long-term adherence to prevention measures.