Ebola Risk Communication Project in Liberia: Lessons in Crisis Communication

“The Ebola outbreak experience that Liberia underwent in 2014 and 2015 provides important public health and crisis communication lessons that can inform responses to future crises...Hence, it is critical to describe and learn from the Ebola information environment in an effort to ensure that future public health responses are effective.“

The report shares the findings from the Ebola Risk Communication Project, which was designed to provide insights into the sources, types, and qualities of information Liberian citizens received about Ebola during the height of the most recent outbreak, in order to derive important recommendations for future crisis communications. The report was produced by the George Washington University Milken Institute School of Public Health and was funded by the Health Communication Capacity Collaborative (HC3), a global United States Agency for International Development (USAID)-funded programme to strengthen developing country capacity in health communication.       

In order to describe the Ebola information environment, the project adopted a crisis communication framework and analysed the content of community-produced communications as well as messages in the mass media to determine the extent to which Ebola-related content conformed to the 10 crisis communication best practices identified by Seeger (2006).  
 
The content analysis included data from the following sources:

• The SMS rumour tracking system (launched by Internews) - Community health workers in Liberia were instructed to pay attention to ongoing and emergent rumours about Ebola and  text-message those messages to the "rumour tracker" system. This system was aimed at keeping local officials, specifically the media, aware of the spread of rumours and enabled them to combat them. 
• Community media, operationalised as the Chalkboards - these are erected in high traffic public spaces and are updated regularly to keep locals informed.    
• Radio programmes: these included programmes produced by UNMIL Radio, ELBC FM, Radio Monrovia, and IREX. In addition, three radio programmes specifically formulated to address the Ebola crisis: Radio Joy, Youth Talk Radio, and Radio Cape Mount.
• Newspapers: these included the Daily Observer, Front Page Africa, and The Inquirer.

The project gathered content from these channels over the time period of December 2013 to May 2015. Over the course of approximately six months, the team collected, organised, coded, and analysed the content of these media channels in order to categorise the underlying themes that emerge. These themes (and the underlying topics) were then quantified in order to determine the frequency with which each theme emerges in the data.  Research methods for this component included analysing the chalkboard and radio programmes, and SMS messages received during and for 12 hours following the shows/update of news on the community chalkboard.

The report outlines the results for each communication channel in detail, analysing results according to themes such as: who was blamed for Ebola, who was credited for solving the crisis, sources and expertise used, rumours mentioned, overall tone of message (e.g., fear inducing), and topics discussed (e.g., number of cases, international support etc.).

Recommendations for future preparedness efforts (looking at the data from the lens of  the best practices of risk and crisis communication) are listed as follows (as taken from the Executive Summary of the report):

"1. Engage in Pre‐Crisis Planning
Overall, it does not appear that the public perception was that of a lack of leadership preparedness. Whereas the initial period was characterized by many rumors that filled the information void, rumors were quickly addressed across all communication channels.  Indeed, the creation of the SMS rumor tracking system went a long way in addressing these rumors head-on.  In the future, under similar circumstances, the public may be less apathetic about the very nature of the government’s response. Thus, providing opportunities for different media to come together proactively, to share lessons learned from this particular response in order to prepare for the next one, seems prudent. In addition, rarely were there messages about the response being unorganized.

2. Express Compassion, Concern, and Empathy
Whereas the community chalkboard was not at the forefront of expressing compassion and empathy (this was not really the purpose of the chalkboard), 11% of radio shows and 17%  of newspaper articles communicated compassion, concern or empathy. We consider this to be less than ideal. During a crisis of this magnitude, it is vital that the community widely perceive the empathy and compassion of its leaders.

3. Forge Partnerships with the Public 
Approximately 15% of radio shows and 9% of news articles communicated about forging public partnerships. Indeed, the radio programs were quite specific about ongoing partnerships in responding to the Ebola crisis.  Whereas the behavioral response tended to focus on steps that individuals could take to protect themselves, little was communicated about how individuals could engage with community organizations and other local institutions to forge partnerships.  We suspect that many individuals did want to contribute to the Ebola response, but we saw little evidence in the media about steps they could take to do so. Providing these avenues for response would likely be an important step in future.

4. Listen to your Audience and Understand its Concerns   
Approximately 10% of radio messages but less than 2% of news articles addressed a willingness to hear from the public. This finding is concerning. If messages do not convey a sense of compassion or willingness to hear from and work with the public, the public may take on the role of adversary, instead of a partner.  Future risk and crisis  communication efforts must take definitive and actionable steps to engage in this practice.

5. Communicate Honesty, Candor, and Openness 
We found that when articles and messages tended to cite their sources of information,  expertise (e.g., one’s level of experience, knowledge, or training) was often mentioned,  although this varied greatly by the type of source.  However, trustworthiness was rarely mentioned at all, for any source, on any channel. One issue is that while expertise is more authentically and naturally mentionable (e.g., “She has been a doctor for the last  25 years”), media personnel might find it more awkward to mention people’s trustworthiness  (e.g., “He is an honest person on whom we can depend”). Therefore, this is an area for which communication training might be advantageous. There are subtle ways of conveying trustworthiness (e.g., noting that a person is going against his or her self-interest)  that can increase the persuasiveness of the source (and what the source is advocating).

6. Accept Uncertainty and Ambiguity
In a crisis, it is important to recognize the inherent uncertainty. Doing so can mean a loss of credibility in the face of being incorrect. None of the chalkboards discussed the need to accept uncertainty; instead, most messages were framed in terms of certainty, leaving little room for nuance. Fourteen (5%) radio messages and 64 (9%) news messages included messages about uncertainty and ambiguity. Fortunately, only 13 (5%) radio messages and 18 (2.4%) news articles explicitly communicated that the crisis was "done and over." 

7. Regard Crisis Communication as an Ongoing Process 
Crisis messages should stress that communicating about the risks and crisis is a dynamic and ongoing practice. Twelve (75%) chalkboards, 62 (22%) radio messages and 639 (86%) news articles stressed this aspect of the crisis. This best practice was successfully communicated to the Liberian public.

8. Collaborate and Coordinate with Credible Sources 
Sources cited in the various articles and messages included government (e.g., Liberian government, President Ellen Sirleaf, the U.S. government), public health agencies  (e.g.,  the  WHO,  CDC), doctors and caregivers (e.g., health care workers, doctors), patients/families of patients, and community members. Radio programs cited at different times all 18 distinct types of sources that we included in our analyses.  And in many cases, their  respective expertise was explicitly mentioned. Likewise, newspaper articles cited all 18  kinds of sources at distinct times, and expertise was often explicitly  mentioned.

9. Communicate Self-Efficacy and Response‐Efficacy
In preventing and controlling infectious disease, a critical step is the awareness and behavioral response(s) of the public regarding actionable and effective steps. Two of the chalkboards (12%) communicated self-efficacy and one communicated response efficacy.  Radio fared better than chalkboards: 53 (19%) communicated self‐efficacy and 41 (16%)  communicated response-efficacy. Similarly, newspaper articles communicated self-efficacy 79 times  (11%) and response efficacy 112 (15%) times."