Addressing COVID-19 Rumors and Behaviors Using Theory in Guyana: A Program Case Study

"The COVID-19 pandemic revealed the need for public health communication efforts to be more proactive. This is especially relevant given the need to address misinformation to promote COVID-19 vaccine uptake..."

The misinformation and disinformation propagated during the COVID-19 pandemic has led to distrust in public health efforts and the promotion of harmful practices that undermine the effectiveness of public health responses, particularly in lower-resource settings such as Guyana. In response, the Ministry of Health (MOH)'s Health Emergency Operations Center (HEOC) worked with the United States Agency for International Development (USAID)-funded Breakthrough ACTION project to develop a theory-based rumour-tracking system to inform Guyana's COVID-19 communication campaign. This article details how Guyana's MOH and Breakthrough ACTION Guyana used the extended parallel processing model (EPPM) to inform their rumour identification strategy and then develop counter-messaging to overcome the effects of that misinformation.

Frequently used to understand decision-making in the face of a public health threat, the EPPM describes how rational considerations (efficacy beliefs) and emotional reactions (fear of health vulnerability) combine to determine behavioural decisions. The following constructs are central to the EPPM: fear, vulnerability (with its 2 components: perceived severity and perceived susceptibility), and efficacy (comprising self-efficacy and response efficacy). The EPPM also includes 2 types of responses: danger control and fear control. When fear is very strong and efficacy beliefs are very weak, some people try to avoid thinking about the threat to feel less frightened, rather than taking action to reduce the threat. Rumors and misinformation can exaggerate fears and undermine trust or confidence in viable solutions, which makes rumour tracking and response so important in the context of public health emergencies like COVID-19.

From June 2020 to December 2020, organisers implemented a 3-step system in which they:

1. Identified rumours: In-person sources included regional communication coordinators, volunteer educators in each hinterland region, and medical staff, who documented rumors heard by community members, patients, or clients. Virtual sources of rumours included social media such as Facebook and Instagram pages of national influencers and the MOH, the MOH website, and WhatsApp messages sent to MOH staff and Breakthrough ACTION Guyana. Breakthrough ACTION developed an electronic rumour log using Google Forms to track rumours in real time.
2. Categorised rumours: The project assessed the logged rumours weekly for their potential risk using an 18-point risk scale. It was found that rumours were typically related to COVID-19 treatment or prevention (40%) and transmission (35%). Most rumours (48%) reflected low perceived vulnerability and low efficacy, 29% reflected high perceived vulnerability and low efficacy, 13% reflected low perceived vulnerability and high efficacy, and 10% reflected high perceived vulnerability and high efficacy. It was found that 71% of the rumours recurred.
3. Employed the EPPM model to synthesise the rumours and develop 12 social and behaviour change (SBC) messages known as MythBusters: (i) high perceived vulnerability and high efficacy rumours included a call to action; (ii) high perceived vulnerability and low efficacy rumours educated about effective and achievable solutions; (iii) low perceived vulnerability and high efficacy rumours educated about risk; and (iv) low perceived vulnerability and low efficacy rumours educated about risk and effective and achievable solutions. The MOH and Breakthrough ACTION Guyana developed the basic message of MythBusters and selected channels for dissemination (e.g., radio, television, and social media) weekly. Custom graphics accompanied the MythBusters, and the project disseminated them using Facebook, Instagram, newspapers, and flyers. It also incorporated high-priority messages to address recurring rumours in entertainment-education "edu-dramas" for radio or television broadcasts. MythBusters related to rumours requiring immediate action went out on the same day of development, whereas the project disseminated all other MythBusters within 1 week. The MythBusters had an estimated reach of 30% (n=151,763) of the population of Guyana aged 15 years and older.

MythBusters were integrated into Guyana's COVID-19 communication campaign, which was implemented from July 2020 to March 2021, focusing on 3 COVID-19 preventive behaviours: physical distancing, hand hygiene, and wearing masks. Regional communication coordinators in each hinterland region worked with a network of volunteers in the communities to deliver COVID-19 campaign messages, educating communities about COVID-19 and prevention behaviours. The campaign nationally disseminated the majority (95%) of MythBusters through multiple channels, including newspapers (71%), social media (57%), flyers (38%), radio (24%), and town criers (24%). Estimates indicate that the campaign reached the entire population aged 15 years and older.

The project implemented additional training for the entire HEOC team on the development of the log system and the EPPM model. "Helping local implementing agencies learn to apply a framework like EPPM can improve program outcomes and sustainability."

Reflecting on the experience, the researchers explain: "The advantage of using a theoretical framework such as EPPM...is that it can point to specific information content (specific inaccurate beliefs) that can be corrected if done in a timely and focused way. The framework helps to take the guesswork out of what to say in response to unscientific ideas circulating in public, redirecting the conversation to the true nature of the vulnerability and what is known to be effective in reducing that vulnerability."

They also suggest that "Institutionalizing SBC into emergency planning can help create conditions under which future emergencies avoid unfolding into long-term development losses because it builds resilience in health systems and communities." To support that instutitionalisation, "The approach described here can be considered a contextually relevant resource for rapidly identifying, synthesizing, and acting on misinformation during health emergencies. The study also provides actionable guidance on responding to and deploying SBC interventions that protect against infodemic and its harmful effects."

The paper examines various avenues for additional research, such as exploring factors associated with successful infodemic management by health authorities, the media, civil society, the private sector, and other stakeholders. "Such research would promote an understanding of how misinformation has affected behavior among different populations and inform the development of interventions that address individual, community, cultural, and societal factors affecting trust and resilience to misinformation." The researchers also suggest that future programmes explore interpersonal communication strategies such as community engagement in addressing rumours as multichannel approaches, which are typically more effective than mass media channels.