Responding to fluctuations in public and community trust and health seeking behaviour during the COVID-19 pandemic: a qualitative study of national decision-makers' perspectives in Guinea and Sierra Leone

• Published in: BMC public health 2024-10, Vol.24 (1), p.2710-13, Article 2710
• Main Authors: Baldé, Habibata, Geurts, Brogan, Fischer, Hanna-Tina, Menelik-Obbarius, Sara, Kaba, Ibrahima, Merhi, Vitali, Stein, Karoline, Diaconu, Viorela, Bahr, Thurid, Weishaar, Heide, Delamou, Alexandre, Mbawah, Abdul Karim, El-Bcheraoui, Charbel
• Format: Article
• Language: English
• Subjects: Adult; Communication; Community; Community engagement; Community involvement; Control; COVID-19; COVID-19 - epidemiology; COVID-19 - prevention & control; COVID-19 - psychology; Decision making; Disease control; Disease prevention; Ebola virus; Ebolavirus; Emergencies; Emergency management; Emergency response; Epidemics; Essential health services; Failure; Female; Guinea - epidemiology; Health aspects; Health behavior; Health care policy; Health facilities; Health services; Health services utilization; Health systems resilience; Humans; Malaria; Male; Management; Medical personnel; Middle Aged; Pandemic preparedness; Pandemics; Patient Acceptance of Health Care - psychology; Perceptions; Public health; Public health administration; Qualitative Research; SARS-CoV-2; Sierra Leone - epidemiology; Social aspects; Trust; Trust (Psychology); Vector-borne diseases; Viral diseases
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-024-20181-w

The level of trust in health systems is often in flux during public health emergencies and presents challenges in providing adequate health services and preventing the spread of disease. Experiences during previous epidemics has shown that lack of trust can impact the continuity of essential health services and response efforts. Guinea and Sierra Leone were greatly challenged by a lack of trust in the system during the Ebola epidemic. We thus sought to investigate what was perceived to influence public and community trust in the health system during the COVID-19 pandemic, and what strategies were employed by national level stakeholders in order to maintain or restore trust in the health system in Guinea and Sierra Leone. This qualitative study was conducted through a document review and key informant interviews with actors involved in COVID-19 and/or in malaria control efforts in Guinea and Sierra Leone. Key informants were selected based on their role and level of engagement in the national level response. Thirty Six semi-structured interviews (16 in Guinea, 20 in Sierra Leone) were recorded, transcribed, and analyzed using an inductive and deductive framework approach to thematic analysis. Key informants described three overarching themes related to changes in trust and health seeking behavior due to COVID-19: (1) reignited fear and uncertainty among the population, (2) adaptations to sensitization and community engagement efforts, and (3) building on the legacy of Ebola as a continuous process. Communication, community engagement, and on-going support to health workers were reiterated as crucial factors for maintaining trust in the health system. Lessons from the Ebola epidemic enabled response actors to consider maintaining and rebuilding trust as a core aim of the pandemic response which helped to ensure continuity of care and mitigate secondary impacts of the pandemic. Monitoring and maintaining trust in health systems is a key consideration for health systems resilience during public health emergencies.