National One Health Message Guide for Priority Zoonotic Diseases in Liberia

"Effective emergency response often depends on complex behavioral changes at the individual, household, and community levels. Consistent, timely, accurate, and thoughtful public health messaging enables multiple stakeholders to speak and engage the public with one clear voice across multiple channels of communication, and it has a critical role to play in influencing individuals and communities in adopting protective behaviors."

One Health is an integrated, unifying approach that aims to sustainably balance and optimise the health of people, animals, and ecosystems. Breakthrough ACTION Liberia worked with the national One Health platform risk communication and community engagement (RCCE) technical working groups (TWGs) to establish, at both national and subnational levels, a multi-sectoral approach to strengthening RCCE. Risk communication is the real-time exchange of information, advice, and opinions between experts or officials and people who face a threat to their survival, health, or economic or social well-being from a hazard, such as a zoonotic disease outbreak. As outlined in this message guide, the approach involves ensuring that messages are not only technically accurate and consistent across all communication channels but that they also show respect for community values, communicate care and concern, and consider local context and culture.

In December 2021, Breakthrough ACTION staff in Liberia identified and trained 74 One Health stakeholders in a Training of Trainers (ToT) that stressed RCCE facilitation techniques. Following each subnational step-down training, each county-level RCCE chairperson and the national group established WhatsApp groups for their members. The increased coordination among these government stakeholders and partners at both the national and subnational levels led to the creation of this national One Health message guide for priority zoonotic diseases (PZDs) for Liberia.

As the process of creating the guide itself shows, effective messaging for PZD preparedness and response requires the collaboration of multiple government ministries and partners to: identify and share existing messages and materials; provide diverse technical expertise to identify essential behaviours and actions needed, as well as how to perform them in local contexts; and ensure that the language and format of the information being presented are appropriate for diverse communities. Thus, the purpose of this guide is to provide a validated messaging reference for presenting accurate, standardised basic health information in simple language, using a health message format relevant to the prevention and management of PZDs in Liberia to:

• Facilitate consistent and credible communication across diverse channels and sources of information;
• Inform the design of activities and materials to raise awareness, promote healthy behaviours, and engage communities in the prevention and management of zoonotic diseases; and
• Provide an informational foundation for timely communication of relevant information to which more detailed and specific information can be added in the event of a PZD outbreak as well as throughout response and recovery phases.

National One Health stakeholders encourage human and animal health providers, programme implementers, media professionals, and others to consult this guide when designing and implementing risk communication interventions for the prevention and management of PZD in Liberia. The hope is that the guide will support an increased understanding of the relationship between human and animal health and how it is affected by their shared environment, as well as how to prevent and manage PZDs.

This document is organised into 4 parts:

1. Orientation to This Guide - an orientation to the resource and message and material development for zoonotic diseases in Liberia.
2. Cross-Cutting Messages - cross-cutting messages for the prevention, detection, and general management of zoonotic diseases.
3. Disease-Specific Messages - disease-specific messages incorporating all relevant crosscutting messages.
4. Additional Resources - additional resources and templates for submission of messages and materials.

Messages in parts 2 and 3 are organised by topic (e.g., wash your hands, dispose of dead animals safely). Within each topic, topline messages are presented first, followed by messages that provide additional detail, anticipate audience concerns, and seek to answer the how and why for each promoted behaviour. Each topic heading is included in the table of contents to facilitate location of relevant messages.

The messages in this guide are designed according to the following principles:

• Use short words and common conversational language, limiting technical and scientific words as much as possible while maintaining accuracy and integrity of the concept.
• Encourage simple, doable actions for prevention and management of zoonotic diseases.
• Present one main idea at a time that focuses on what people need to know and do, why they should do it (benefits and risks), and how they should do it, to promote selection of messages and information appropriate to the channel of delivery.
• Consider the population's access to materials required to perform the behaviours and the local adaptations that may be required to perform promoted behaviours.
• Acknowledge the concerns or emotions (e.g., fear, anxiety, sadness) that people may experience because of the emergency or the information presented.
• Appeal to emotions and sense of individual and collective responsibility.
• Respect cultural beliefs and values.
• Recognise that animals are an important and valuable part of people's livelihoods and cultural lives.
• Emphasise preventing person-to-person transmission of disease in the event of an outbreak.
• Focus on available facts, with consistency across experts and acknowledgment of uncertainties and what is unknown.
• Maintain consistency in phrasing.
• Provide essential health information in a timely manner, to which additional information can be added.

As noted here, the content and intended audiences of messages are likely to evolve as the emergency progresses. During and following an outbreak, the foundational messages in this guide can be adapted to respond to concerns, feedback, changing circumstances, and shifts in context. The messages can also be used to encourage continuation of behaviours adopted during the emergency and over the course of recovery to support community resilience and preparation for potential future outbreaks.

The messages shared in this guide can be applied through a full spectrum of communication activities and channels and in times of preparedness and response. These activities include, but are not limited to the following: public announcements and press conferences/releases; media communication (print, video, radio, and public awareness campaigns) and social media; social mobilisation and partner engagement; and interpersonal communication and community engagement through local structures including county health workers, environmental coordinators, and community volunteers from across the One Health sectors. Social mobilisation and community engagement activities may also include a number of complementary, mutually reinforcing approaches such as: house-to-house visits and distribution of informational materials; community theatre and storytelling; community dialogues and action planning; school-based activities; engagement of community dancers; town hall discussions and discussions held as a part of community court sessions; and mobilisation of local influencers such as traditional and religious leaders, community-based organisations, or town criers.

Notably: "To meet the needs of all groups, it is important to engage communities, vulnerable groups, and individuals to promote understanding of disease epidemics and response in terms of gender. Initiating community engagement interventions and highlighting the varying impact of infections and emerging diseases such as zoonotic diseases based on gender will enable men, women, girls, and boys to all be viewed as people that can be infected by the diseases, despite the differences. The One Health National Messages Guide serves as a reference document to facilitate such community engagement interventions."

For more information on One Health RCCE in Liberia, visit the Liberia One Health Platform.