Effective health messaging in emergencies Risk communications guidelines for public health emergencies #coronavirus #Covid19

Household water treatment mural, Clara Town Health Centre, Monrovia, Liberia. Photo credit: Simon Lawson 2012 (CC BY 4.0)


Fear can be effective at driving preventative behaviour change in the short term, but is a poor motivator for sustainable behaviour change.

This is a key lesson learnt from emergency responses to epidemics, such as cholera and Ebola virus disease, and the typical emergency approach to communications.

Sooner or later disease outbreaks run their course.

As fear of the disease abates, preventative behaviours promoted during the emergency – such as handwashing with soap and household water treatment (e.g. with Aquatabs) – decline, and all too often donated emergency supplies disappear.

This leaves communities vulnerable to, and ill prepared for, new outbreaks.

Billboard showing neonatal care information at a Rohingya IDP camp, Rakhine State, Myanmar. Photo credit: Simon Lawson 2015 (CC BY 4.0)

Opportunity, ability and motivation

Hygiene behaviour to prevent diarrhoeal diseases (such as cholera), respiratory infections (such as coronaviruses: SARS, MERS, Covid-19) and other viral diseases (such as Ebola) is highly dependent on opportunity, ability and motivation.

There is little point in promoting a particular preventative behaviour if the target population lack:

  • the opportunity to practise it – for example, through access to hygiene facilities, water and soap
  • the ability to do it – through knowledge, skills, self-belief, social support (norms)
  • common motivations for sustainable behaviour change, such as disgust (for instance, at not washing your hands with soap after using the toilet), affiliation (wanting to be part of the group) and nurture (the desire to care for one’s children or family).
Epidemics can be more quickly controlled when the affected population knows how to protect themselves, and their relatives, and the community is engaged to limit the spread of the disease, as well as when an enabling environment exists for those protective behaviours to emerge.

Global Task Force for Cholera Control, Framework for the development and monitoring of a national multi-sectoral cholera plan (NCP Framework)

Often, the challenge is less about motivating behaviour change to prevent a particular disease and more about enabling people to practise the desired preventative behaviour.

Preventing the spread of Covid-19

Many countries are promoting physical (social) distancing – asking people to keep at least 2 metres (6 feet) apart in public spaces.

Long line, Southern California, USA. Photo credit: Russ Allison Loar 2020 (CC BY-NC-ND)

Can people do this in densely populated urban slums?

Market, Conakry, Guinea. Photo credit: Simon Lawson 2012 (CC BY 4.0)

We need a paradigm shift – we should be thinking less about ‘changing’ and more about reinforcing/improving/enabling desired behaviours.

We’re not starting from zero!

Delivering healthcare to Colombia’s Amazon villages. Photo credit: N. Mazars/EU 2019 (CC BY-NC-ND 2.0)

Planning a health emergency communications intervention

Community engagement – community-led total sanitation, social marketing or public health promotion – is a process, not an event.

Bear this in mind when you’re planning an intervention.

It will need support until it evolves enough to be truly self-sustaining, maintained by local communities themselves.

Choices for action should be decided by community consensus, and reinforced with support from peers, traditional and religious leaders and other influencers.

Before you start, ask yourself:

  • what messages you want to get across
  • who the information is for
  • how the messages will be used.

Answering these questions will help you:

  • clarify your message(s)
  • identify your target audience
  • choose the communications channel best suited to reaching your audience.

The answers to these questions, and the decisions you make based on them, will be crucial to the success of your communications product or campaign.

The Big Six – when you write a summary of your communications plan, try to answer the six questions who, what, why, where, when and how. Keep your plan clear and concise.
Nutrition know-how for mums and mums-to-be saves lives, Odisha, India. Photo credit: Pippa Ranger/DFID 2011 (CC BY-NC-ND 2.0)

Research question 1: Who is your target audience?

Field mission in Nigeria. Photo credit: Samuel Ochai/EU 2019 (CC BY-NC-ND 2.0)

Write a profile of the target audience, including their:

  • age group
  • culture
  • language
  • ethnic group
  • socio-economic status
  • disability
  • gender
  • literacy level
  • internet/phone access
  • access to sanitation
  • previous experience of contagious disease
  • how much they know about the subject
  • any preconceptions they might have
  • people who influence them (e.g. religious and/or traditional leaders, role models, the media they consume)
  • other factors that might be relevant (e.g. social norms that might act for or against the desired behaviours).
Beware of secondary audiences – Try to avoid targeting widely different groups of people with the same materials (e.g. the public and trained health professionals). Fit your message to one audience.

Research question 2: What are your communications objectives?

UNICEF ‘Breast Milk is Best’ guerilla marketing billboard campaign, Sierra Leone. Design by Lineix 2018 (CC BY-NC-ND)

Make a short list of simple objectives (preferably no more than four) and rank them in order of priority. Think about:

  • what messages you want to get across
  • what you want the audience to know and to do as a result of your communications

Having answered these questions, think about the communications content – what information do you need to include?

  • With a poster or billboard, what are the key messages or points of understanding the audience needs to get from seeing the material?
  • For a promotional video, like a public service announcement, what are the key messages to get across to the audience?
  • In a radio spot, what is the essential information that the audience should take away from listening?
Less is more – try not to cover too many separate issues. Focus on a few essential messages to deliver them effectively.
People listen to songs teaching how to avoid catching Ebola, Isanga, Uganda. Photo credit: Anna Dubuis/DFID 2019 (CC BY 2.0)

Budget and resources

The amount you have to spend and the resources you have at your disposal will have a crucial impact on:

  • how you decide to treat your subject matter
  • the channels of communication you use
  • how you present the material
  • what you can achieve.


Think about who will need to approve the project at each stage of production. Try to keep the number of people making editorial decisions down to an absolute minimum – and do try to avoid personnel changes mid-project!

Planning checklist

Some things to keep in mind.

  • Channels of communication – radio, video and graphics, music, social media and messaging apps, billboards, posters, etc.
  • Social marketing – are you tapping into the aspirations of your audience? Will practising the desired behaviour make them feel good about themselves and how they are seen by others?
  • Enabling environment – opportunity, ability, motivations, social norms
  • Role models and influencers – using religious leaders, musicians, sports stars to lend credibility and build public trust
  • Local skills – can local producers, designers and communicators do this work?
  • Unintended outcomes – avoid provoking fear, distrust and violence against health workers
  • Managing the infodemic – how to counter rumours and misinformation.
UNICEF handwashing billboard campaign, Sierra Leone. Design by Lineix 2018 (CC BY-NC-ND)

Effective health messaging in emergencies: Risk communications guidelines for public health emergencies #Coronavirus #Covid19 | Written by Simon Lawson | Edited by James Middleton

For more information email Simon Lawson (Nomad C4D & WASH Consulting) simonnomad@icloud.com

Simon Lawson is an Aid Works associate
Published by Aid Works