Health communication management: the interface between culture and scientific communication in the management of Ebola in Liberia

The research questioned the efficacy of standard biomedical information sharing and communication processes in ensuring rapid and reliable behavioural changes in the control of epidemics, especially in high-context cultures. Information processing arousals and behaviour change motivations are subject to the level of interactions in the extrinsic and intrinsic elements of an information. Following, epidemic control can only be successful if relevant elements of a system’s values, norms, beliefs and practices for information processing are superimposed on scientific communication to create shared meanings. An empirical research approach in grounded theory underscore the data collection of this research with the data analogy utilising the MAXQDA Analytics Pro software. Ebola behavioural changes were identified to be enabled by the functional properties of community mobilisation as a structure and process for meaning making and behavioural motivation. A contextual health communication model dubbed the ecological collegial communication model has been modelled for epidemiological control as the output of the research. Specific to the methodology, a systematic qualitative and data analysis process in grounded theory was adopted for conducting the research and the dissertation writing. Commencing the process was the identification and analysis of the problem from the perspectives of the challenges to the Ebola communication management. This was comprehensively identified from the fundamentals of the process of communication to the communication itself and was assessed from the motivational factors underlying the behaviours within which the rationality of the behaviours could be understood for their inflexibility to change or their insensitivity to the Ebola messages. The mediations of the behavioural motivators in the cognitive processes to information processing were considered for their intrinsic and extrinsic values to arouse information processing and persuade change. To explore the interface between communication and culture in cognitive processes of information processing and decision making, literatures on behavioural theories, including anthropological theories from which the processes and determinants of behavioural enactment are predicted were reviewed in chapters two to four. Intention (also used interchangeably in this dissertation as motivation) was unanimously construed as proximal in determining behaviours in the literatures. However, intention was also construed to have linkages with other factors in the determination of behaviours.:Dedication ii Declaration iii Acknowledgements iv Table of contents v List of figures vi List of photos vii List of matrices vii List of tables vii List of appendices viii Abbreviations ix 1 Communication and culture of the 2014/2015 West Africa Ebola outbreak 1 1.1 Introduction 1 1.2 Conceptualisation of the research problem – the key factors of the Ebola outbreak 4 1.2.1 Structural violence 7 1.2.2 Communication deficiency 10 1.2.3 Cultural models (values and practices 20 1.2.3a Death and funerals 21 1.2.3b Caregiving 26 1.2.3c Reliance on traditional healers 31 1.3 Research objectives 37 1.4 Definitions 38 1.5 Questions formulation and research questions 42 1.6 Justification 52 1.7 Conclusion 58 2 Theoretical frameworks consistent with the 2014/2015 Ebola outbreak health communication approaches – A discourse 59 2.1 Introduction 59 2.2 Psychological/behaviour science models 60 2.2.1 Health belief model 61 2.2.2 Protection motivation theory 64 2.2.3 Theory of planned behavior /reasoned action 71 2.2.4 Social cognitive theory / social learning theory 76 2.3 Summary 79 3 Information processing/communication theories 81 3.1Introduction 81 3.2 Elaboration likelihood model 81 3.3 Activation model 86 3.4 Narrative theory and entertainment education 88 3.5 Summary 95 4 Ecological theories / framework 97 4.1 Introduction 97 4.2 The PEN-3 Model 98 4.2.1 Health education (cultural identity)100 4.2.2 Cultural appropriateness of health behavior (cultural empowerment) 101 4.3 Bioecological theory 103 4.4 Developmental process of Bronfenbrenner’s model in the framework of the 2014/2015 Ebola outbreak 108 4.5 Theoretical framework of this dissertation 119 5 Research process and methodologies 125 5.1 Introduction 125 5.2 Justification of the research methodology 128 5.3 Overview of Monteserrado County 134 5.4 Techniques/procedures 137 5.4.1 Archival materials/documents 138 5.4.2 Ethnographic/observations 139 5.4.3 Key informants/in-depth interviews 142 5.4.4 Focus group discussions 143 5.5 Data analysis 146 5.5.1 Codes 147 5.5.2 Qualitative analysis employed in the research 152 5.6 Role of the researcher 153 5.6.1 Origins of the project 153 5.6.2 The discourse - philosophical worldview 156 5.6.3 Concluding thoughts 157 6 Data analysis: cultural practices, health and communication in the Liberian context 160 6.1 Introduction 160 6.2 Ethnicity and religion 162 6.3 Social organization 171 6.4 Aspects of death and burial practices 179 6.5 Concept of health and health care 186 6.6 Communication and information sharing approach in Liberia 193 6.6.1Traditional communication and the town crier in Liberia 195 6.6.2 Contribution of Crusaders for Peace 201 6.6.3 Development of overarching Ebola communication messages 206 6.7 Conclusion 210 7 Data analysis: Socio-cultural patterns in Ebola perceptions, content of messages and behavioural outcomes 212 7.1 Introduction 212 7.2 Parent codes – summative description and discussions 214 7.3 Understanding the socio-cultural patterns in Ebola knowledge and behaviours: Perceptions of Ebola transmissions 226 7.4 Content and nature of Ebola messages in perceptions and behaviours 237 7.5 Conclusion 276 8 Data analysis: Understanding the motivators of Ebola behaviours – an analytical interrelationships model perspective 278 8.1 Introduction 278 8.2 Patterns of Ebola behaviours 279 8.3 Conclusion 317 9 Decoding: the interface between culture and communication in the Ebola communication management 319 9.1 Introduction 319 9.2 Contextual elements of effective communication – the interface 321 9.3 Cognitive heuristics to “…protect yourself…” 336 9.4 Processes of moderations of “protect yourself” in cognitions 339 9.5 Conclusion 343 10 Theoretical and conceptual inferences from empirical data and framework for a culturally appropriate communication 344 10.1 Introduction 344 10.2 Research questions 344 10.3 Epidemic control: The cultural model framework to persuasive communication for epidemic management 359 10.3.1 The composite conceptual analytical elements of the model 364 10.3.1a Model definition and assumptions 365 10.3.1b The ECCM – the interactive elements of a system 367 10.3.1c Pattern of communication in the ECCM 371 10.3.2 Summary 374 10.4 Processes of how to apply the ECCM 375 10.5 Limitations of the model 382 10.6 Conclusion 383 11 Conclusions and recommendations 385 11.1 Introduction 385 11.2 Key conclusions 385 11.3 Implications 387 11.3.1 Policy framework implications 387 11.3.2 Theoretical implications 390 11.4 Further research 393 11.4.1 Approach to communication 393 11.4.2 Cultural dynamics 396 11.4.3 Health perceptions 398 11.4.4 Ebola orphans and victims 398 11. 5 Research limitations 399 References 40

Farmers’ willingness to invest in livestock disease control: the case of voluntary vaccination against bluetongue

Animal health authorities in the European Union nowadays consider voluntary approaches based on a neoliberal model of cost and responsibility sharing as a tool for controlling livestock diseases. Policy makers aim for policies that are soft and optional, and use insights from behavioural economics and social psychology. Voluntary approaches are flexible in terms of legislation and can be effective at lower costs, provided that farmers are willing to participate. In 2008, the Dutch animal health authorities used a voluntary vaccination approach to control an emerging bluetongue epidemic that started end of 2006. Nearly 60,000 holdings with ruminants were already affected by the end of 2007 and experts indicated that transmission could only be stopped through mass vaccination. Farmers were motivated to participate by informational and financial, incentive-based policy instruments. Economic theory predicts that farmers underinvest in private disease control measures in the presence of externalities. These studies, however, assume farmers only consider the private economic motives and that they only can be extrinsically motivated via (monetary) incentives. If the willingness to invest in livestock disease control is also driven by intrinsic and social motives, this could imply that not only financial compensation, but a mix of policy instruments is needed to make voluntary approaches work. The overarching research objective of this thesis was to assess the key determinants of farmers’ willingness to vaccinate against bluetongue and study the impact of different policy designs on the effectiveness of voluntary vaccination approaches to bluetongue disease control. A three-stage research approach was conducted. Two models of decision making, one from economics and one from social psychology, were first applied to the case study to obtain a solid understanding of important perceptions and motivations that farmers have to invest in livestock disease control. These motivations (sometimes incentives) and perceptions were then related to different attributes of a vaccination scheme to have a better understanding of how a higher uptake can be obtained. In the third stage, the effect of the interplay between farmers’ collective behaviour and disease epidemiology on disease rate and vaccination uptake was studied. Expected utility theory was used in combination with decision analysis and Monte Carlo simulation in chapter 2. The economic risk and monetary outcomes of the vaccination decision were considered, intrinsic or social motives ignored. The theoretical expectation from the analysis is that with high probabilities of herd exposure and disease effects at the start of the outbreak the farmer decides to vaccinate. Re-vaccination is uncertain during the course of the epidemic due to a lower probability of herd exposure and enduring protection against infection from previous vaccination. Factors that make re-vaccination more likely to happen are risk-averse behaviour and farm management aimed at the export of heifers. The decision moment – before or during an epidemic – and the characteristics of the disease – endemic, epidemic or emerging – are important factors in perceptions of disease risk. Chapters 3 to 5 used data from a survey that was based on the reasoned action approach. Data were analysed with a variety of statistical, mostly multivariate, techniques. The relative importance of the social-psychological constructs in predicting the intention to participate in a hypothetical reactive vaccination scheme against bluetongue was assessed in chapter 3. It was found that intended vaccination behaviour was mainly explained by farmers’ attitude, but also by social pressures from injunctive and descriptive norms. Perceived behavioural control was the least important predictor of intention. The most influential beliefs underlying the social-psychological constructs were assessed in chapter 4. Results suggested that instrumental beliefs (e.g. risk reduction) as well as experiential beliefs (e.g. animal welfare) were important drivers of the attitude towards vaccination against bluetongue. This indicates that in addition to monetary outcomes of the decision, at least a group of farmers also consider the non-monetary (or non-pecuniary) outcomes. The results further showed that the most influencing referents for the farmer are the veterinarian, his or her family members and colleague dairy farmers (peers). Two influencing control beliefs were associated with the provision of information and perceived trust and confidence in the vaccine safety, effectiveness and government approach to control the disease. The aim of chapter 5 was to explore factors that could explain heterogeneity in farmers’ attitudinal beliefs. In particular, perceived risk, measured by a relative risk attitude and risk perception, and the Big Five personality traits were associated with variability in these beliefs. Conscientiousness discriminated farmers into a group of ‘vaccination intenders’ and non-intenders although it remained somewhat unclear how it relates to the decision problem, as it can be a sense of duty, achievement striving or both. The perceived risk measures were related to the milk production intensity and also discriminated intenders from non-intenders. These differences in perceived risk indicated that farmers might not be commonly risk averse, however, it is important to account for the domain specificity of risk taking behaviour. A survey-based discrete choice experiment was used in chapter 6 to study more deeply farmers’ choices for different voluntary bluetongue vaccination scheme designs. A generalised random utility model of farmers’ behaviour allowed for heterogeneity in motives to invest in bluetongue disease control. Results showed that farmers have private economic motives (incentives) to participate in a vaccination scheme, such as to insure the production risk from disease infection and to maintain the export of heifers. Interaction effects found between social-psychological constructs and specific designs of policy instruments highlighted the importance of perceived trust and confidence in the vaccine safety and effectiveness and in the disease control strategy chosen by animal health authorities. Attitude interacted positively with government communication (information) provided via veterinarians. Descriptive norm interacted positively with a lower perceived probability of adverse effects. This suggests that farmers are more likely to vaccinate if they perceive that others in their social network perform vaccination without experiencing adverse effects. Injunctive norm interacted negatively with a higher level of government subsidy. This suggested a crowding-out mechanism through which subsidization adversely affect farmer’s motivation to comply with the vaccination policy. The interplay between farmers’ collective behaviour and bluetongue disease epidemiology was studied in chapter 7 with an agent-based model. The utility model specification from chapter 6 was used to describe the decision-making process of farmers. Other components that added to the dynamic nature of the model were a social network structure of the diffusion process of sharing information about vaccination status and a susceptible-latent-infectious-recovered model of disease spread. The effectiveness of different bluetongue vaccinations scheme designs was studied as measured by disease rate and vaccination uptake. Results of chapter 7 showed that vaccination schemes that focus more on motivating farmers via informational instruments were somewhat more effective than predicted from the comparative static analysis in chapter 6. Motivation via financial incentives resulted in a somewhat lower effectiveness than was predicted from that same model. This might be explained as an emergent effect that evolves under specific vaccination scheme designs from the interactions between farmers themselves and with the environment from which they observe the progress of the disease. These schemes focus more on serving the information needs of farmers and raising the perceived trust and confidence in the disease control approach rather than on incentivising with higher levels of subsidy. Three themes for livestock disease control emerged from the synthesis of the results in chapter 8, which were subsequently discussed in relation to the wider economic and (social) psychological literature. These themes coincide with shortcoming of the standard economic model of rational choice to describe and predict behaviour. The first theme was about understanding how farmers cope with risk in the context of livestock diseases. The second theme focused on the usefulness of financial compensation as a policy instrument. The third theme discussed the role of trust and social norms. After discussing the implications for policy making, main scientific contributions and suggestions for future research, the chapter concluded that: Dutch dairy farmers who operate large-scale and intensive farms or keep heifers for export are likely to have private economic motives to vaccinate against bluetongue (Chapter 2, 4, 5 and 6).Farmers’ willingness to vaccinate against bluetongue is mostly driven by attitude, followed by perceived social pressures from injunctive norms and descriptive norms. This implies farmers can be motivated intrinsically, extrinsically, or both (Chapter 3).Dutch dairy farmers have intrinsic motives to vaccinate against bluetongue. They do not want to be confronted with animal suffering but want to keep job satisfaction high from working with healthy animals (Chapter 4).Dutch dairy farmers have social motives to vaccinate against bluetongue. They consider what important referents, such as the veterinarian or family members, think they should do and take into account the perceived behaviour of peers (Chapter 3 and 4). Perceived risk, personality traits and past behaviour are important behavioural variables for explaining the heterogeneity in beliefs to vaccinate against bluetongue (Chapter 5). The efficacy of financial, incentive based instruments to motivate to vaccinate against bluetongue is heterogeneous and not necessarily positive for each farmer. They are not effective if farmers already expect a positive net benefit from vaccination or if they crowd-out the motivation to comply with the vaccination policy (Chapter 2, 4, 6, 7). The efficacy of informational policy instruments to motivate farmers to vaccinate against bluetongue is positively affected by farmers’ attitude towards vaccination and in case farmers perceive the communication channels used as credible and trustworthy (Chapter 3, 4, 6). The efficacy of social interaction mechanisms in policy making, such as the perceived social pressuretovaccinateagainstbluetongue,ispositivelyaffectedbyfarmers’trustandconfidence in the government approach to control the disease (Chapter 4, 6, 7).</p

Towards an information security awareness process for engineering SMEs in emerging economies

With most employees in Engineering Small and Medium Enterprises (SME) now having access to their own personal workstations, the need for information security management to safeguard against loss/alteration or theft of the firms’ important information has increased. These Engineering SMEs tend to be more concerned with vulnerabilities from external threats, although industry research suggests that a substantial proportion of security incidents originate from insiders within the firm. Hence, technical preventative measures such as antivirus software and firewalls are proving to solve only part of the problem as the employees controlling them lack adequate information security knowledge. This tends to expose a firm to risk and costly mistakes made by naïve/uninformed employees. This dissertation presents an information security awareness process that seeks to cultivate positive security behaviours using a behavioural intention model based on the Theory of Reasoned Action, Protection Motivation Theory and the Behaviourism Theory. The process and model have been refined and verified using expert review and tested through action research at an Engineering SME in South Africa. The main finding was information security levels of employees within the firm were low, but the proposed information security awareness process increased their knowledge thereby positively altering their behaviour

Global Bioethics

Two new factor have been added to the ideological change in the second half of the past century: the “ecological impact” of humankind on the environment due to the population increase; and the “ innovative impact of science, first with atomic physics, which introduced the scission of the fundamental unit of matter, the atom, and then witch molecular biology, which led to the decoding of genetic information and intervention of biological engineering that annihilate our concepts of individual and species as fundamental units in biology. This stage of fundamental rethinking is however overshadowed by the threat of ecological disaster and catastrophic population increase, which not only impose limits to development, but undermine the very survival of Humankind. The future survival our species in fact depends on the interaction between its reproductive characteristics and the productivity of the territory, which, even if increased by the intellectual capability of the human brain, has intrinsically limits. The adaptive choices (which are also biotechnological and biomedical) of the interaction between human population and the natural ambience is the conceptual basis of the new discipline “Global Bioethics”

THE LIVED EXPERIENCES OF ELEMENTARY SCHOOL TEACHERS’ IMPLEMENTATION OF SOCIAL-EMOTIONAL LEARNING: TRANSITIONS FROM IN-PERSON AND REMOTE SETTINGS

This qualitative study examined elementary school teachers\u27 transitions from in-person to remote social-emotional learning during the COVID-19 pandemic in a northeastern US public school district. This study addressed the following central research question using Bandura\u27s (1977) self-efficacy theory and CASEL\u27s Framework (2021) for social and emotional learning: What were teachers’ lived experiences while teaching social-emotional learning (SEL) during both remote and in-person instruction in elementary school throughout the Covid-19 pandemic? Eight teachers from one suburban elementary school shared their experiences meeting students\u27 social-emotional needs during the pandemic. This study examined teacher perspectives on social-emotional learning in in-person and remote settings during the COVID-19 pandemic. Interview questions provided narrative inquiry study answers. According to interviews, teachers implemented social and emotional learning with uncertainty, anxiety, and fear. Teachers believed they could teach social and emotional learning remotely and in person despite the pandemic because of their perseverance, awareness, and social interactions. They did this by relying on their colleagues for support and encouragement, realizing the importance of their work with students, and allowing students to express their emotions and feelings while learning remotely and in person

The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development

Background: Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited. Objectives: To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention. Data sources: All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014. Review methods: A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation. Results: Overall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from ‘goals and planning’ and ‘identity’ groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation. Limitations: There was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity. Conclusions: Evidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention. Future work: There is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity

Human Service Professionals’ Perceived Ability to Support Title I Schools During the COVID-19 Pandemic

Human service professional practitioners (HSPPs) who work in Title I schools help students overcome challenges including absenteeism and behavioral problems and serve as liaisons between the school, family, and student. The pivot to online education during the COVID-19 school shutdowns meant that HSPP services also pivoted. The purpose of this generic qualitative study was to understand how HSPPs perceived their ability to serve Title I students during the pandemic through the lens of Bandura’s self-efficacy theory. Semistructured interviews were conducted with 15 HSPPs who delivered services to Title I students before and during the pandemic. Participants reported their service delivery was effective prior to the pandemic despite a lack of resources. Themes from coding analysis included (a) an ability to effectively deliver services before the COVID-19 pandemic despite a lack of resources; (b) not feeling that their job was undoable; (c) significant disruptions in pandemic service delivery (increasing student needs, changes in job responsibilities, communication/trust issues); (d) there was no way to be prepared; and (e) they gained helpful insights into professional priorities, the use of new organizational tools, and new resources for disruptions. Results could be used by HSPPs, education administrators, and stakeholders in the development of comprehensive virtual plans in schools, which could help parents, HSPPs, and school administrators pivot more smoothly and mitigate potential issues during these types of events

Human Service Professionals’ Perceived Ability to Support Title I Schools During the COVID-19 Pandemic

Human service professional practitioners (HSPPs) who work in Title I schools help students overcome challenges including absenteeism and behavioral problems and serve as liaisons between the school, family, and student. The pivot to online education during the COVID-19 school shutdowns meant that HSPP services also pivoted. The purpose of this generic qualitative study was to understand how HSPPs perceived their ability to serve Title I students during the pandemic through the lens of Bandura’s self-efficacy theory. Semistructured interviews were conducted with 15 HSPPs who delivered services to Title I students before and during the pandemic. Participants reported their service delivery was effective prior to the pandemic despite a lack of resources. Themes from coding analysis included (a) an ability to effectively deliver services before the COVID-19 pandemic despite a lack of resources; (b) not feeling that their job was undoable; (c) significant disruptions in pandemic service delivery (increasing student needs, changes in job responsibilities, communication/trust issues); (d) there was no way to be prepared; and (e) they gained helpful insights into professional priorities, the use of new organizational tools, and new resources for disruptions. Results could be used by HSPPs, education administrators, and stakeholders in the development of comprehensive virtual plans in schools, which could help parents, HSPPs, and school administrators pivot more smoothly and mitigate potential issues during these types of events