Building confidence in crises – the roles of Sierra Leonean religious leaders’ during the 2014-2016 Ebola outbreak

Abstract Background Religious leaders have been involved in risk communication campaigns for many years across West Africa such as their involvement in the HIV/AIDS pandemic response. Little is known about religious leaders’ perceptions of their role in communicating Ebola risks during the 2014-2016 outbreak in Sierra Leone and the strategies they adopted to communicate these risks. Methods In this qualitative study 10 semi-structured interviews were conducted with religious leaders in Freetown, Sierra Leone, to better understand their perceptions of their roles communicating risk during the outbreak. Five Christian and five Islamic leaders were recruited from multiple national religious organisations including male and female leaders. The data was analysed using thematic analysis. Results Three themes were developed from the data which illustrate the different strategies religious leaders used when establishing public confidence in their role communicating risk and the messages they communicated during the outbreak. The religious leaders describe how they established themselves as non-political actors in the outbreak response, they provided support to their communities and used collaboration as a means to effectively communicate risk. The religious leaders adapted pre-existing roles and established new ones in order to build confidence among their communities. They flexibly and pragmatically utilised scriptural texts within these strategies to communicate risk and to establish confidence in their messages. Conclusions Religious leaders were pragmatic in their approach to risk communication, leveraging political distrust and collaborating with other actors to strengthen their position. Interreligious unity as well as scripturally supported messaging helped establish confidence in the public health emergency response. Author Summary Religious leaders are both positively and negatively associated with the promotion of protective behaviours during outbreaks. During the 2014-2016 Ebola outbreak, thousands of religious leaders were engaged to communicate Ebola risks and protective Ebola messages across Sierra Leone. Working with public health professionals they developed Ebola specific messages by selecting specific passages from scripture to support medical messages. These messages were positively associated with safe burial behaviours during the outbreak in Sierra Leone. In this study, semi structured interviews were conducted with religious leaders involved in risk communication campaigns during the outbreak. Our results highlight that religious leaders were pragmatic in their approach to risk communication, leveraging political distrust and collaborating with other actors to strengthen their position. Interreligious unity as well as scripturally supported messaging helped establish confidence in the public health emergency response. In their role communicating risk religious leaders prioritised building confidence by advocating for community supported Ebola-measures and by establishing themselves as non-political actors in the outbreak response. Public health messages developed by religious leaders in line with scriptural texts can be used as part of risk communication campaigns to improve their public acceptability.