A Theory-Based Socioecological Model of Communication and Behavior for the Containment of the Ebola Epidemic in Liberia

Figures & data

Fig. 1. A metatheory of health communication (Kincaid et al., 2012).

Table 1. Ebola conceptual matrix: Example of individual-level factors identified for two prevention behaviors—isolation of the sick and safe burials, October 2015

Behavioral outcome: Prevention	Ideational variables
	Knowledge/skills	Beliefs/attitudes	Perceived risk/susceptibility	Self-efficacy	Response efficacy	Perceived norms
Isolation of the sick	Stay 1 m away from sick people/bodies^a,b	Attitudes toward infected people (stigma)		Confident to isolate infected family members	Isolation works to prevent infection to others	Cultural practices regarding caring for the ill
Safe burial	People who die from Ebola are highly contagious Avoid touching the clothing, bedding, and personal belongings of dead persons Stay 1 m away from Ebola dead bodies Call HWs to assist with safe burial and handling of the body^c and clean the home of the dead person Do not return home until HWs clean the house Go with HWs to funeral site Avoid sharing food or drink and communal washing of hands during funeral rites Delay funeral feasts until the disease crisis has abated (document from MOHSW instructs no funerals or rituals—this may be difficult …)	Attitudes toward HWs (trust) Beliefs about the use of chlorine, smell, other effects (generally accepted for cleaning)		Confident will call HWs to handle burial and house cleaning Confident to avoid communal washing and sharing practices at burials	Agrees HWs’ process is effective to prevent further infection Agrees avoiding communal burying practices is effective to prevent infection	Cultural practices regarding burials Thinks others will accept/are handling burials through HWs Any norms/cultural practices regarding the use of chlorine?

Note. HW = health worker; MOHSW = Ministry of Health and Social Welfare.

^aBodily fluids include the blood, saliva, urine, stool, sweat, vomit, and semen of the infected person. ^bEbola symptoms include (a) early symptoms (can appear from 2 to 21 days after exposure): fever, severe headache, joint/muscle pain, sore throat, chills; and (b) more severe symptoms: nausea and vomiting; diarrhea (can be bloody); red watery eye; rash (red bumps); chest pain/cough; stomach pain; severe weight loss; bleeding, usually from the eyes; near dead bleeding from the nose, rectum, ears. ^cSafe burial includes bury promptly, as soon as is possible; bury in 2-m-deep grave.

Fig. 2. Pathways conceptual framework for Ebola prevention and control (adapted from Kincaid et al., 2002). ETU = Ebola Treatment Unit; SMS = short message service/text messages; CCC = Community Care Center; HWS = hand washing with soap; ORS = oral rehydration solution.

Kincaid, D., Delate, R., Storey, J., & Figueroa, M. (2012). Advances in theory driven design and evaluation of health communication campaigns: Closing the gap in practice and theory. In R. Rice & C. Atkin (Eds.), Public communication campaigns (4th ed., pp. 305–319). Newbury Park, CA: Sage.

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