COVID-19 vaccination national radio advertising credibility assessment by rural consumers: The influence of indigenous medical knowledge systems and traditional beliefs

Abstract

The rural consumer has been largely ignored in advertising research, yet they constitute more than 50% of the population in Africa. The study aimed to explore rural consumers’ assessment of COVID-19 vaccination radio advertising credibility with a peculiar focus on the influence of indigenous medical knowledge systems and traditional beliefs in Zimbabwe. The interpretive paradigm was adopted in the embedded single case study. The rural population which was purposively sampled consisted of 6Focus Group Discussions (FGD) and 12 interviews of rural consumers. Thematic approach was used to analyze the data. The results show that credibility of radio adverts on COVID-19 is dependent on the source of information, political perceptions, religious and personal experiences on COVID-19. Rural consumers also relied on traditional medicines to treat COVID-19. The rural consumers have strong belief in spirituality and witchcraft which had a bearing on the acceptance/non acceptance of COVID-19 vaccination radio adverts. The study provides theoretical insights and also practical contribution to COVID-19 vaccination managers, advertisers and health marketing practitioners to enhance the acceptance and trust of national radio ads, so as to increase rural consumers’ vaccination.

Keywords:

• rural consumers
• radio advertisement credibility
• COVID-19 vaccination
• indigenous medical knowledge systems
• traditional beliefs

Public interest statement

The study aimed to establish rural consumers’ evaluation of COVID-19 vaccination national radio advertisements and the extent to which their perceptions were influenced by indigenous medical knowledge systems and traditional beliefs in a typical sub-Saharan Africa pre-emerging market of Zimbabwe. Using interviews and discussions from groups of rural consumers, it was noted that trust in radio advertisements produced by the government covering the whole country depended on source of information, political considerations, personal experiences with the disease, and religious beliefs. Rural consumers’ views were also influenced by the extent to which they relied on traditional medicine to combat COVID-19. Beliefs on witchcraft also obscured their acceptance of the vaccination message. Key factors which militate and those which enhance rural consumers’ trust in national radio advertisement to uptake vaccination were provided. The model can assist public health officers, advertisers, governments and NGOs to promote vaccination of rural people in Africa.

1. Introduction

COVID-19 cases in Zimbabwe were 246,870 from January 2020 to April 2022 (World Health Organization, 2022). There were a total of 5,455 deaths due to COVID-19 during the same period in Zimbabwe (World Health Organization, 2022). What is alarming is the low COVID-19 vaccination uptake, with 8,366,555 vaccine doses having been administered up to March 2022 (WHO, 2022). These doses translate to 3.58 million fully vaccinated consumers, which is a paltry 24.1% of the country population. This COVID-19 vaccination percentage for Zimbabwe is far below half of the whole world vaccination average of 58.8% (WHO, 2022).

The rural consumer has been largely given a blind eye in advertising research in marginalized economies such as Zimbabwe. This study was aimed at taking a deeper insight into rural consumers COVID-19 vaccination behaviour since they constitute more than 65% of Zimbabwe’s population (Bank, 2020). To achieve herd immunity of COVID-19 vaccination, the nexus must be on rural consumers. Corpuz (2021) recommended a multi-sector approach to understand peculiar inhibitors to vaccination uptake and craft strategies to burst public mistrust of vaccines.

The thrust of the study was on national radio advertisement messages relating to COVID-19 vaccination. Most of these advertisements in Zimbabwe are government sponsored, and there are issues on lack of trust in the government (Kugarakuripi & n.d.oma, 2022). The extent of mistrust could be dynamic depending on whether the consumers of such radio messages are rural or urban consumers. In this study, the focus was on identifying specific rural consumers’ national radio trust enhancing and repellent factors through qualitative analysis.

Rural consumers are known to have their own Indigenous Knowledge Systems [IKS] (Moyo, 2013) with regards to medications and vaccination. The study decorticated a wealth of indigenous medical knowledge systems relevant to COVID-19 pandemic and vaccination. The compatibility and conflicts of national radio ads messages and indigenous medical knowledge systems were juxtaposed. The object of which was to craft a rural consumers’ national radio ad trust enhancing and repellent factors model with regards to COVID-19 vaccination ads messages. The model would then be applicable to general vaccination ads messages for public health promotional campaigns in a rural setting in sub-Saharan Africa and beyond.

The African traditional customs “die hard” (Van Dyk, 2001) and these are still prevalent in rural communities. The African traditional beliefs encompass health and medical beliefs which influence rural consumers’ health decision-making and behaviour. The compatibility of modern ads messages on COVID-19 vaccination and rural consumers’ beliefs has not received adequate attention from scholars. Marketing science scholars have concentrated on urban and cosmopolitan consumers (Viswanathan, 2017); hence, research on rural consumers culture (Jaravaza & Saruchera, 2021) and on COVID-19 vaccination is sparse in extant literature.

More so, there have been arguments on COVID-19 being a disease of urbanites and the elite (Zambakari et al., 2021). There is a need to establish the extent to which rural consumers perceive their vulnerability to the disease. If IKS is brought into the fray, how would rural consumers synthesize these divergent sources of information pertaining to COVID-19 vaccination? The following research questions were addressed in this study:

1. Do rural consumers’ view COVID-19 national radio advertisements as credible?

2. What are the indigenous medical knowledge systems on COVID-19 and its vaccination? Does such knowledge influence consumers’ radio ads trust?

3. How compatible are the COVID-19 national radio advertisement messages to rural consumers’ traditional beliefs?

The article develops logically as follows: just below is the overarching theory on the main variables of the study, beneath comes research philosophy and methodological framework of the study. This is followed by presentation of findings as well as discussions and results-based model of rural consumers’ national radio ad trust enhancing and repellent factors. The next sections are on conclusions, limitations and grey areas for future research. The last section is on recommendations.

1.1. Elaboration Likelihood Model (ELM)

Kitchen et al. (2014) argued that the ELM is widely cited and is a prominent theory of persuasion. Despite being propounded in the 1980s by Petty and Cacioppo (Cacioppo & Petty, 1981; Cialdini et al., 1981), the ELM remains relevant in advertising theory in the twenty-first century (Kitchen et al., 2014). Hence, the ELM was the overarching theory of this study.

The ELM provides a clear framework on how message receivers process persuasive advertisements and the attitudinal changes as outcomes. The ELM articulates the existence of two routes to persuasion of consumers:the central and peripheral routes (Petty & Cacioppo, 1986). The central route is followed when a person is highly motivated or interested in the advertisement message. The recipient would also have ample time to consider the merits and demerits of alternative decisions. In this case, the route followed by rural consumers upon getting a persuasive national radio advertisement might be the central route if the consumer has the cognitive resources to engage in critical thinking. Decisions which are taken as an outcome of the central route are not easily swayed by what others are doing (Cacioppo & Petty, 1981; Petty & Cacioppo, 1986). However, the peripheral route is followed by consumers who (1) are ignorant of the issue on the advertisement, (2) are not motivated and (3) do not have adequate time to analyze before making a decision (Cacioppo & Petty, 1984).

The ELM can be applied to rural consumers in terms of how they handle national radio ads. The peripheral route is followed by rural consumers who haven’t committed time and effort to understand the COVID-19 pandemic in terms of vaccination. Such consumers would have heard the COVID-19 radio ad without any prior knowledge of the pandemic and therefore can be easily swayed or distracted by superficial issues or cues arising in their context (Limbu et al., 2022). The key concept of the theory is “elaboration”. Cacioppo and Petty (1981) described “elaboration” as the extent to which people think deeply about an issue. Factors which contribute to higher or lower levels of “elaboration” include personal experience. In line with the health belief model (Limbu et al., 2022), a former COVID-19 patient who suffered critically is expected to have higher elaboration and would follow the central route rather than peripheral route to persuasion. However, where elaboration is lower, the peripheral route may be followed with high susceptibility to be influenced by remote cues arising in the consumer’s context such as political considerations of the national radio broadcaster.

There are several factors that influence the extent of elaboration done by consumers (Cacioppo & Petty, 1984). The first factor is the essence of the issue being advertised. In the context of this study, the importance of COVID-19 vaccination to the recipient determines the degree of attention given to messages relating to vaccination. A former COVID-19 patient or someone who had a close relative suffering from the disease or who died of the pandemic would need more elaboration. The concern shown by such people with some negative background regarding the disease is also supported by the health belief model (Rosenstock, 2000).

According to the health belief model (Rosenstock, 2000), a person’s health-related behaviour depends on a number of factors:

1. The belief that he/she is susceptible to the disease (in this case COVID-19)

2. The seriousness of the threat to get the disease.

3. The perception on the severity of the disease to cause death, pain, disability and any other disadvantage.

4. The person’s belief in executing any action required.

5. The perceived benefits of the recommended action.

Elaboration is high when the experience is vivid in the message receiver’s memory. Another factor is availability of time to analyze details provided on the message (Cacioppo & Petty, 1984; O’Keefe, 2013; Petty & Briñol, 2011). The recipient must also have adequate cognitive resources to pay attention (O’Keefe, 2013) such that level of literacy becomes relevant. Rural consumers may have low literacy but listening to the radio may be easy to them such that the literacy constraint is minimized.

1.2. Source credibility

Umeogu (2012, p. 112) succinctly defined source credibility as; “a situation where message believability is dependent on the credibility status of the sender in the mind and eyes of the receivers”. Source credibility as a concept emanates from Aristotle’s book; “The Rhetoric” (Umeogu, 2012). Rhetorician ethos, according to Aristotle, is the backbone of communication, influencing receivers’ mind and beliefs. Ethos in Aristotelian discourse implied the sender/communicator’s knowledge, moral authority and goodwill.

The source credibility theory originated from the seminal work of Hovland et al. (1953). According to the theory, there are high chances of the audience being convinced or lured to accept a message if the sender is credible. The evaluation of the credibility of the sender is not necessarily objective but this comes from the “mind and eyes” of receivers (McCroskey et al., 1974; McCroskey & Young, 1981; Rubin et al., 2020).

There are three main dimensions of source credibility: (i) trustworthiness (ii) competence (iii) goodwill (Cornan et al., 2006). These key dimension are basically perceptions which fortunately can be created, managed and cultivated (Cornan et al., 2006). Source credibility in advertising is the main rationale for spending huge advertising expenditure in hiring celebrities to feature on advertisements of organisations (Umeogu, 2012). Consumers admire and believe in the authenticity of a message coming from their icon. Eisend (2006) argues that there is a positive link between trustworthiness, competence and goodwill of the sender and consumers’ willingness to view the message as the truth which warrants them to take action. However, there is need to match the product being promoted with the sender’s known personality, preferences, knowledge and lifestyle (Shimp, 2000). For instance, it is a mismatch to use a celebrity Christian church pastor to advertise cigarettes.

1.3. Source credibility in health communication

Several studies in extant literature support the notion that source credibility has a huge bearing on audience or recipients’ attitudes and actions (Ohanian, 1990; Zakaria et al., 2020) . Reliability of source is very crucial in health communication (Zakaria et al., 2020). Health communication aims to influence health behaviours through dissemination of information (Redmond et al., 2011). Findings by Redmond et al. (2011) revealed the essence of television, newspaper, internet, social media, friends, relatives and family members in influencing health beliefs and behaviour. Cancer patients were noted to derive their health information from medical officers and family members and also from radio, television and social media (Kim & Xie, 2017). The success of an advert is measured on the extent it impacts on consumers’ cognitions, emotions and ultimately behaviour (Yilmaz et al., 2011).

1.4. Indigenous knowledge systems in health

Indigenous knowledge is a body of knowledge, skills and practices that has been developed and passed over several generations (Mascarenhas, 2004). The transition of such knowledge has been outside the modern school system and has been a legacy of rural communities (Kaya, 2007). As people live and interact with their natural environment, medical solutions are developed from the flora and fauna of their communities. Health scares, pandemics and general illnesses were cured within a given cultural locale using animals and plants found in the rural area. Unfortunately, such medicines and practices were not systematically documented but were dynamic, innovative, adaptive and experimental (Kaya, 2007). African indigenous knowledge systems have been marginalized and viewed as inferior due to the relegation of Africa as poor and primitive in the global economy (Kaya & Seleti, 2014).

It is not safe to over rely with Western economies, African medical knowledge systems must be nurtured as a survival strategy, especially for rural subsistence consumers during pandemics such as COVID-19. Rural consumers cannot afford to get medication and they may also shun modern COVID-19 vaccinations. Hence, there is a need to conduct research on COVID-19 African indigenous knowledge systems to improve public health. In line with New Partnership for Africa’s Development (NEPAD), collation of indigenous knowledge systems relating to COVID-19 is a priority.

Saray (2001) noted the pervasiveness of African indigenous knowledge systems in traditional medicines estimating that almost 75% of rural people use local medicines. Southern Africa has a wealth of flora and fauna where several medicinal and nutritional products are derived from and used by rural populations (Kaya, 2007; Saray, 2001). Traditional medicines and fruits have been administered to HIV/AIDS patients to boost their immunity. In Tanzania, indigenous medicinal plants, wild fruits and cashew were used to improve immune system (Kaya, 2007). Anand (2005) noted the beneficial effects of traditional food stuffs, juices and medicinal concoctions in improving immune systems of AIDS patients. For the HIV/AIDS pandemic, Muhanse M4 was used by local Tanzanians as a traditional remedy to enhance immunity(Mhame, 2004). Traditional medicines were preferred because they were much cheaper than antiretroviral pills. In South Africa, locals used African potato (hypoxis) to reduce CD4 count and also reduce HIV in the patient’s blood stream (De Klerk, 2004). De Klerk (2004) noted that traditional healers use the African potato to treat cancer, STIs and several chronic viral and bacterial diseases. The Tugen community in Kenya has an indigenous medical solution proffered by traditional herbalists. They use roots, leaves bark, and animal parts (Maundu & Aman, 2003).

1.5. Traditional and religious beliefs

Traditional beliefs in the African context are viewed as a way of living which can actually be classified as a “religion” outside Christianity and Islamic religions (MacGaffey, 2016). The concept of African traditional religion can be traced to Parrinder (1954)’s writings and later developments by Mbiti (2015) and Idowu (1968). African traditional beliefs are in the DNA of Zimbabweans (Humbe, 2020), such that when faced with a life threatening situation they may resort to their traditional beliefs. Modernism was viewed as a lighter religion done when things are not really serious. Traditional beliefs in Africa are very much alive; “The old gods are not yet dead. The old forms, including ancestor worship, have received greater significance since the rise of nationalism, so that festivals associated with the original pre-Christian religion have drawn thousands. The ancestor cult receives a new emphasis even from Christian leaders” (Oosthuizen, 1986, p. 6).

2. Methods and materials

The study positions itself within the interpretive paradigm. The interpretive approach accommodates multiple perspectives on the same incidence (Addae & Quan-Baffoour, 2015; Pham, 2018). In this study, rural consumers’ views on the credibility of COVID-19 national radio advertisement were explored. Further, the research examined the compatibility of national radio adverts on COVID-19 vaccination with rural consumers’ indigenous medical knowledge systems and traditional beliefs.

The study employed an embedded single case study. According to Yin (2009, p. 35), an embedded single case study is a “single case study with multiple units of analysis”. Data were collected from three provinces (Mashonaland Central (MC), Manicaland (MAN) and Masvingo (MAS) using open-ended interviews and Focus Group Discussions (FGD). Convenience sampling was adopted to select the three provinces basing on accessibility and a need to reduce costs, a view shared by Houser (2015) and Risiro (2020). A case study was relevant as it provided detailed information about a phenomenon as alluded by Patton (2015).

Permission from the Ministry of Rural Development, Promotion and Preservation of National Culture and Heritage was sought in order to get access to rural consumers through Village Heads. The Village Heads purposely assisted in identifying villagers who had access to radio adverts. Twelve individual interviews were conducted to generate data using open-ended questions. Open-ended questions allowed the researchers to probe in-depth responses about the uptake of COVID-19 vaccination on rural consumers. Patton (2015, p. 14) observed that, “open ended questions and probes yield in-depth responses about people’s experiences, feelings and knowledge.” Further, six Focus Group Discussions (FGD) with a membership ranging from four to six participants were facilitated across the three provinces. According to Remler and Van Ryzin (2015) at least 2–3 FGD can provide credible findings. A list of pilot-tested questions were designed in English and translated into the dominant local language, Shona. The use of vernacular language allowed the rural participants to express their feelings and attitudes regarding radio advertisement on COVID-19 vaccination in the language of their choice. Additionally, FGD enhances different perspectives and trustworthiness of data as indicated by Patton (2015). Interviews and FGD lasted between 30 and 35 minutes. Field notes and audio recordings were used to capture participants’ responses. The facilitators summarized recorded information to the research participants after the interviews and FGD to ensure that accurate/valid data has been recorded.

Data were analyzed using a thematic approach as recommended by Creswell (2014) for a qualitative study. Data generated was transcribed, coded and grouped into main and sub-themes. Data was then presented according to themes as well as direct quotes from the participants.

The procedures used in the study to ensure that respondents’ rights were respected were guided mainly by Cohen et al. (2018). In addition, permission was sought from the Village Heads and the participants. In order to ensure participants’ confidentiality, the responses were assigned alpha-numeric codes, for example, MANFGD1, meaning Manicaland Focus Group Discussion participant 1. The codes used were to identify the province where the contribution was made, the instrument used to collect the data as well as the participant who made the contribution. Such coding ensures data trustworthiness since it can be traced to the participant who made the contribution.

3. Findings

A thematic approach was adopted to present the findings. Findings were presented verbatim, and participants were free to give responses in the language of their choice. In cases where the participant gave responses in the local language, Shona the response was translated into English.

3.1. Rural consumers’ assessment of the credibility of radio adverts on COVID-19 vaccination

Rural consumers’ assessment of the credibility of radio adverts on COVID-19 vaccination is dependent upon a multiplicity of factors.

3.1.1. Adverts have a hidden political agenda

Some rural consumers did not believe in the radio adverts on COVID-19 vaccines because they thought COVID-19 was introduced by foreign countries that wanted to wipe off Africans and take over their resources. MANIP1 had this to say:

I did not believe in the advert because I thought COVID-19 and vaccination was a grand plan by foreign nations to ensure Africans are wiped out in order to take natural resources from Africa.

Another participant (MASFGD1) argued:

COVID-19: COVID-19 occurred in Zimbabwe after the 2018 general elections that were followed by mass protects such that we thought that COVID-19 figures on deaths were exaggerated in order to pronounce lockdown.

It was evident from the research participants (MANI1; MASFGD1) that some people did not believe in COVID 19 vaccination as they thought it was a political agenda by foreign countries who wanted to kill Africans through COVID vaccination so as to exploit African resources. Further, some participants believed that the Government was exaggerating the effects of COVID-19 in order to impose lockdowns after the contested 2018 elections in Zimbabwe which resulted in mass protests.

3.1.2. Religious beliefs and indoctrination

Religious ideology and beliefs had an impact on the credibility of radio adverts on COVID-19 vaccination as illustrated by the following excerpts:

MASFGD1: Ini pekutanga ndirimunhu akakura ndirimuchitendero chisingaiti zvechipatara kana kubaiwa majekiseni, saka zvinhu zvaive zvakandiomera kuti ndimhanye kuzobaiwa.

(At first, I could not be vaccinated because I grew up in a Church that does not believe in seeking medical treatment at a hospital)

3.2. MASFGD3: I was not vaccinated because in our church vaccination is associated with Satanism

MASFGD8: In our Church we were not allowed to be vaccinated because vaccination is taken as Satanism. I was only vaccinated because at my work place, they wanted proof that every worker was vaccinated

MCI2: Our religious teachings prohibited us from being vaccinated since we believe that vaccination has got some side effects such as numbness, stroke and barrenness.

The views by the participants show that the credibility of radio adverts on COVID-19 to rural consumers is dependent upon a person’s religious beliefs. If the radio advert does not conform to one’s religious belief, the rural consumer does not believe in the advert and will be reluctant to be vaccinated. MASFGD1 and MASFGD8 at first were not vaccinated because it was against their religious belief and teachings; however, persuasion and cohesion from workplace may compel some people to get vaccinated as illustrated by MASFGD8. Rural consumers may also not appreciate radio adverts due to misinformation from their religious teachings. Congregants believe in the teachings of their leaders and if these teachings are against radio adverts, rural consumers are unlikely to take up advice from those adverts. From the excerpts, MCI2 did not believe in the advert due to misinformation from the religious teachings that associated vaccination with serious side effects.

3.2.1. Personal experiences and susceptibility to radio adverts

Different personal experiences influenced the trust in radio adverts as shown by excerpts from MANI1 and MASFGD7:

MANI1: COVID-19 vaccination is not important to me because I know a number of guys who were vaccinated and still got ill. My uncle fell ill twice, before and after being vaccinated. When my uncle got ill, his symptoms were much worse than before he was vaccinated. From that experience I do not see the benefit of being vaccinated.

MASFGD7: At first, I did not take seriously radio adverts because I thought the adverts were false but after experiencing some relatives who fell ill, I started to believe and then got vaccinated.

The two scenarios narrated by MASFGD7 and MANI1, points to the fact that, personal experiences on COVID-19 particularly from a person’s family has an impact on the credibility and acceptance of radio adverts by rural consumers. Personal experiences by MANI1 had a negative impact on their view of radio adverts on COVID-19 vaccination. MANI1 had the belief that the COVID-19 symptoms from a family member were worse after vaccination. On the contrary, MASFGD7 believed in the advert and got vaccinated after observing relatives who were falling ill from COVID-19.

3.2.2. Misinformation about COVID-19 vaccination

MASFGD1: We were told that all people who were vaccinated against COVID-19 were going to die within five years and some of them would even cite examples of people who were vaccinated and died so it took us some time to accept vaccination.

MASFGD4: When COVID-19 vaccination started, we had mistrust with the vaccine. We thought that the drug was on experiment and we were being used as Guinea pigs, so it took some time for us to get vaccinated.

MASFGD9: Ndaisaida kubaiwa bcoz zvaizi ukabaiwa unozofa kana kuti hauzoiti mwana.

(I did not want to be vaccinated because people were saying that, if you get vaccinated you will die or give birth to children with disabilities).

The excerpts (MASFGD1; MASFGD4 and MASFGD9) reveal that rural consumers were initially hesitant to be vaccinated because of misinformation which they gathered from their peers and those whom they trusted. The rural consumers believed that getting vaccinated was going to cause deaths, barrenness or giving birth to children with disabilities. The rural consumers also mistrusted the whole process of COVID-19 vaccination as they thought they were being used to experiment the efficacy of these new drugs on the market.

3.3. COVID-19 radio adverts, traditional medicine and beliefs

This section explores the influence of traditional medicine and beliefs on COVID-19 vaccination uptake among rural consumers in Zimbabwe.

3.3.1. Indigenous medical knowledge and radio adverts on COVID-19 vaccination

Various participants gave their responses regarding the use of indigenous medicines and their acceptance/non-acceptance of radio adverts on COVID-19 vaccination:

MCI10: We have traditional medicines which we use to treat COVID-19 such as zumbani. We boil and then drink the water just like tea as well as steaming. This helped to relieve some pains

MCI12: I believe in traditional medicine like zumbani to treat COVID-19. I also took Chinese medicines which is in capsules and is a collection of herbs. In addition, I took ginger and fortunately it worked for me in treating COVID-19 so I do not see the reason for getting vaccinated.

MCI11: Modern pills have side effects; they affect the liver and kidney. I used traditional-based pills. These pills are made from our herbs, roots and fruits which are produced here in Africa. It means the ingredients which they are derived from are more beneficial than the pills because they do not have side effects.

MASFGD2: I fell ill from COVID-19 and I used zumbani, lemon and ginger as well as steaming but this did not cure me. I was then cured at the hospital that is when I realized the importance of getting vaccinated.

It was evident from the interviews and FGD with the participants that some rural consumers believed in the use of traditional medicines to cure COVID-19. The most common herb used by rural consumers was zumbani which was used for drinking and steaming. The participants (MCI10; MCI12) believed that the use of traditional medicine (zumbani, ginger, Chinese herbs) and taking fruits like lemon were useful in the treatment of COVID-19 such that the participants could not bother getting vaccinated against COVID-19. MCI11 has more confidence and trust in the use of traditional medicine over COVID-19 vaccination as shown by the participants expression that traditional medicine was made out of “our herbs”, “our roots”, “our fruits” produced in Africa. The expression by MCI11 further demonstrates that, some rural consumers are ethnocentric, have more trust in taking medicines or vaccines they think are locally produced or produced from countries they trust. However, for some rural consumers like MASFGD2 who used traditional medicine to treat COVID-19 but could not get well are more likely to accept radio advert on COVID-19 and get vaccinated.

3.3.2. Compatibility of radio adverts with traditional beliefs on COVID-19 vaccination

This section unpacks the views of rural consumers on the uptake of COVID-19 vaccination against their traditional beliefs.

3.3.2.1. The influence of ancestral spirits on COVID-19 vaccination

Some rural consumers believed that epidemics and natural hazards that befall people were a result of people who are no longer seeking protection from ancestral spirits as illustrated from the following excerpts:

MANFGD3: In the past people used to brew beer (musoso/zvitsanza/mukwerere) that was offered to the ancestral spirits by Chiefs. In return the ancestral spirits protected people from various ailments and provided them with adequate rains.

MANFGD4: Our ancestors are angry because we are no longer revering our ancestors and sacred forests where chiefs were buried. Sacred mountains are now used for worshipping by Christian denominations; as such the ancestral spirits are now angry resulting in illnesses such as COVID-19.

MANFGD3 believed that epidemics and other environmental hazards are a punishment from the ancestors. In the past communities used to brew rain making ceremony beer (musoso/zvitsanza/mukwerere) and offered it to the ancestors who in return provide the community with rains and protection from epidemics. MANFGD4 also attributed illnesses like COVID-19 to angry ancestral spirits as a result of communities that are destroying sacred forests where Chiefs were buried. More so, sacred mountains believed to inhabit ancestral spirits are now being used as shrines by other Christian denominations.

3.3.2.2. The influence of witchcraft on COVID-19 vaccination

Some rural consumers attributed illnesses to witchcraft and as such could not believe in radio adverts on vaccination. One of the elders (MANFGD1) argued:

Handina kubaiwa nekuti chinokonzeresa urwere uroyi. Vamwe vanhu vane godo nekubudirira kwako uye kwevana vako saka vanokuroya.

(I was not vaccinated, falling sick on illnesses like COVID is due to witchcraft, people who are jealous of your success or the success of your children).

Another participant (MANFGD2) added:

In our African tradition nothing will happen without someone causing it. For COVID to cause illness to someone there is a witch who would have caused it. As such we should request traditional healers to protect our homes from witches who cause illnesses

Resistance to accepting radio adverts on COVID-19 vaccination can be a result of people believing in witchcraft. MANFGD1 believed that witches cause illness to individuals as they will be jealous of one’s success. MANFGD2 believed in being protected from falling ill by traditional healers rather than getting COVID-19 vaccination.

3.3.2.3. The impact of traditional and modern medicine on COVID-19 vaccination

The study discovered that traditional and modern medicines were compatible as illustrated by the excerpts:

MCI10: My view is that, COVID vaccination and indigenous tradition are compatible with vaccines because the COVID vaccination is extracted from trees and herbs which we believe in as Africans. The only difference between traditional and modern medicine is that modern medicine has undergone further processing and given to patients in measurable quantities.

MCI11: Getting COVID-19 vaccination is good for us because the number and quantity of the vaccine are approved. Modern and traditional medicines are comparably the same but traditional medicine is still at a lower level of development in terms of processing and rightful quantities to use.

The respondents (MCI10; MCI11) believed that COVID-19 vaccination was compatible with traditional medicine. For MCI10 and MCI11, it was imperative and logical to be vaccinated since modern vaccines are more synthesized and taken in approved and tested quantities. The respondents believed that modern vaccines have undergone rigor in terms of research, processing and experimentation unlike traditional medicine. It is apparent from the respondents that trust of radio adverts on COVID-19 vaccination by rural consumers is dependent upon their perceived quality of the vaccine or medicine.

4. Discussion

4.1. Rural consumers’ assessment of the credibility of radio adverts on COVID-19 vaccination

The following write-up discusses how political views, religious beliefs and personal experiences impact upon rural consumers’ uptake of radio adverts on COVID-19 vaccination.

4.1.1. Perceived covert political agenda influence uptake of radio adverts

Some participants did not believe in the COVID-19 radio adverts because they thought that the adverts had a hidden political agenda. These respondents, in accordance with the elaboration likelihood theory were operating on the peripheral route to persuasion ((El Hedhli & Zourrig, 2022) and political issues were the superficial cues which eclipsed the contents of the COVID-19 radio adverts message. Some participants thought that COVID-19 was meant to kill Africans in a bid to take over African resources. Other participants found radio adverts on COVID-19 as untrustworthy since this took place soon after the general elections and the consequent mass demonstrations in Zimbabwe (Magaisa, 2019). As such radio adverts on COVID-10 vaccination and lockdowns were viewed by some respondents as a way of suppressing mass protests. In Zimbabwe, people generally believe that national radio and television are controlled by the ruling party that won the 2018 elections. Rubin et al. (2020) have observed that the acceptance of advert messages as credible by consumers depends on the extent in which they trust the source. In a study of cancer patients, Kim and Xie (2017) found that cancer patients received information from family members and medical personnel whom they trusted. Clearly, the people’s views shows that trust of radio adverts messages by consumers is dependent on the credibility of the source.

4.1.2. Religious beliefs and indoctrination hinder uptake of radio adverts

The study unpacked that religious beliefs and indoctrination by religious leaders was an impediment for rural consumers to take up radio adverts on COVID-19 vaccination. Misinformation and misconceptions about COVID-19 vaccination by religious leaders instilled fear and resistance to uptake of vaccines by congregants. The findings are in line with Chigevenga’s (2021) study who found that myths and misconceptions around COVID-19 vaccination can discourage people from getting vaccinated.

4.1.3. Personal experience influence uptake of radio adverts

Radio advertisements’ trustworthiness and acceptance among rural consumers are influenced by personal experiences and relatives’ sensitivity to COVID-19. MANI1 had a negative attitude of vaccines after experiencing a situation whereby a relative health condition subsequently worsened after getting vaccinated against COVID-19. However, MASFGD7 was convinced by the radio advertisement on COVID-19 vaccination and decided to get vaccinated after observing family members who were suffering from COVID-19. The finding conforms with the health belief model’s perceived susceptibility and severity, which was determined by monitoring relatives who were afflicted with COVID-19 (Suess et al., 2022).

4.1.4. Misinformation is an impediment to rural consumers’ uptake of COVID-19 vaccination

Participants from FGD (MASFGD1; MASFGD4; MASFGD9) exposed that fear of the unknown and misinformation was an impediment to rural consumers’ uptake of COVID-19 vaccination. These findings confirmed Dzinamarira et al. (2021) who noted the distrust of Chinese vaccines and the resultant misinformation which spread in the communities. Further, the study revealed that it takes some time for people to accept new vaccine and get vaccinated. There is a “let us wait and see attitude” when new information or vaccine is introduced as illustrated by participants MASFGD1 and MASFGD4 who were only vaccinated after some time when the vaccine was introduced.

4.2. COVID-19 Radio adverts, traditional medicine and beliefs

The following section is a discussion on how traditional medicine and beliefs influence rural consumers’ acceptance/non-acceptance of radio adverts on COVID-19 vaccination.

4.2.1. Indigenous medical knowledge and radio adverts on COVID-19 vaccination

It was apparent from the interviews and FGD with the participants that confidence and trust in indigenous medicines and fruits in treating COVID-19 influences some rural consumers in getting vaccinated or believing in the radio adverts on COVID-19 vaccination. The participants (MCI10; MCI12) believed that the use of traditional medicine were useful in the treatment of COVID-19. A study on zumbani (lippia javanica) by Maroyi (2017) and Mfengu et al. (2021) has shown that zumbani’s phenolic compounds were effective in treating respiratory ailments in most parts of Africa. The participant (MCI11) had strong belief that locally produced traditional medicine had fewer side effects than foreign vaccines. Chigevenga (2021), using the health belief model framework, noted these anticipated side effects as perceived barriers to COVID-19 vaccination uptake. However, for some rural consumers like MASFGD2 who used traditional medicine to treat COVID-19 but could not get treated are more likely to accept radio advert on COVID-19 and get vaccinated.

4.2.2. Compatibility of radio adverts with traditional beliefs on COVID-19 vaccination

The acceptance/non-acceptance of COVID-19 vaccination radio adverts is deliberated against the participants’ beliefs in ancestral spirits, witchcraft and use of traditional medicines in the treatment of COVID-19.

4.2.2.1. Beliefs in ancestral spirits influence radio adverts uptake

Rural consumers attach a lot of significance to the spiritual world (Humbe, 2020) which may inhibit their trust of radio adverts on COVID vaccination. FGD participants (MANFGD3; MANFGD4) believed that epidemics like COVID 19 and other environmental hazards were a punishment from angry ancestors on communities that were failing to perform traditional ceremonies and religious groups that worshipped in sacred mountains. Ancestral spirits are believed to influence what happens to the living such as drought and diseases (Baker, et al., 2011). In a study carried out in the Eastern Highlands of Zimbabwe, Risiro (2020) found that traditional ceremonies were performed in sacred forests and mountains in request for rains and protection from environmental hazards. The finding is further confirmed by Arunotai (2006) who found that in Thailand and Malawi beer was poured onto the ground in order to appease the ancestors in return for protection from environmental hazards.

4.2.2.2. Beliefs in witchcraft on radio adverts uptake

People who believe in witchcraft may be reluctant to listen to radio advertisements on COVID-19 immunization. MANFGD2 preferred getting treatment against COVID 19 from traditional healers rather than being vaccinated. The findings are consistent with a study by Humbe (2020) who found that African traditional beliefs are in the DNA of Zimbabweans, such that when faced with a life-threatening situation they may resort to their traditional beliefs. The findings from the research confirm a study by Biri and Manyonganise (2022) on the beliefs in witchcraft in Zimbabwe. The authors discovered that witchcraft was perceived as the major cause of illnesses, deaths and bad luck. Further, Biri and Manyonganise (2022) revealed that traditional healers were consulted to protect individuals from witchcraft.

4.2.2.3. Perceived quality of vaccine influence radio adverts uptake

The respondents (MCI10; MCI11) believed that COVID19 vaccination was compatible with traditional medicine. However, the participants felt that it was imperative and logical to be vaccinated since modern vaccines are more synthesized and taken in approved and tested measurable quantities. It is apparent from the respondents that trust of radio adverts on COVID-19 vaccination by rural consumers is dependent upon their perceived quality of the vaccine or medicine. The perception that IKS is inferior to western science is confirmed by Kaya and Seleti (2014) who found that African indigenous knowledge systems have been marginalized and viewed as inferior due to the relegation of Africa as poor and primitive in the global economy.

4.3. Overview: Model of rural consumers’ national radio ad trust enhancing and repellent factors

The ultimate outcome of the study was a condensed model of rural consumers advertisement trust enhancing and repellent factors basing on the findings discussed above.

The schematic model is depicted in Figure 1, and it comprises four major parts: (1) rural consumers’ radio ad trust enhancing factors (weak traditional beliefs, positive personal experiences, trust in government, positive perception of modern vaccines, inferiority perception of Indigenous Knowledge Systems, and pro-vaccination religious ideology); (2) rural consumers’ radio ad trust repellent factors (stronger traditional beliefs, negative personal experiences and misinformation, mistrust of the government, negative perception of vaccines, strong belief in traditional medicines, and anti-vaccination religious ideology); (3) stronger enhancing factors and weaker repellent factors propelling national radio ad trust to torpedo COVID-19 vaccination uptake by rural consumers; and (4) weaker enhancing factors and stronger repellent factors obliterating national radio ad trust, national advertisement effort falls into the oblivion of the chasm. However, the government also employed a coercive strategy by making it mandatory for all civil servants and also people who wanted to participate in government programs to have been vaccinated. Such a strategy did not relate to national ad trust or credibility.

Figure 1. Rural consumers’ national radio ad trust enhancing and repellent factors model.

5. Conclusion, limitations and areas for future research

The study explored rural consumers’ views on the credibility of COVID-19 national radio advertisement. Further, the research examined the compatibility of national radio adverts on COVID-19 vaccination with rural consumers’ indigenous medical knowledge systems and traditional beliefs. Some participants believed that radio advertisement on COVID-19 had a politically global and local hidden agenda. Globally, the rural consumers believed it was a strategy by foreign nations to vaccinate people so that they die and they will take away African resources. Locally, in Zimbabwe, some rural consumers did not believe in the radio advert because people thought the government was putting in place lockdowns as a way of suppressing masses from carrying out demonstrations after a disputed 2018 elections. It was also found that, if radio advert on COVID-19 were not conforming to one’s religious belief, the rural consumer does not believe in the advert and is likely not going to be vaccinated unless there is external pressure from work place which may require everybody to be vaccinated. Personal experiences on COVID-19 particularly from family and relatives have an impact on the credibility and acceptance of radio adverts by rural consumers. Rural consumers may also not trust radio adverts due to misinformation and misconceptions from their religious teachings, family and friends.

It was evident from the interviews and FGD that rural consumers who believed in the use of traditional medicines to cure COVID-19 could not bother getting vaccinated against the epidemic. Some rural consumers had more trust in taking medicines or vaccines they think are locally produced or produced from countries they trust. However, for some rural consumers who once used traditional medicine to treat COVID-19 but could not treat him/her, they were more likely to accept radio advert on COVID-19 and get vaccinated.

The study revealed that the participants believed that epidemics and other environmental hazards are a punishment from the ancestors as a result of people dishonoring the sacred places believed to be inhabited by the ancestral spirits. The rural consumers’ belief in the spiritual world can be an inhibitor to uptake of radio adverts on COVID-19 vaccination. It was further established that resistance to taking up radio adverts on COVID-19 vaccination can be a result of people believing in witchcraft and getting treatment or protection from traditional healers. Rural consumers who believed that traditional medicines were inferior to modern medicines believed in radio advert on COVID-19 vaccination and were vaccinated. It was apparent from the respondents that uptake of radio adverts on COVID-19 vaccination by rural consumers was dependent upon their perceived quality of the vaccine or medicine.

However, the major weakness of the study was being confined to Zimbabwe only, a cross cultural study would be insightful. Moreso, other media outlets which are accessed by rural consumers such as Short Message Service (SMS) and Whatsapp could also be studied.

6. Recommendations

The findings of the study have practical implications on the acceptance of radio adverts and uptake of COVID-19 vaccination. Some rural consumers did not view radio adverts as credible due to the origin or source of information. The study therefore recommends that radio adverts on COVID-19 come from trusted sources of information such as medical doctors who are respected in the community and who are known to have medical knowledge on the epidemic. There was also a lot of misinformation and misconceptions about COVID-19 which inhibited people from being vaccinated. Officers in the medical field and people respected for their knowledge in the community should be engaged to dispel misconceptions about COVID. Pamphlets, posters with accurate information about COVID-19 can be distributed in the community for rural consumers’ consumption. Another impediment to radio adverts trust was religious teachings by Church leaders. Some Church leaders discouraged their members to be vaccinated. The Government should work together with Church leaders, conscientizing them on COVID-19 such that they are able to teach accurate information to their congregants. Church leaders should also participate in advertising COVID-19 vaccination on radio programs. The other aspect was a strong belief among rural consumers that COVID-19 and other epidemics and environmental hazards are caused by angry ancestral spirits and witchcraft. In this regard Traditional leaders must be engaged and empowered with knowledge on COVID-19 so that they disseminate correct information to their subjects and encourage them to get vaccinated. In the current study some rural consumers viewed traditional medicines as inferior. It is recommended that the Government through the Ministry of Health support financially on human capital development, research and development of traditional medicines including improvements in packing and distribution of quantities to be consumed on prescription.

Disclosure statement

All authors did not have any conflict of interest

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Divaries Cosmas Jaravaza

Dr Divaries Cosmas Jaravaza (PhD, WITS) and the research team are conducting a series of studies in African healthcare marketing and public health promotion, taking into account indigenous knowledge systems and mind in context. This research paper brings out one of the key themes of our thrust. The bigger picture is cross-cultural studies on these themes.