Published: 25 March 2022
Research has uncovered how historical and contemporary injustice and institutional mistrust influenced how public health information was received by ethnic minority communities during the COVID-19 pandemic. Professor Tushna Vandrevala describes how important it is to get government messaging right and the advice from her research on creating inclusive and effective health behaviour communications.
The news that COVID-19 has disproportionately impacted people from ethnic minority groups in terms of incidence and deaths came early in the pandemic. For example, in the second wave of the pandemic, the risk of dying from COVID-19 was much higher for the Bangladeshi and Pakistani ethnic groups, who were more likely to live in multi-generational homes, and work in low-income jobs with high exposure.
Public health messages have had a key part in keeping the pandemic under control - for example, who can forget ‘Stay Home, Protect the NHS, Save Lives’? However, for people from ethnically diverse communities, their cultural beliefs, practices and experiences, alongside structural inequalities, have a critical but overlooked role in health promotion.
The power of socio-cultural and socio-structural context
We were funded by the NIHR and UKRI to study developing and delivering targeted COVID-19 health interventions to Black and Asian and Minority Ethnic communities living in the UK. We wanted to understand how ethnic minority groups conceptualised COVID-19 and how this influenced COVID protecting behaviours, such as testing and vaccination uptake.
I led Phase 1 of the study, which involved interviews with Black (African and Caribbean) and South Asian (Indian, Pakistani and Bangladeshi) community members. We used these interviews to co-design films that spoke to the needs of the community during the pandemic.
Our work highlighted that when it comes to understanding public health messages and engaging in COVID protecting behaviours, people from ethnic minority groups may face some specific barriers. For example, people from these groups encountered economic and financial hardship, as well as job insecurity and wider issues of racism, alienation and stigmatisation exacerbated by the pandemic. Understanding the differing lived experiences of ethnic minorities is important to ensuring that health behaviour communications are embedded in cultural beliefs, economic concerns and long-standing issues faced by these groups.
Ironically, our research showed that the media’s emphasis on how people from diverse backgrounds were more likely to become ill and die from COVID-19 actually made people from diverse backgrounds feel visible, stigmatised and blamed. We found that the primary concern for Black and South Asian people was to provide for their families, rather than focus on the threat of COVID-19, and cultural and religious beliefs and misconceptions about COVID-19 impacted on their engagement with testing.
A key finding from our research was that for people from ethnic communities, COVID-19 was embedded in mistrust that was strong across health care and government institutions. Disease outbreaks and pandemics can expose and worsen long-standing health inequities, systemic racism, and marginalisation.
Genesis of COVID-19 related conspiracy theories
Our work also highlighted widespread COVID-19 related conspiracy theories. The belief that significant events are the result of hostile actions from powerful groups who ‘pull the strings’ reduced vaccination up-take in the Black community during the pandemic.
Participants in our study employed a number of group-based COVID-19 conspiracy beliefs. There was a belief that powerful people within society aimed to cause intentional harm to particular groups in society (themselves) through the virus, or through virus-protective measures.
These beliefs were linked to the historical and contemporary injustices experienced by our study participants, and their mistrust of institutions. This context affected how they assessed new information on public health during the pandemic.
We also found that these conspiratorial beliefs could be aggravated by messages from the government and public health agencies that didn’t match participants’ identity. This institutional messaging often wasn’t culturally appropriate and didn’t represent ethnic minority groups. Critically, belief in conspiracy theories shaped the study group’s decision-making, leading to resistance to uptake of COVID testing and vaccinations. Because group-based conspiratorial beliefs stem from threat and uncertainty at a group rather than individual level, they are particularly complex to tackle.
Recommendations for health messaging
Our work shows how important it is to get institutional messaging right. The extent to which new messages or cues ‘hit home’ and are understood are dependent on the person’s existing frames of reference and the context of their life. Any new information needs to link to existing courses of action, ways of thinking and interactions. Our research found that institutional messaging from government and public health agencies failed to find an anchor in terms of our respondents’ individual and group identity and their lived experience.
Our findings suggest conspiratorial beliefs prevented public health communications from anchoring within individual and group-based black identities. Conspiracy beliefs were not isolated or particular to a situation or a person, but widespread. Given this, stronger, groups-based interventions and strategies are needed to combat against communities being alienated from health messaging.
Our work clearly indicates the importance of inclusion and representation in developing public health messages. Doubts are more easily addressed through a grounded account from a trusted source, like testimony from community members and leaders. Awareness and acknowledging of the influence of past, endemic issues of discrimination, racism and injustice in health messaging and reflecting on ethnic minority communities’ lived experiences provides an opportunity to build trust.
There is a need to develop and provide access to clear, accurate, targeted, and visible educational materials for ethnic minority groups. We need to work with authentic and trusted local sources to deliver important public health messages. Additionally, funding bodies need to prioritise research that unpacks how wider socio-cultural and socio-structural context and differing lived experiences influence the way members of diverse communities engage with health behaviours and wider institutions.
We need issues of racial justice and equity to be at the forefront of health and social care research to create better ways to address the complex contextual lived experiences of our ethnic communities.
Professor Tushna Vandrevala, Professor of Health Psychology, Kingston University and St George’s, University of London