Unraveling the effects of the Ebola experience on behaviour choices during COVID-19 in Liberia: A mixed methods study across successive outbreaks

Abstract

Abstract Background The burden of the COVID-19 pandemic in terms of morbidity and mortality differentially affected populations. Between and within populations, behaviour change was likewise heterogeneous. Factors influencing precautionary behaviour adoption during COVID-19 have been associated with multi-dimensional aspects of risk perception; however, the influence of lived experiences during other recent outbreaks on behaviour change during COVID-19 has been less studied. Methods To consider how the direct disease experience (‘near misses’) and behaviour change during the 2014–2016 Ebola virus disease (EVD) outbreak may have impacted behaviour change during the early waves of the COVID-19 outbreak in West Africa, we analyzed data from a mixed-methods study that included a phone-based survey and in-depth interviews among vaccinated Liberian adults. Logistic regression via generalized estimating equations with QIC-based model selection was conducted to evaluate influence of the interaction between and individual effects of outbreak (EVD and COVID-19) and ‘near miss’ experience on adoption of individual precautionary behaviours. Thematic analysis of interview transcripts explored reasons for differential behaviour adoption between the two outbreaks. Results At the population level, being a ‘near miss’ was not associated with significantly different behavior during COVID-19 versus Ebola; however, overall, people had lower odds of adopting precautionary behaviors during COVID-19 relative to during Ebola. Qualitatively, participants often reflected on themes around more proximal and personal experiences with Ebola than with COVID-19; they also commented on how EVD led to better preparedness at the systems level and within communities for how to behave during an outbreak, despite such awareness not necessarily translating into action during COVID-19. Conclusion The results suggest that perceived proximity and intensity to disease threats in space and time affects behavioural decisions. For successive disease threats, comparisons of the present outbreak to past outbreaks compound those effects, regardless of whether individuals had directly been impacted via a ‘near miss’ experience. Measures, such as risk communication and community engagement efforts, that gauge and reflect comparisons with previous outbreaks should be considered within response strategies to enhance precautionary behaviour adoption.