Community trust of government and non-governmental organizations during the 2014-16 Ebola epidemic in Liberia

PLoS Negl Trop Dis. 2022 Jan 27;16(1):e0010083. doi: 10.1371/journal.pntd.0010083. eCollection 2022 Jan.

Abstract

The West African Ebola Virus Disease epidemic of 2014-16 cost more than 11,000 lives. Interventions targeting key behaviors to curb transmission, such as safe funeral practices and reporting and isolating the ill, were initially unsuccessful in a climate of fear, mistrust, and denial. Building trust was eventually recognized as essential to epidemic response and prioritized, and trust was seen to improve toward the end of the epidemic as incidence fell. However, little is understood about how and why trust changed during Ebola, what factors were most influential to community trust, and how different institutions might have been perceived under different levels of exposure to the outbreak. In this large-N household survey conducted in Liberia in 2018, we measured self-reported trust over time retrospectively in three different communities with different exposures to Ebola. We found trust was consistently higher for non-governmental organizations than for the government of Liberia across all time periods. Trust reportedly decreased significantly from the start to the peak of the epidemic in the study site of highest Ebola incidence. This finding, in combination with a negative association found between knowing someone infected and trust of both iNGOs and the government, indicates the experience of Ebola may have itself caused a decline of trust in the community. These results suggest that national governments should aim to establish trust when engaging communities to change behavior during epidemics. Further research on the relationship between trust and epidemics may serve to improve epidemic response efficacy and behavior uptake.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cross-Sectional Studies
  • Epidemics / psychology*
  • Female
  • Government
  • Health Knowledge, Attitudes, Practice
  • Hemorrhagic Fever, Ebola / prevention & control
  • Hemorrhagic Fever, Ebola / psychology*
  • Humans
  • Incidence
  • Liberia
  • Male
  • Middle Aged
  • Organizations
  • Retrospective Studies
  • Surveys and Questionnaires
  • Trust / psychology*

Grants and funding

RA received support from a NSF Graduate Research Fellowship (2015); LH, SL received support from a DOD Global Emerging Infections Surveillance grant (#P0244_15_N3; url: https://www.health.mil/Military-Health-Topics/Combat-Support/Armed-Forces-Health-Surveillance-Branch/Global-Emerging-Infections-Surveillance-and-Response). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.