Dr. Hung Nguyen, Anchanah Jeyamohan, Dr. Feng Chang
University of Waterloo's School of Pharmacy
As a society, we have largely adjusted to life post pandemic. However, the pitfalls of our public health system are far from forgotten. Authorities struggled with communicating changing guidelines and protocols as new evidence emerged. Rapid dissemination of new information was countered with overwhelming, rampant misinformation that spread online, which misguided communities and diminished community resilience. Vulnerable populations, such as older adults living in rural areas, were overlooked by public health campaigns and experienced service gaps.
In Fall 2022, we interviewed older adults living in rural communities to ask them about their thoughts on COVID-19 related messaging, their actions in response to the messaging, and what strategies they would recommend for communications in rural areas. We recorded, transcribed, and coded the interviews. Once the study concluded, we contacted the participants to confirm the accuracy of our analysis.
Presentation on this topic occurred on November 7th, 2023 as part of Gateway Centre of Excellence in Rural Health (CERH)'s lecture series featuring Dr. Hung Nguyen, Dr. Feng Chang, Dr. Ashley Rose, and Kristen Watt.
Emerging Themes: Confusion
Three themes emerged from the conversations. Firstly, the participants felt confused by the various messages conveyed during the pandemic. They were concerned about the messages' accessibility due to a lack of older adult-friendly user interface, and many found the content of messages harrowing.
“It's hard to send a newscast to other people if you want them to know about something. So although I watch the news, it wasn't as accessible, I didn't find it that reliable”
“You know, for my mom, she just doesn't have access to computer or the skills so I would send along and provide her with information and then she'd pass it along to her friends and so, elderly and rural access to information, I observed as very very, very, very limited. She's the kind of person who still gets a newspaper to her door.”
“I felt like we were at war… “
Emerging Themes: Information Sources
The second theme related to sources of information available and the trust of older adults in their friends, media, word-of-mouth, and science:
“I trust my friends, our community of friends, they all got shots… and my family all did. So I'm not in a situation where people are negative about what we had to do for COVID.“
“Everything I got was filtered through the media. I don’t think I heard anything from, you know, a politician’s mouth.”
“OK, so the messaging from the media for example or on the newscast. I would have to evaluate where the source was, where in fact it came from and then find out if the information was something that was available to verify, like verifiable and even throughout COVID because of the new variances”
“When it comes to Twitter, I'm choosing my sources. I choose who I follow. So I guess it might have been quite different if you chose other sources than I did, but I found the sources, which were university science profs typically, who were doctors that I trusted.”
“I felt that there was so much unknown that we had to rely on the scientists that knew more than I certainly did. So yes, I relied on our scientific community.”
On the other hand, many participants reflected distrust in the government:
“They did a terrible job, an absolutely horrific job.”
Emerging Themes: Effective Communication
Thirdly, older adults provided recommendations for more effective communications in the future. The content of the message should be fun:
“Using humour… where people were wearing their masks, but they had their masks below their nose and you know there was some funny, fun stuff about that which I really liked… Again, it doesn't judge anyone, it just makes it fun. And in a very severe and terrifying time for everyone in the initial stages… that kind of messaging works for everyone”
A top-down approach to conveying messages should be replaced by a round-table format:
“Sometimes, from the top down, it is not the most effective. I think that we have some people that can do a better job ... I think that sometimes the collaboration, I think when they have a table format where different people are at the table together and it's government and public health and representatives from key areas... it's inclusive”
News media should play the role of primary sources of information for people in rural areas:
“People still turn on the news, and that is their source, or they receive their newspaper, they open their newspaper, they read it front to back, and that is their source.”
Non-politicized messages are expected:
“Yeah, I'm just lucky to have people that I can consult if I need to, and people that I trust….. And I suppose that's what makes your community resilient…Is having enough people that you trust to give you the correct answer without politicizing it”
Conclusion
Overall, participants expressed uncertainty with the messaging during the pandemic, which led to increased distress and confusion in their communities. Participants expressed disappointment with the gaps in government messaging and desired more structured, consistent, and personalized messaging.
Different levels of access were also reflected. Some participants had access to social media, used the internet frequently, and employed different news sources to triangulate information. On the other hand, others only listened to the news for information.
Lastly, the importance of word-of-mouth was a common theme. Participants mentioned getting information from trusted sources such as family, friends, peers and trusted health professionals. Word of mouth leveraged the rural communities’ close-knit, neighbour-helping-neighbor approach to health.
Being a self-selected group, we had a small sample with most key informants being highly educated, hence having stronger health literacy, and being primarily female. This means we leave other perspectives, such as lower education levels and the male population, underrepresented.
Further research will be needed in this area. Even with a limited sample, these participants represented a unique subset of rural residents with valuable lived experience. All participants worked in professions that involved significant long-term community involvement, including law enforcement, health, and education. They provided insights into the nuances of interactions within tight-knit rural communities.
Lessons learned here can help guide more tailored approaches for rural older adults in not only future pandemic scenarios, but other health-related messaging such as immunization campaigns. Tapping into powerful rural community networks and trusted sources will help advance the efficiency of delivery. Communication is an art after all. Success is built upon meeting the needs and preferences of the population on the receiving end.
About Gateway Centre of Excellence in Rural Health
Founded in 2008 in the community of Seaforth, ON, Gateway CERH is a not-for-profit rural health research organization run by a community-based volunteer board of directors. Gateway CERH's main mission is to better the health and quality of life of rural residents through research, education and communication. Learn more on the Gateway CERH website at: https://www.gatewayruralhealth.ca/ and follow on Instagram, Facebook, Twitter, LinkedIn and YouTube
A brief disclaimer: the views expressed in these lectures may not necessarily reflect Gateway CERH’s views or opinions, but we believe in providing a platform for a range of perspectives and thoughtful discussion.
Gateway CERH has a full library of lectures and information about the upcoming presentation that can be found on our website: https://www.gatewayruralhealth.ca/lectureseries
Or watch all past lecture online on YouTube: https://www.youtube.com/@GatewayCERH/videos
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