[For a communication addressing populations' health literacy]. / Pour une communication basée sur la culture en santé (health literacy) des populations.

The concept of "health literacy" has been widely used in English-speaking countries for about 20 years. However, its meaning has evolved since its first definition as "cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health", to be most often centered on the narrower meaning of "functional health literacy", which is the ability to read and understand written medical documents. This narrow definition excludes illiterate populations and don't take into consideration the social skills. Moreover, it doesn't take into consideration the barriers erected by the culture. Working in the field of health communication, we propose the broadest concept of "health culture", which encompasses health literacy as well as all the representations that influence people decisions about their health. The health culture approach makes it possible to base strategies, messages and communication tools on the representations of the target populations, in order to sensitize them to the behavioral changes promoted by this communication. We show some examples of its application in public health programs in sub-Saharan Africa: breastfeeding, pregnancy support, Ebola virus disease, HIV testing, tuberculosis, and COVID-19.

Public Perceptions, More Than Misinformation, Explain Poor Adherence to Proven COVID-19 Control Measures.

Since the beginning of the COVID-19 pandemic, there has been a profusion of studies and webinars on the infodemic (the rapid diffusion of information on the internet). The infodemic is often cited as a key factor in the lack of adherence to COVID-19 preventive measures, including vaccination. A study we conducted in West Africa questions the reality of this impact: the majority of people who do not adhere to the preventive measures draw their opinion from their own experience, not from what they have viewed or read on social networks. Historically, resistance to public health messages and interventions, including vaccination, existed before the advent of the Internet. Studying the perceptions of the population and not only the circulation of information is necessary to fully understand the lack of adherence to the COVID-19 preventive measures and to build an effective communication strategy.

Revisiting COVID-19 Communication in Western Africa: A Health Literacy-based Approach to Health Communication.

Adherence to protective measures is a major component of COVID-19 epidemic control. COVID-19 health literacy is a major driver of this adherence, and the evaluation of health literacy levels is the basis for designing an effective communication strategy. We conducted a quantitative socio-anthropological study of the knowledge of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and perception of the prevention messages in Burkina Faso, Cabo Verde, Guinea-Bissau, Ivory Coast, and Sierra Leone. There are widespread erroneous ideas regarding the transmission of and the protection against COVID-19. The majority of people are unaware that asymptomatic individuals can transmit the virus. Knowledge of the risk factors for severe disease is not sufficient, and the majority of individuals fear contracting COVID-19 by visiting a health center. Our study also shows the achievements of communication campaigns on several aspects: almost everybody has heard of the virus and heard or read the messages on the protective measures and a large majority of people think that these measures are effective against COVID-19. Based on these results, we propose a communication strategy that will emphasize that asymptomatic individuals can transmit the virus, emphasize the risk factors, reassure individuals regarding the safety of frequenting health centers, and design specific messages targeting young populations.

Erroneous Communication Messages on COVID-19 in Africa.

Adherence of the population to COVID-19 prevention recommendations is crucial to control the epidemic. However, a study of communication messages around COVID-19 in 15 West African countries showed a number of unfounded messages, as well as a lack of communication on critical information to understand the prevention measures being promoted. Incidents of violence that have taken place recently suggest that general mistrust and hostility could grow, similar to the events that occurred during the previous Ebola epidemics. It is therefore urgent to review and revise the COVID-19 communication messages currently used in sub-Saharan Africa.