Assessment of risk perception, knowledge, and trust in messages for COVID-19 control among most-at-risk communities in Uganda: A qualitative study

When a new disease spreads across the globe, the most powerful tool available to stop it is often not a medicine or a vaccine, but a message. For a public health campaign to work, people must first understand the threat, believe that the threat is real, and trust the people telling them how to stay safe. This chain of understanding is fragile. If a community knows the facts but does not feel personally at risk, or if they distrust the source of the information, they will not change their behavior. In the early days of the pandemic, health officials in Uganda faced this exact challenge. They needed to know if their warnings were being heard, if the people they were trying to protect believed the danger was real, and whether they trusted the government enough to follow the rules.

To find the answers, researchers from Makerere University and the Ministry of Health traveled to twelve districts across Uganda in August 2020. They chose these specific locations because they were high-risk areas, sitting along major trade routes and border crossings where the virus could easily move. The team did not just send out surveys; they sat down with hundreds of people to listen. They spoke with 392 individuals, ranging from school principals and religious leaders to truck drivers, market vendors, and sex workers. Through group discussions and private interviews, they asked a simple but vital question: what do you know about this virus, how much do you fear it, and do you trust the advice you are getting?

The researchers found that the people of Uganda were remarkably well-informed. Most participants knew that the disease was caused by a virus from China, understood how it spread through coughs and close contact, and could list the basic ways to stop it, such as wearing masks and washing hands. Radio was the primary source of this information, reaching into rural homes where television and internet access were limited. In cities, people turned to television and social media. The Ministry of Health was widely recognized as the main authority, and in many communities, local leaders and health workers were trusted voices who could translate official warnings into something meaningful.

However, knowing the facts did not automatically lead to following the rules. A significant gap existed between what people knew and what they actually did. While many said they were willing to wear masks and wash their hands, the reality on the ground was different. For those working in the informal economy—people who relied on daily wages to feed their families—the economic pressure of the pandemic often outweighed the fear of the virus. Lockdowns and restrictions meant no work, and no work meant no food. For these workers, the immediate threat of poverty felt more real and immediate than the potential threat of a disease that, at the time of the study, had not yet caused many visible deaths in their own neighborhoods.

This disconnect was fueled by a complex mix of doubt and observation. Some people in the informal sector began to question whether the virus was even real, or if it was a political tool used to control the population. They pointed out that while some areas were strictly locked down, others, including major transport routes, remained open. They saw politicians holding large rallies while ordinary citizens were told to stay home. This inconsistency eroded trust. If the rules were not applied fairly, why should anyone follow them? Furthermore, some communities held deep-seated beliefs that the virus only affected foreigners or that traditional remedies, like drinking local alcohol, could prevent infection.

The study also highlighted a practical barrier that no amount of messaging could solve: the cost of protection. Even when people wanted to follow the guidelines, they often could not afford soap, clean water, or masks. For some, the idea of wearing a mask for long periods was physically uncomfortable, leading to fears that it would cause breathing problems or other health issues. The written materials provided by the government were often in English or only a few local languages, leaving many people who spoke other dialects unable to read the instructions.

Ultimately, the research revealed that a successful pandemic response requires more than just broadcasting information. It requires a deep understanding of the community's daily life, economic struggles, and cultural context. The researchers concluded that while awareness was high, adherence to safety measures was low because the risk felt distant to many, and the cost of following the rules was too high for others. To move forward, health officials needed to build on the trust that already existed with local leaders, ensure that messages were available in every local language, and address the economic realities that made it impossible for some families to prioritize safety over survival. The path to controlling the virus was not just about science; it was about listening to the people and understanding the world they lived in.