A mixed-method approach identifying Regional Social Media Influencers as Message Source

for Public Health Communication during Health Emergencies like COVID-19

ABSTRACT

The global public health crisis, COVID-19 pandemic has put one and all under anomalous

circumstances. Such situation calls for a public health message design which reiterates the general

preventive recommendations in an innovative and tailored manner for repetitive priming. Since,

dynamics of Social Media Influencers (SMIs) in Health and Fitness related information sharing are

gaining progressive attention, they can play an important role in communicating persuasive,

customised and region-specific public health messages. The aim of study was to identify key factors

in persuasive message design for shaping public's intention to follow the advice/information when

source of message is a Social Media Influencer. The theoretical underpinning of this study come

from Dual Process Models of Persuasion and Theory of Reasoned action. A sequential Mixed-

Method research approach was adopted for the study. Firstly, three focus group discussions were

conducted with Pre-Final and Final year Medical students. This set of experts was identified to be

closely related to health sector alongside being Second Generation Digital Natives. The findings

from this initial exploratory phase helped in development of survey instrument for main phase of

the research. Data were collected digitally in the form of questionnaire from 332 respondents. The

data analysis was done using Confirmatory Factor Analysis and Structural Equation Modelling. An

integrated model has been presented that identifies how Source and Information-centric factors,

Homophily and Attitude towards information shared by SMI antecedence Public’s Intention to

Follow an Advice. The findings illustrated that the influence of SMI’s Credibility, Information

Quality and Homophily on Public’s Intention to Follow is direct as well as mediated by Attitude

towards the Information shared by SMI. Knowledge of proposed relationships and focus group

recommendations can work as a guide in designing a persuasive/comprehensive public health

message for online communication in current and similar times.

Keywords: Public Health Communication; Social Media Influencers; Persuasive Message;

Behavioural Intention; COVID-19 Pandemic

1. Introduction

COVID-19 pandemic has put the world in the most unprecedented situation. Scientists and

researchers globally are striving to find an effective cure for the viral disease. In order to break the

chain of rapid spread of the virus, Lockdowns have been imposed in most of the countries. While

COVID-19 continues hammering the world, tenacious efforts are being put to make people across

the globe to cling to the CDC-recommended Non-pharmaceutical interventions (NPIs). Various

global, national and regional health campaigns have been designed in order to increase public

awareness about virus transmission and prevention (Olum & Bongomin, 2020). Mediums of mass

communication, including Social Media Platforms have been employed for disseminating pandemic

related updates (Chan et al., 2020). Inclusion of Wireless media alongside traditional mass media

for communicating NPI’s in present situation can be accredited to "Shelter in Place” or “Stay at

Home" orders.

Among many other lifestyle changes virus has brought, a notable change has been observed

in internet usage and use of internet for seeking health related information (Wai, 2020). There are

over 4.57 billion active internet users world wide and 3.96 active social media users as of July, 2020

https://www.statista.com/statistics/617136/digital-population-worldwide/). Engagements on posts

have significantly increased, especially for healthcare, consumer goods, and entertainment

industries. (Wai, 2020 https://www.tributemedia.com/blog/how-covid-19-is-changing-social-media-

usage-and-platforms). A survey conducted in 2010 which included more than 12,000 Internet users

across 12 countries concluded that the people belonging to emerging economies such as India

(39%), Russia (39%), China (32%) and Brazil (29%) used online modes to seek health information

more frequently (McDaid & Park, 2011). Refer HC 3 Seow Ting Lee & Julian Lin (2019). Deloitte
(2016) mentions that millennials tend to obtain more information from social media than from

traditional media like TV and social media is an integral part of people’s life.

Social media is a platform where people with shared interests can connect and discuss topics of

their choice and concerns in real-time

(https://academic.oup.com/eurpub/article/29/Supplement_4/ckz185.681/5624362) . It has reformed

communication making the virtual platforms hub for discussing every topic, including health

(Cappella et al., 2014; Kaplan, 2018; Knowledge@Wharton, 2017 (HC SM and PH 5)). People all

over the world are sharing huge volumes of information about their personal health as well as health

of their communities publicly. (HC SM and PH 3). In response to these this shift on virtual

platforms the health officials have started using social media as communication channel for health

message dissemination (HC SM and PH 5). The true meaning of communicating over Social Media

is engagement and two-way interaction, but public health officials, organisation and practitioners

have used it only for mass information dissemination which seem to lack the true essence of

engagement (Amy Burnett Heldman, MPH,1 Jessica Schindelar, MPH,1 James B. Weaver (HC SM

and PH 4)). Public health organizations, such as the United States Centers for Disease Control and

Prevention (CDC), the US Food and Drug Administration (FDA), the World Health Organization

(WHO),etc have established social media presence but they have rarely focused on engagement.

Amy Burnett Heldman, MPH,1 Jessica Schindelar, MPH,1 James B. Weaver (HC SM and PH 4)

also suggest that using influencers on social media could be beneficial for of increasing

engagemnt and this could be done by identifying key partners and public health infuencers who are

leading health related conversations in their field. (HC SM and PH 3) have mentioned that there is a

rising sentiment that health authorities should appropriately adopt and implement Internet

technologies to look after public health. (HC SM and PH 3)

In recent years, a lot of innovative ideas and strategies have been suggested and implemented for

Public Health Communication (PHC) over social media which address public as single monolithic

group (HC SM and PH 8). Celebrity influencers have been used for health communication

(Chapman & Leask (HC CI 1 cite source), William J. Brown & Marcela Alejandra Chaván de

Matviuk (2010); William J Brown & Michael D. Basil (1995); ALATAS ET AL 2020 (HC CI 4)

FIND CITATION) but using them still poses a challenge of designing personalised persuasive

messages. The need is to design messages that are tailored for a specific and relatively

homogeneous people (HC SM and PH 8). An article by HC QP3, mentions views of various health

communication experts who suggest that there’s little point in pushing a message or a campaign

where the suggestions are not feasible to follow like pushing hand wash campaigns in a area of

water scarcity. Messages would be persuasive and effective only if they are designed in accordance

with health experts and then, regional leaders are use to disseminate those messages in as

customised way as possible (HC QP3). HC SMI4 mention that influencers can help to sail through

current times by encouraging people, to abide by NPIs such as social distancing and wearing masks.

They further explain how influencers have the power to persuade public by sharing engaging

personal content. They can do so by displaying how they have adapted to the situation and by

sharing personal stories for example, a video on how they a avoiding personal gathering on their

birthday and instead celebrated it over video call. This would make the messages more accessible

due to the source it is shared, more persuasive due to the personal touch , and more acceptable due

to relatibility. Andrews, J. L., Foulkes, L., & Blakemore, S.-J. (2020). HC SMI 4. (Pilgrim &

Joschko, HC SMI 2) mentioned that presence of young audience online and high attractiveness of

influencer marketing would change the dynamics of using influencers in the field of health

communication.

There are evidences which support that social media platforms like Twitter and Facebook have been

used in past to spread information related to health emergencies like Swine Fue in 2009

https://academic.oup.com/eurpub/article/29/Supplement_4/ckz185.681/5624362
, Haiti Cholera outbreak in 2010, etc. These social platforms provided facility to engage with public

and spread awareness information. They also worked as myth-breakers and quick source to correct

any misinformation being spread. With these events, (HC SM and PH 3) mention that in case of

sudden outbreaks, social media could facilitate communication and report public health related

concerns faster and more reliably than traditional methods.

Hence, the purpose of this study was to explore the suitability of SMIs in communicating public

health messages in view of public's intention to follow the message. Specifically, this study

addresses the designing of persuasive, customised and region-specific public health messages in

case of using Regional SMIs as message source. The study identifies key determinants of a

persuasive message and verifies their impact on public’s intention to follow it. The mediating role of

public’s attitude towards a persuasive message and their behavioural intentions has also been

explored. This study contributed to both practice and literature. First, this study fills the literature

gap associated with SMIs in healthcare sector. Based on dual process models of persuasion and

Theory of reasoned actions, a model for communicating persuasive messages for public health has

been developed and empirically tested in accordance with expert suggestions. The model can be

used in further researches pertinent to use of SMIs for persuasive communication in various sectors.

Second, a sequential mixed method approach has been adopted in study with opens doors for

verifying the propositions in more comprehensive manner. The results of first study, qualitative in

nature (using focus groups) served as basis for the second study, which was quantitative in nature

(questionnaire based survey). Future researches can adopt such methods to conduct studies which

propose innovative and newer ideas and otherwise require meticulous care. Finally, for

practitioners like health officials, various international, national and regional health organisations

and other concerned authorities, this study has a direct practical implication, were the model

designed under supervision of heath and digital experts can be adopted for use in current pandemic

situation as well as for future. A plan can be devised for inclusion of regional influencers with

message designed by health experts to be shared in as tailed form as possible for better reach and
acceptance. This work is structured as follows: first, literature related to persuasive message design

and theories which support the argument have been presented. Second, the focus groups ideas and

discussion have been summarised to design the research instrument in for next step. Third,

hypotheses have been postulated and quantitative research methodology has been discussed.

Finally, results and conclusions are presented and some possibilities for future leads have been

outlined for better understanding of role SMI’s can play in Public Health communication.

2. Theoretical background

2.1 Advances in Public Health Communication

Health communication got a formal recognition in 1960s. Since then, medical science, health

communication, social sciences and communication technologies have evolved significantly. PHC

in today’s digital era, synchronises the modern study methods and new paradigms with optimism for

social impact. It tends to serve as a ray of hope for the mankind (Charles T. Salmon &

Thanomwong Poorisat, 2019). PHC became important to make public aware about various diseases

and to disseminate knowledge about preventive measures. The knowledge dissemination was

aspired to save lives and to create a a world which would be disease-free (Tesh, 1988).

The public health campaigns in past have been designed in a top-down, broad based

communication manner which seem generic. Recently, alternative communication methods have

come to spotlight where, members of public health target communities have been considered and

engaged (Dutta and Dutta, 2013). Understanding of difference in social and cultural worlds leads to

development of meaningful messages which can bring about social change (Lindsay Ems, Amy L

Gonzales, 2015 HCQP 5 fIND REFERENCE). A culture-centered approach to health

communication is necessary to develop strategies that are relevant for a specific community’s

cultural framework (Airhihenbuwa, 1995). Some studies have been dedicated to create messages

which are aimed at approaching people with a suitable message design partnered with trusted local
leaders. This could spread the word in a localised manner for clear, relaxed and relatable

communication (HC QP 4).

Baym (2010) suggested that communicating online can be seen as personal channel within a public

space, where communication can be both, interpersonal (messages directed to other individuals

within a group) and public (available for anyone to read) at the same time (HCQP 5 fIND

REFERENCE). A few public heath communication studies have been addressed in aspect of

hyperlocal messaging and on social platforms. Although, social platforms have seen a rapid

increase in the number of users there hasn’t been a lot of smart thinking on message deign which

could resonate with people using social platforms in a stronger way. Various researchers have

suggested the use of social media in PHC to be in a “Wild West” phase (HCQP 5 fIND

REFERENCE, Harris et al., 2013; Mayo Clinic, 2012; Thackeray et al., 2012). Recently a study by

Lindsay Ems, Amy L Gonzales, 2015 contributed on usage of social media at organizational level.

The study suggested on how efficient, culture centered and scalable communication strategies

which are intended to improve health outcomes can be designed by public health communicators.

HC QP 5 ‘No one has really xed the model of health communications for the 21st century,’ he said.”

Refer HC QP 4

2.2 Designing Persuasive messages

Persuasion is a term which can be used in many contexts of influence. It can influence other

person's believes, attitude, intentions, motivation or even behaviour (Gass & Seiter, 2010).

Persuasion is one of the most broadly studied and researched areas in social psychology (Fiske et

al., 2010). The persuasiveness of a message in online context is said to possess to qualities which

are: message’s ability to be perceived as reliable information source by the receivers and its

capability of influencing receiver's attitude (Refer HC IAT 1 Nunes R.H. et al (2018)). Some

theories and models relevant to the message design and to identify features of a persuasive message
have been mentioned in next sub-sections. These theories and models have aided the structuring of

conceptual framework for the current study.

2.2.1 Yale’s attitude change model

Yale's model describes the conditions which tend to change people’s attitude when they come

across a persuasive message. These conditions can be described as “who said what to whom” where

(i) who: the source of communication, (ii) what: nature of communication and (iii) whom: the

audience, all three are important for a persuasive communication (Hovland, Janis, & Kelley, 1953).

Various important features have been associated to these conditions like: (i) Credibility (Hovland &

Weiss, 1951; Kumkale & Albarracín, 2004) and Attractiveness (Eagly & Chaiken, 1975; Petty et

al., 1997) of the message source. The messages seem more persuasive when they come from a

credible source (whom people trust) and whom they find attractive than the one's coming from a

less credible or less attractive source. (ii) Subtleness, Quality, Timing and Frequency of the

communication (Miller & Campbell, 1959) have been stated to be important features which define

the nature of communication and medium used for sending the message and finally (iii) Attention

(Festinger & Maccoby, 1964), Intelligence, Age (Krosnick & Alwin, 1989) and Self-esteem

(Rhodes & Wood, 1992), of the audience. It is easier to persuade people who pays attention, have

lower intelligence, moderate self-esteem and are younger in age (Rhodes & Wood, 1992). This

model has lead to enormous volumes of research into the nature of persuasion. The model defines

the important conditions in order to have a persuasive communications but lacks in elaborating the

actual persuasion process. It tends to assume that change in attitude would come is idea of a

persuasive message is learnt but Dual approach theories like Elaboration Likelihood Model (ELM),

Heuristic Systematic Model, etc suggest that merely learning an idea of a persuasive message does

not assure persuasion. Persuasion may even occur when these conditions are partially or even not at

all fulfilled.

2.2.2 Dual process theories of persuasion

Most of the popular theories on persuasion mention the use of two types/routes of persuasion i.e.

either Systematic route or Peripheral route or both. The messages which are delivered more

thoughtfully and are content/ information centric, tend to follow the central or systematic route

whereas the messages which are more spontaneously sent, tend to use a peripheral or heuristic route

(Chen & Chaiken, 1999; Petty & Wegener, 1999). Heuristic route is more direct and quick, hence

generates affective responses to the message whereas Systematic route involves a more careful

approach to the cognitive elaboration of the message/information sent HC ATT & PERSUASION.

Both the routes can be effective in different situations for different people. So, it is important to

know weather a particular approach of sending a message has suited the situation or not. Two

important theories in dual process persuasion are: The elaboration likelihood model (ELM) and

heuristic-systematic model (HSM) (Chaiken, 1980; Davis & Tuttle, 2013; Yang, 2015; Zha et al.,

2018 HC ATT & PERSUASION). Both the theories suggest the use of aforementioned routes. The

difference is that ELM suggests that individuals can use only one route at a time for processing a

message that is either either central or peripheral route where as HSM suggests the co-occurrence of

the two routes (HC ATT & PERSUASION).

Both the theories have been widely used in various context such as advertising, persuasive

communication, information adoption, health communication, risk prevention, knowledge

dissemination, etc. The studies related the source/information related cue processing to attitude or

behavioural changes. Chaiken (1980) mentioned the use of systematic versus heuristic cues for

persuasive messages which suggested that low levels of issue involvement leads to choosing the

heuristic path where as higher levels of issue involvement lead to a systematic information

processing (HC Persuasion). A study by Ryu and Kim (2015) mentioned that in a systematic

processing mode, risk-prevention messages can be processed effectively based on quality of

message, person's ability to process the message and their motivation. Information processing by

dual routes in context of online travel sites was studies by Tang, Jang and Morrison (2012) which

confirmed that central route was used when people are more involved where as peripheral route is
followed if experts are given priority than self-evaluation (Tang et al., 2012). Kong & Goh (2015)

reassured the usage of ElaboRAtion likelihood model in social media context. They mentioned the

antecedents of a persuasive message, moving through dual processing route in affecting the

behavioural intentions in consumer decision making (HC ELM 1) . Teng et al. (2014a) have

mentioned argument quality, credibility and attractiveness of the source, and source perception to

be important characteristics of a persuasive message that would follow the central route for lasting

effect. Refer HC IAT 1 Nunes R.H. et al (2018)

Zhang et al. (2014) employed systematic processing cue: argument quality and heuristic processing

cue: source credibility to study the perception and purchase of consumers towards online product

reviews using HSM . Fu et al. (2018) investigated how information on social media influences the

shopping intentions of consumers Based on the HSM and theory of informational social influence

(HC HSM 2). A study by Xiao et at. (2018) investigated the influence of informational cues on

credibility of content shared byYouTube influencers using HSM. Many researches have used both

ELM and HSM as guiding theories for their studies (Jung & Kim, 2016; Reimer & Opwis, 2005;

Watts et al., 2009). Reimer & Opwis, 2005( HC BOTH ) explained the interplay between the two

routes of persuasion i.e. they suggested that heuristic and systematic routes are not mutually

exclusive. One route dominates other under different conditions. Both models were used together

by Jung et al. (2016) to explore the effect of peripheral and central information cues on online

nutrition information credibility.

for references check HC IC 1

2.3 SMIs for Public Health Communication

Social media influencers (SMIs) can be seen as independent third party endorsers who have the

ability to persuade and shape attitude of their audience through their content (Freberg et al., 2010).

(HC SMI 6) SMIs, can be seen as human brands on social media who have perceived authenticity to

attract other social media users and expand their social reach exponentially (Kay et al., 2020).
Influencers differ from celebrities in the way they gain their Followership (McCracken, 1989 ; De

Veirman et al., 2017). Celebrities are famous in their fields and have followers/fans even before

joining social websites whereas social media influences gain popularity by posting content on

online social platforms. SMIs have been established their presence in various fields ranging from

advertising, paid partnerships, entertainment, infotainment, health and fitness communication,

lifestyle blogging, etc. Using SMIS for health communication is suggested and supported by

various studies. Pilgrim & Joschko (2019) studied influencers in context of health and fitness

communication. They said that Influencers on social media design their content in a way that wins

them the trust of their followers and their followers perceive them to be their friends (HC SMI2). A

study by Byrne et al., 2017 mentioned that Social Influencers, especially qualified dieticians and

nutritionists are the best source of credible and accurate information on social media as they can

motivate their followers to choose a healthier diet and stay fit (HC SMI 3). Andrews et al., 2020

have suggested that Public health bodies should enrol and even incentivise the social media

influencers who have strong online presence to diffuse information regarding social distancing and

risk of COVID-19. They believe that loyal adolescent audience of these influencers can be targeted

in most naive manner through them (HC SMI 4). For present study the focus is on SMIs who have

established online presence and distinguished followership at regional/local level. Various Health

experts and practitioners have suggested the necessity of pushing localised and region specific

messages though local opinion leaders in situation of crisis like COVID-19 pandemic (HC SM and

PH 8), HC QP3,). These views harmonise with the views of focus group discussion outcomes

(mentioned in Table 1)

2.4 Theory of Reasoned Action (TRA)

The TRA explains the relationship between attitude, subjective norms, behavioural intentions, and

actual behaviour of individuals (Fishbein & Ajzen, 1975; Madden et al.,1992; REFER HC IAT 2

Erkan & Evans, 2016 ). Theory considers individual’s intention to be main predictor of their actual
behaviour. Attitude and subjective norms are considered as antecedents of behavioural intentions.

TRA and its extension: Theory of Planned behaviour TPB (Ajzen, 1991 HC IAT 4) are the most

widely accepted and used theories while predicting the behavioural intentions. TPB postulates the

same relationships as TRA with Intention Behavioural Control (PBC) as an additional antecedent

to Behavioural Intention. Various studies in which TRA/ TPB have been applied are listed: TRA

has applied in predicting the relationship between e-word-of-mouth and purchase intention (Cheung

& Thadani, 2012; Erkan & Evans, 2016 Prendergast, et al., 2010); attitude and purchase intention

( Chang, et al., 2005; Hsu et al., 2013; for reference check HCIAT1); to explain medical

information seeking behaviour online, like Orfan et al. (2007) explained the patterns of cancer

related information seeking over internet , Rickwood et al. (2005) mention the factors that affect

help seeking for mental health problems in young adults; in information systems to to study attitude

as prime antecedent of the intention to use (Davis et al., 1989; Taylor & Todd, 1995 (REFER HC

IAT 4)), etc. Similarly, TPB has been used for understanding behaviour, intentions, and attitudes in

multiple contexts like in understanding healthcare professionals’ behaviours and intentions (Godin

et al. ,2008), like to study Nurse’s attitude and intention to follow preventive clinical practices use

of filter needles (Gagnon et al.,2016 HC TPB); to advertising on social networking platforms like

Facebook (Sannes & Wiese, 2018); on purchase intention via online shopping sites (Hsu et al.

(2013), etc

However, current study considers only two components of TRA, which are: attitude and

behavioural intention as used by Erkan &Evans (2006) for studying eWOM influence in social

media context. Intention has been selected instead or actual behaviour since present context

suggests a model for future applicability. None of the study so far has empirically tested the the use

of SMIs, specially regional SMIs in communicating public health messages. The other antecedent

of intention i.e. subjective norms, which suggests the approval of other people or group in case

behaviour performed has been overlooked since, following an influencer or opinion leader implies

conformity to a group/community of individuals who think alike/share similar interests. Instead,

Homophily was agreed upon as a relevant factor by the focus group (Table 1) to find predict the fit

between the SMI and message recepient (in this case, SMI’s followers). Therefore, only the

aforementioned constructs have been borrowed and applied to understand the public's attitude

towards the health message communicated by SMI and to predict their intention to follow the

message in context of COVID-19. For conceptual framework, the constructs were finalised and

relationships were hypothesised only in accordance with the focus group discussion outcomes

highlighted in next section.

3. Study 1

Since, strategies for PHC on social media platforms, specially involving SMIs are at nascent stage

(rarely implemented), and next to nil in case of health crisis like COVID-19, it was necessary to

seek advice from various experts. The focus group studies were conducted in pursuit of:

understanding the current status of NPI adoption in public; evaluating existing channels of PHC;

obtaining views on using SMIs as information source and discovering factors pertinent to shape

public's intention to follow the NPIs.

3.1. Participants and procedure

The participants of focus group were pre-final and final year students belonging to a medical

college in Jammu, India. This set of contributors was espoused firstly, as they are presumed

proficient of taking cognisance of current health crisis and secondly they are “Second Generation

Digital Natives”, since they were born after 1990, they were exposed to Web 2.0 while growing up

(Helsper & Enyon, 2009). The prospects were invited over a WhatsApp group for voluntary

participation in the discussion. Due to regulative guidelines, physical gathering size was restricted

to four individuals (including one moderator), while others participants and a second moderator

joined via video conferencing to ensure descriptive validity. Three focus groups were carried out in

this fashion with a total of 16 participants. The term of each gathering ranged from 55 to 70 mins in

length. The discussion was guided by a few questions appurtenant to the current health crisis
including what PHC channels are currently in place and their message design, views on adoption of

NPIs, suggestions to boost current strategies and ideas for implemeing new ones and finally views

on inclusion of SMIs in communication process. Following discussion points were literature-driven,

including factors affecting intention to follow NPI’s, attributes of a persuasive message and

strategies for quick and effective implementation (see Appendix for complete set of questions).

While the main points were tapped upon, the moderator had multiple opportunities to steer

conversation towards emerging themes and capture additional insights.The comments acquired

from all three gatherings were noted and broken down in light of existing literature accessible.

Tables were created using Numbers 10.1 (spreadsheets) for each key point and responses of each

participant were arranged. Since, devising relevant themes was of paramount importance, each

response was studied by two authors independently to remove possible biases and ensure

interpretative validity. The themes derived are presented in Table 1.

[Table 1 near here]

3.2 Results of Study 1

As a result of analysis, three overarching attributes to design a persuasive message in case of SMIs

emerged which could help in shaping public’s intention to follow the recommended guidelines in

current scenario : 1) Source related attributes and 2) Content related attributes and 3) Relatibility

attribute. More precisely, ten noteworthy sub-categories that emerged were: Trust, Expertise,

Reliability, Bonding, Visual Aesthetics, Language, Engagement, Similarity and Attitude. Among

these sub-themes, trust, expertise, reliability, and engagement were categorised under SMIs’/ Source

related attributes, while visual aesthetics and language were associated to Content related attributes.

Similarity and Bonding were categorised as Relatibility attributes and Attitude was kept as a

separate construct as some of the aforementioned factors were proposed to be antecedents to

attitude as well.
In addition to key attributes of a persuasive message, few anecdotes provide an insight into the

current situation and relevance of using SMIs in present scenario. For instance, the following

excerpts illustrate the public's ignorance/ partial compliance to the recommended NPIs:

“I’ve seen lot of people wearing masks but the wrong way. Some below the nose, some on their neck, hanging

on one ear and even just holding in their hands & not wearing it. ”

“Initially people were serious about it and avoided visiting others or letting others in their house but now

people are ignoring the norms. Like in case of domestic help/ maids who visit number of houses, they have

resumed working as well which brings a threat of community spread.”;

“India has meet and greet culture so people are violating social distancing by meeting their friends and

extended families.”

The sample excerpts also illustrated the fear in people if they catch infection and some measures

which can be helpful in that respect:

“people are watching videos on WhatsApp and other sources and implementing those home remedies and

believing those superstitions instead of simply abiding by the NPIs”

“It’s scary to hear in the news, people escaping from the quarantine facilities”

“.. patients who recovered from COVID have circulated videos on Internet. It is good technique to spread the

word and break public’s misconceptions about what would happen if they get infected..”

“..people have misconceptions that they will die of the virus… authentic and trustworthy sources can share

videos in regional languages on same to builds sense of trust and ends the chaos in minds.”

The following excerpts illustrate inclusion of Regional influencers & opinion leaders in PHC to be

worth:
“influential person in a region like Sarpanch (head of a village) are being used to communicate

precautionary messages. They are considered trustworthy and their opinions are accepted by others. This

strategy has worked as an example in some regions of India.”

“Regional customisation of messages is necessary and local people who are famous online should be

contacted as everyone is indoor and online due lockdown…addressing mass gatherings online can work in

current scenario”

“ it is much easier for people to relate with people coming from same setting/ background. They seem more

relatable”

“ i know people who trust their nutritionists and fitness trainers more due to personal contact”

Lastly, the data analysis revealed that ways in which SMIs can present the message to their

audience, once designed and approved by the authorities:

“they are great story tellers so message shared that way stays in mind for longer”

“how-to videos which would guide people to understand the proper way of following NPIs like wearing

masks and hand washing / sanitising can be shared”

“interesting content, likes funny stories could be posted addressing how they are avoiding meeting friends

and relatives and making them understand the true meaning of social distancing”

“language used should be easy to understand and preferably regional”