Listen, understand, repeat: The circular approach to good communication in a health crisis

by Herkulaas MvE Combrink, The Conversation

edited by Sadie Harley, reviewed by Robert Egan

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During a health crisis, the first instinct is often to give people information. Governments make announcements. Experts explain what is happening. Health departments share information on television, radio, social media and through communities. The idea seems simple: give people the right information, and they can make better decisions.

But does simply providing more information resolve uncertainty, misinformation or public concern?

My research focuses on infodemics, using artificial intelligence and machine learning to understand how misinformation spreads, identify information voids and analyze the concerns and questions that emerge during a crisis.

In a recent paper, a group of researchers involved in studying infodemics and I examined the system South Africa put in place to understand public concerns and what responses were recommended to address them.

During the COVID pandemic, South Africa's national Department of Health established a technical Risk Communication and Community Engagement working group that used a research approach called social listening to identify what people were saying, asking and worrying about in relation to the pandemic.

To do this, public conversations and feedback were tracked across social media, online news, public WhatsApp streams, call centers and community channels.

Regular social listening reports brought this information together to identify concerns, misinformation, rumors and gaps in understanding. These reports alerted health authorities and partners to emerging concerns and provided recommended actions for addressing them.

The social listening system was structured as a circular process: listen, understand the problem, recommend a response and keep listening.

We wanted to understand two things:

• which misinformation themes appeared across the social listening reports
• what actions were recommended in response.

We studied 91 reports produced between 2021 and 2023. What emerged was that similar concerns kept appearing, despite the existence of a system to address them.

What people were worried about

At least two researchers reviewed the information independently so that the findings did not depend on one person's judgment. We grouped statements that were saying the same or very similar things. In total, we identified 964 instances of misinformation across 12 themes and 573 recommended actions across six themes.

More than half of the misinformation was directly about COVID. The rest was about vaccines and various health-related concerns.

The reports reflected recurring areas of uncertainty and misinformation around vaccine safety and side effects, trust, treatments and government communication.

The recommendations focused on improving how health information was communicated and managed, and on working more directly with communities.

This meant going beyond broadcasting the same national message to everyone. Recommendations included community information sessions using local media platforms and engagement activities that included working with people within communities who could place complex health information into a locally relevant language and context.

Why did the concerns keep appearing?

Our study did not track what happened after recommendations were made. Furthermore, the study could not determine whether individual recommendations were implemented, how widely they reached communities or whether they changed what people understood, believed or did.

It is possible that concerns recurred because the information environment changed. New questions emerge, information voids develop as circumstances change, and misinformation can reappear or take different forms. A concern appearing again at a later point therefore does not necessarily mean that exactly the same information problem has persisted.

This is why the gap between listening and outcome matters. Identifying a concern is only the first step. What also matters is how that concern is translated into a response, whether the response reaches the intended audience, whether it addresses the underlying question, uncertainty or information void, and whether anything changes afterward.

Across the reports, five principles appeared repeatedly that can help health authorities and risk communication practitioners translate social listening insights into more responsive public health communication.

First, understand the concern. Social listening can show health communicators what people are worried about, instead of assuming what people need to know.

Second, use that information to improve how health information is framed. If the concern is about vaccine side effects, for example, providing general information about COVID may not address the actual concern.

Third, work with trusted people to communicate and engage with communities. The reports recommended community participation as well as involvement from public figures and other credible voices. The purpose is to communicate through relationships and voices that communities recognize.

Fourth, use appropriate communication channels. Something posted online does not necessarily require an online response. Communication can be through community radio, newspapers, faith-based and community organizations, outreach programs and community health workers.

Finally, keep listening because concerns change. New rumors appear, old ones return, and people's questions change as circumstances change.

The purpose of social listening is not simply to build another dashboard counting posts, likes and mentions. Its value lies in connecting what is being heard to decisions about what needs to be communicated, to whom, through whom and through which channels, and then listening again to determine whether the information environment has changed.

When we hear a concern, we should ask: Who is saying this? Why are they worried? Could this cause harm? Who do they trust? What language do they speak? Where do they get their information from? And, after we respond, has anything changed?

These findings matter beyond COVID-19, as it will not be the last time countries face uncertainty, fear and rapidly changing information. The next challenge may be another infectious disease, a vaccine, a new treatment or an entirely different public emergency.

The unanswered question is what happens between identifying a concern, recommending or implementing a response, and determining whether anything changes in what people understand, believe or do. Social listening gives us the ability to hear the problem. The next challenge is understanding what happens after we hear it.

Publication details

H. M. V. E. Combrink et al, Managing an infodemic in the global south: a systematic evidence synthesis from COVID-19 social listening reports, Frontiers in Public Health (2026). DOI: 10.3389/fpubh.2026.1787026

Journal information: Frontiers in Public Health

Key medical concepts

COVID-19 (Coronavirus Disease 2019)Vaccines

Clinical categories

Preventive medicineCommon illnesses & PreventionInfectious diseases Provided by The Conversation Who's behind this story?

Sadie Harley

BSc Life Sciences & Ecology. Microbiology lab background with pharmaceutical news experience in oil, gas, and renewable industries. Full profile →

Robert Egan

Bachelor's in mathematical biology, Master's in creative writing. Well-traveled with unique perspectives on science and language. Full profile →

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