Communicating clearly and inclusively during public health emergencies: Lessons from Ghana’s COVID-19 response

In low-income urban settings, effective communication is essential during health emergencies. Yet few mixed-methods studies have assessed how public health messaging can be made more inclusive to drive behavior change in such contexts. This study evaluated the Hygiene Behavior Change Coalition campaign implemented by Water & Sanitation for Urban Populations (WSUP-HBCC) in three low-income Ghanaian cities to determine reach, recall, and effectiveness and inform future risk communication. We conducted a mixed-methods evaluation (household survey, n = 245; 57 key informant interviews; and 44 focus groups). Quantitative data were analyzed in STATA, and qualitative data were thematically discussed. Nearly all (99%) respondents accessed at least one message. Television (76%) and radio (66%) led in campaign message clarity and trust ratings. Respondents trusted interpersonal communications (54%) more than social media (8%). Overall recall of prevention (92%) and transmission (77%) messages was high. However, message uptake among female head-porters and persons with disabilities was constrained by a lack of complementary material support and poor inclusiveness. Our findings suggest that combining mass-media “blasts” with community dialogue, disability-inclusive formats, and targeted material support maximizes behavior change. This study advances risk-communication practice by demonstrating how media and interpersonal channels synergize to influence behavior change in low-income urban contexts.