Of 300 potentially relevant references identified by electronic searches and screened, 86 met the inclusion criteria and were included in the review. Details of the number of returns for each database and reasons for exclusions are in the PRISMA chart (Figure 1). References and summaries of all included articles are shown in Supplementary Material: Bibliography. In terms of the overall quality of the evidence, the combined GRADE profile was as follows: only 1 article was grade A (1.1%), 30 articles were grade B (35%), 40 articles were grade C (46.5%), and 15 articles were grade D (17.5%). Thus, almost all of the evidence in this review (98.9%) is medium to low grade (B-D). The GRADE classification given to each article is shown in the bibliography tables for transparency, it was not used to compare or weight the evidence from individual studies.
The thematic analysis generated two main themes and ten subthemes, illustrated by table 2 (Table 2). These are described below.
[Table 2]
4.1 The relationship between emergency communication and community resilience
This first section of the results presents evidence from the literature relating to the relationship between community resilience and health emergency communication, focusing on ways in which they interact.
4.1.1. Building trust and collaboration within communities
The evidence suggests that trust and collaboration within communities are foundational elements of community resilience that can facilitate effective communication during health emergencies (Dharmasena et al., 2020; Marfori et al., 2020; Miles et al., 2018). The paper by Dharmasena et al. (2020) explores the role of public relations in building community resilience to disasters caused by natural hazards, offering perspectives from Sri Lanka and New Zealand. It highlights how trust-building efforts through strategic communication contribute to community cohesion and resilience. Additionally, Marfori et al. (2020) discuss public health messaging during extreme smoke events caused by wildfires in Tasmania, emphasising the importance of trust in disseminating health information effectively during crises. Miles et al. (2018) illustrate how the frequency of emergency communications and knowing when to expect communications to occur can affect perceptions of community resilience.
Community cohesion, or ‘groupness’ is also an important factor that affects how communities respond to emergency communications (Forsyth, 2012). The literature indicates that in times of recovery, community networks and connections, bonded by groupness, can foster trust and collaboration, helping to manage the enduring effects on communities, such as mental health issues and the effects of longterm illnesses (Hall et al., 2023; Wilson et al., 2023). Trust is built through the community’s relationships, addressing social identities, social norms, assets, values, and traditions. Robert Punam’s (2000) idea of social capital has been used to describe these positive and productive aspects of sociability for community resilience (Aldrich & Mayer, 2015). However, there is a well-established literature which critiques the concept for its potential to reinforce inequalities, support negative behaviours, and suffer from conceptual ambiguity and measurement challenges (Fine, 2007; Farr, 2004).
Community dynamics can foster or hinder inter and intra-community trust and collaboration, as well as perpetuating positive or negative behaviours and outcomes through ‘behavioural contagion’ (Villalonga-Olives & Kawachi, 2017), however this is a contested term in the psychology literature. Research suggests that interactions between social cohesion (groupness) and individual person characteristics can lead to ‘conformity or exclusion’ (ibid). How these factors affect trust and collaboration in relation to emergency communications is unclear. Understanding the gaps in the evidence on psychosocial-behavioural aspects of community resilience is essential for informing trust-building initiatives that achieve improved health outcomes (Drury et al., 2019). For example, research conducted during the COVID-19 pandemic shows that phenomena that include –‘risk deliberation networks’, voluntary compliance with government guidelines, and citizens' subjective health experiences – influenced each citizen's health-related behaviours and community-led risk discourses in the face of the urgent health crisis (Lim & Nakazato, 2020).
This literature elaborates on how various communities’ ‘social bonds’ (interpersonal connections), ‘cultural memory’ (or collective remembering), and historical background, provide the foundations for trust and community cohesion (Bzdok & Dunbar, 2020). A previous review of the literature found that maintaining cultural traditions post-disaster promotes community cohesion, fostering a sense of belonging and solidarity, which aids in psychological and social recovery (Norris et al., 2008). Similarly, a study by Paton and Johnston (2001) highlights how cultural identity acts as a trusted protective factor, mitigating the adverse effects of stress and trauma on community wellbeing. Other research focusing on indigenous communities facing climate crisis, demonstrates that acknowledging shared cultural context significantly enhances cooperative adaption in the face of environmental challenges (Cunsolo Wilox et al., 2012). In this example, the processes of ‘social learning’ and the development of shared mental models within communities is thought to foster collective understanding and cooperation, strengthening community resilience in the face of climate emergency.
Across the literature overcoming historical mistrust and fostering genuine collaboration are recognised as key aspects of both community resilience and the success of health communication strategies (Jones & Barry, 2018; Corbin et al., 2021). Community leaders, as well as their leadership approaches, are known to play a vital role in this respect, helping to build trust and encourage cooperation in different communities (WHO, 2017). Evidence is that a diffused model of leadership across communities can create a resilient community by actively engaging members in addressing different types of health challenges (Dulebohn et al., 2012; Gardiner and Martin, 2022). In the context of a health emergency, clarity about community leadership structures is essential for ensuring clear communication channels between central government, local authorities, and the community (Boin et al., 2010; Drury et al., 2013).
A central perspective, regarding disaster prevention and management efforts, is to pivot health communications towards building communities’ understandings of acute risks and fostering trust (Links et al., 2017). Clear communication procedures and reliable channels are considered crucial for timely and accurate information dissemination, reducing uncertainty, and facilitating a coordinated effort to address immediate and long-term risks (Comfort, 2007). Looking across studies shows that, while health communicators may seek to inspire confidence in authoritative preventive measures, resilient communities exhibit adaptive capacity, relying on trust and collaboration that is built ‘naturally’ within their membership (Berkes & Folke, 2000; O’Sullivan et al., 2014). Folke (2006) highlights the importance of exploring these social dimensions of resilience in the context of the climate crisis, emphasising social processes like, social learning and social memory, mental models and knowledge–system integration, visioning and scenario building, leadership, agents and actor groups, social networks, institutional and organisational inertia and change, adaptive capacity, transformability and systems of adaptive governance.
4.1.2. Identifying resources and their distribution
Being able to identify and access resources, such as information, assets, infrastructure, and financial support, among communities are critical aspects of a community’s resilience (Aldrich & Meyer, 2015; Cutter, 2008; Lam et al., 2016). In terms of economic resources, there is robust evidence from many studies to show financial factors significantly shape community resilience, with stable economies enabling effective adaptation and communication (Sherrieb et al., 2010; OECD, 2014). Resilient communities tend to have access to robust social infrastructure, including public buildings, shops, transport systems, and telecommunication networks, while impoverished areas with high levels of social deprivation tend to lack such resources and the means to access (Bruneau et al., 2003; Lam et al., 2016).
Evidence is that allocation of resources, such as targeted emergency preparation sessions in schools, provision or access to social media communications can enhance both community resilience and effective health emergency communication (Page et al., 2019; Silver, 2019; Kar, 2016). Furthermore provision of access to learning and information resources enhances community resilience by empowering individuals to adopt proactive measures during emergencies (Cutter et al., 2008; Paton, 2006). Several studies internationally highlight the societal benefits of equitable resource distribution in enhancing community resilience and supporting vulnerable populations during and after emergencies (Adger, 2005; Aldrich & Meyer, 2015). Fair resource distribution across various cities and counties, has been found to promote trust, cooperation, inclusion, and engagement, enhancing effective health communication in the face of health risks (UNISDR, 2014; Cutter et al., 2003).
4.1.3. Tailoring communication strategies
In this literature, several studies have shown that insufficient insight into complex community dynamics, including cultural norms, shared identities, and distinctive characteristics, coupled with a lack of understanding of preferred communication methods, has undermined health communication efforts (Acosta et al., 2018; Chandra et al., 2018; Rimal & Lapinski, 2015). For example, emergency messages may be perceived as culturally insensitive, untrustworthy, or irrelevant to different communities. In the context of an infodemic surrounding an emergency event such as the COVID-19 pandemic, ‘trusted messengers’ within communities can help to guide intended audiences to health information from credible sources (Taguchi et al., 2023). To address these challenges, authors have emphasised the importance of co-designing and customising communication strategies with communities, not only to maximise the accessibility, effectiveness, and resonance of health messages, but also to ensure interventions are having the intended effects (Lwin et al., 2014; Neelakantan et al., 2015). Specific barriers to communication have been identified as including language, literacy levels, and preferred channels, however their significance differs at the individual level, reflecting diverse communication needs and capacity across populations and nations (Neelakantan et al., 2015).
In this literature, tailored communication strategies are recognised as being crucial for effectively engaging often overlooked populations, such as school children’s understanding of natural disasters (Sharpe, 2018). Challenges of digital poverty and digital literacy are significant barriers to communication in emergencies and preparation for emergencies (Bukar et al., 2022; Gaspar et al., 2021). Bukar et al. (2022) explore social media's role in COVID-19 recovery, underscoring the need for customised approaches to address different community’s primary concerns. Tailored communications using culturally sensitive messaging is considered to be vital for effective health communication at various crisis levels and thresholds (Gaspar et al. 2021; Cutter et al., 2008; Norris et al., 2008).
The literature also shows that actively involving communities in dissemination efforts can contribute to resilience by fostering a sense of ownership and empowerment among community members (Olshansky, 2012; National Academies, 2012). It could be that involvement in dissemination enhances community cohesion and collaboration, enabling members to better identify and address their own unique contexts and challenges.
4.1.4. Considering inclusion and equity
This literature suggests that communities emphasise inclusion and equitable benefits for their members, including access to resources and support (Veil & Bishop, 2014; Sampugnaro & Santoro, 2021; Sayers et al., 2023; Veil, 2008). One example, the study by Veil and Bishop (2014), examines opportunities and challenges for public libraries to enhance community resilience, highlighting the role of libraries in providing equitable access to information and resources within communities. Furthermore, Sampugnaro and Santoro (2021) investigate the pandemic crisis and Italian municipalities' responses, emphasising the need for inclusion strategies that address the diverse needs of communities during emergencies harnessing a ‘spirit of solidarity’ in the face of multiple endemic negative factors such as political fragmentation and poverty. Review studies conducted by Norris et al. (2008) and Patel et al. (2007) provide evidence that communities with equitable access to healthcare services and strong mental health support, demonstrate heightened resilience, possibly enabling recovery from emergencies. Additionally, research such as that conducted by Galea et al. (2005) after the September 11 terrorist attacks in New York City, highlights the importance of a holistic focus on community inclusion for whole community healing and recovery following adversity. A community’s networks and bonds can ensure that during health emergencies vital information and resources are shared and all community members are included and informed about what to do (Patel et al. 2007; Norris et al., 2008).
4.1.5. Community engagement and feedback
Several studies demonstrate that engagement of community members and the opportunity to provide feedback to health communicators, rather than simply dissemination of standardised information, improves the effectiveness of health emergency communication (Zhang et al., 2021; Anthony et al., 2019; Sampugnaro & Santoro, 2021; CO, 2022). In the context of COVID-19, community engagement in China and elsewhere helped to confront uncertainty and counter rumours effectively, strengthening international cooperation and evidence-based decision making for prevention and control measures (Hu & Qiu, 2020). One way that community resilience is thought to support community engagement is by disseminating timely and relevant information, for example via different communities’ school networks or social media networks (Takahashi et al., 2017; Anthony et al., 2019). A specific example, the communication strategies of the US National Weather Service to protect communities, emphasise the importance of community engagement in weather-related risk communication efforts, informed by the theory of ‘microboundary spanning’ (small-scale actions that connect different parts of an organisation or community, fostering collaboration and communication across boundaries) (Yan et al., 2022). Research on place-based communities that actively participate in decision-making, problem-solving, and disaster preparedness, further highlights a link between community engagement and effective emergency communication (Schiavo, 2021). Involving communities in planning and response efforts, either through open community meetings or online forums, fosters a sense of community ownership and empowerment (CO 2022; Yeo et al., 2018).
The findings presented above show the ways that community resilience and health emergency communications complement each other. The second theme of the findings identifies strategies and interventions to enhance both community resilience and emergency health communication.
4.2. Strategies and interventions to enhance community resilience and health emergency communication (Case studies)
The findings in this section look more closely at the types of strategies and interventions that might enhance community resilience, with benefits for the effectiveness of health emergency communication. Table 3 summarises themes in the literature (drawing on 25 included articles) and provides 16 case studies from various countries and contexts, ranging from culturally inclusive strategies in emergency response, to recovery-focused peer health promotion projects in shelters, and government-funded community programmes addressing inequalities.
4.2.1 Facilitating community structures as channels for communication
Facilitating community structures as channels for communication involves various strategies to ensure effective dissemination of health emergency information and engagement with diverse community groups. Establishing contact with networks of active community members and individuals with access and functional needs (e.g., individuals with and without disabilities, who may need additional assistance because of any condition, temporary or permanent, that may limit their ability to act in an emergency), can enable the swift distribution of critical updates (CDCP, 2023) (case study: US Centre for Disease Control and Prevention). Targeted social media campaigns play a crucial role in involving the public in resilience planning and communication efforts, leveraging existing online platforms to engage broader audiences and disseminate information (An et al., 2021), however these benefits may not be accessible to all (case study: Precision public health campaign). Social media engagement has proven instrumental in shaping community resilience perceptions during the COVID-19 pandemic, with platforms facilitating social support networks and aiding in the evaluation of community strengths and weaknesses (Xie et al., 2022) (case study: US COVID-19 social media engagement).
Other types of community structures, notably mutual aid groups and community grassroots support organisations, have been shown to provide a pivotal role in fostering community resilience (Fernandes-Jesus et al., 2021; O’Dwyer et al., 2022; Vanderslott, 2024). Interventions to recruit and train ‘community health ambassadors’ or ‘community champions’ emerge as key drivers of resilience promotion, inspiring collective action and ensuring inclusivity by representing diverse voices within communities (Kamal & Bear, 2022). In Sri Lanka, mothers' support groups played a pivotal role in empowering communities amid the COVID-19 pandemic: key contributions included establishing communication networks, fostering a supportive environment for preventive behaviours, organising vaccination clinics, distributing essential supplies, arranging recreational activities, promoting home gardening, and monitoring community activities (Wijesinghe et al., 2023).
Additionally, unpaid or family caregiver networks and formal community care networks (e.g., home carers, community support workers) serve as crucial communication channels for clinically vulnerable groups, reaching behind closed doors to those who may not be well enough or have the capacity to engage with health messaging systems (Boyce & Katz, 2019; Bear et al., 2020). This raises the question of how to engage with, involve, and support paid and unpaid carer groups in health emergency planning and better utilise their networks in emergency response efforts.
4.2.2 Respecting personal data and private boundaries in health emergency communication
Research during COVID-19 illustrates that health communication often navigates sensitive personal and private territories, where individuals may be reluctant to disclose health information or openly discuss personal views or information like vaccination status (Vandrevala et al., 2022). Challenges arise when some community members engage inconsistently, preferring to maintain distance or privacy, potentially as a coping mechanism against stigma or criticism (Hanson et al., 2022). An individual focus, on self-reliance and self-protection to cope with fear and stress, could impede communal resilience efforts by undermining community cohesion (Heris et al., 2022). Thus, balancing individual privacy with fostering prosocial community-focused resilience is essential for a whole of society approach to health emergencies. The complexity of these issues is illuminated by trauma-informed community resilience models, which emphasise addressing resilience comprehensively at both individual and group levels, acknowledging the connections between personal coping strategies and community support systems (Miller-Karas, 2023; Heris et al., 2022). Initiatives such as organising community forums, establishing peer support networks, and implementing targeted information campaigns, can create safe spaces for open dialogue, reduce stigma, and foster community understanding on individual and community health risks (case studies: New York Public Library, Norway ReConnect, WHO IMS).
Educational programmes and school-based interventions can further promote collective resilience by emphasising the interconnectedness of individual and community wellbeing, underlining the critical role of schools in delivering health communications and resilience-building interventions (Takahashi et al., 2017; Forsberg & Schultz, 2023) (case study: school-based interventions in Gaza). This prompts the question of how communication initiatives can effectively uphold personal privacy while strengthening community resilience in the face of health emergencies (e.g., English NHS health ambassadors, AHA web-based information).
4.2.3. Targeting outreach for effective crisis communication
This literature emphasises that targeted outreach is crucial for effective crisis communication and can be achieved through initiatives that encourage proactive community engagement in crisis communication. For example, establishing decision-making forums or platforms for active community participation has been shown to empower young people across Europe to contribute to resilience planning, ensuring cultural relevance and increasing community engagement (Council of Europe, 2017) (case study: Council of Europe young people’s participation). Interactive emergency preparedness workshops have been used to educate residents about response strategies for natural hazards, fostering community ownership and dialogue while empowering individuals to develop community-centric definitions of resilience and participate in resilience-building efforts (Semmens et al., 2023) (case study: CREATE Resilience project).
Tailoring outreach strategies to address specific community’s needs helps mitigate vulnerabilities, ensuring equitable distribution of support and resources, thereby bolstering economic recovery and overall resilience (National Academies, 2012). For example, in the context of earthquake risk,audience segmentation approaches, based on individual’s behavioural patterns, can engage different groups of the public more effectively than standardised national campaigns (Adams et al., 2017). Thus, a range of targeted outreach strategies and interventions is required to effectively support the adaptable emergency responses that diverse individuals and communities typically need and prefer.
4.2.4. Building resilience through communication initiatives
The literature indicates that building resilience through communication initiatives can help to develop understanding of cultural dynamics, emphasising cultural literacy and humility as integral components (case study: Seattle Fire Department). For example, Lekas et al. (2020) advocate for an inclusive approach rooted in self-reflection, appreciation of lay expertise, power sharing, and continuous learning, ensuring that resilience planning considers the diverse cultures within communities. Actively involving community members in decision-making processes can empower some members to shape initiatives' cultural relevance, thereby enhancing their effectiveness and long-term sustainability (Norris et al., 2008).
Trends in the governance of health systems towards increasing active patient and public involvement (PPI) mirrored in public involvement in health research, further underscore the benefits of involving wider groups of the public in roles in emergency communications, such as the role of community health ambassadors (case study: Toronto Shelter Networks). Other initiatives, such as training community champions (South et al., 2024) (case study: UK COVID-19 pandemic), community health champions, peer supporters, or patient advocates, can involve individuals already experienced and engaged in health systems or voluntary and community organisations (VCOs).
Additionally, crisis communication strategies such as place-based roundtables or consultation workshops, that discuss the unique uncertainties that arise during emergencies, can enhance the potential of health communication to build community resilience (case study: Anglesey Council Wales).
4.2.5. Demonstrating commitment to equity and inclusion in health emergency communications
Upholding equality laws and anti-discrimination policies within social systems lays the foundation for an inclusive health emergency environment, to ensure that all communities receive crucial information and support during times of crisis (Adger et al., 2005; Cutter et al., 2008). Developing and disseminating emergency communication campaigns in multiple languages spoken within the community is a crucial first step in overcoming language barriers and promoting inclusivity (WHO, 2017). The WHO has developed a framework to broaden its reach to diverse audiences, committing to publish in six languages, thereby making access to health information and WHO communication resources more equitable and effective (case study: WHO). By prioritising multilingual content and inclusive communication strategies (e.g., for those who are blind, partially sighted, D/deaf, hard of hearing or those with learning disabilities) health emergency communications could better serve the diverse needs of communities, promoting equity and inclusion in disaster response efforts. Furthermore, using evaluation methods that consider diverse perspectives can enhance the effectiveness of resilience initiatives to be assessed inclusively and developed more coherently to reflect the needs of diverse communities (Cutter et al., 2008).