A total of 10,400 people were interviewed, and 5,41 households visited in all regions. The most represented regions were Centre1973 (19%), Far North1810 (17.4%) and Littoral1477 (14.2%). The median age of the participants was 32, with an Inter-quartile range of 25 to 43. The sex ratio (M/F) was 0.94:1 indicating a slight preponderance of women. Most of the participants were married, 4938 (47.5%), and the most common level of education was secondary, 4891 (47%). Finally, the Christian Catholic religion was most represented with 3803 (36.56%) (Table 1).
The most used by participants are television (23.56%), radio (21%) and social networks (15.91%), regardless of age group (Table 2).
In terms of trust, television is most reliable for 28.71% of participants, followed by radio (22.39%) and social networks (10.39%), regardless of age. Those living with comorbidities trusted television (30.59%) and radio (24.03%). Health informations provided by public health (34.12%), community (22.20%) and religious (16.07%) leaders are the most reliable (Table 3).
The most attractive communication tools were posters (7,143 or 42.79%) and banners (3,889 or 23.39%) for all age groups and all genders. Regarding acceptance to COVID-19 vaccination, 3154 (30.32%) participants were vaccinated. Radio (21.67%), television (20.63%) and Community Health Worker (CHWs) (9.65%) were the most frequently used communication channels.
The health information provided by public health leaders (34.12%), community leaders (22.20%) and religious leaders (16.07%) was the most reliable for participants.
Posters (42.97%), banners (18.7%) and flyers (16.76%) were the most attractive tools (Fig. 1).
The use of communication channel was statistically influenced by the presence of comorbidity (P < 0.001; OR =-0.44 [-0.64 - − 0.24]), and the use of a communication tools by level of education, notably secondary (P < 0.001; OR = 0.42 [0.24–0.59]) and university (P < 0.001; OR = 0.42 [0.20–0.65]). It was also influenced by the Eastern region (P < 0.001; OR = 1.44 [0.49–2.40]), the Far North (P < 0.001; OR = 0.98 [0.50–1.45]), Littoral (P < 0.001; OR =-0.66 [1.06–0.26]), North (P < 0.001; OR=-0.76 [1.16–0.36]) and South (P < 0.001; OR = 1.37 [0.42–2.33]). (Table 4).
Qualitative section
Three main topics emerged from the interviews: involving the most influential resource people in communication, capitalizing on community spaces, and capitalizing on influential communication channels and tools.
Involving the most influential resource people in communication
Several participants felt that community, traditional and religious leaders are better placed to deliver effective communication within the community, because the population trust them, and they are role models.
’(...) in a group where the traditional authority does not agree with what you come to do, they also have their means of communication to influence the communities not to accept what you bring, you are not going to see people running to start telling people here is the chief says that they’ (Es_EI_PFR_17/11/2023)
Journalists were seen by some participants as influential, as they conveyed a reliable and trusted message. They felt that the risk of misinformation coming from them was low, because they verify it.
“I consider information from Journalist those I know because I think they cannot give information that is not verified so when I see information from them, I take it very serious.” (NW_FGD_FE_21/11/2023)
Healthcare staff were the people authorized to maintain effective communications within the community. Several participants had taken the example of the influence of the message given by personnel during the COVID-19 pandemic.
CHWs are people who can communicate and convey information quickly because they are constantly in contact with the community, also with leaders who trust them on the quality of the message.
In addition, the type of messages to be conveyed must be adapted to each community. The local language must be used to ensure that the information is accessible to all, especially in rural areas.
“ « You have to speak their language [...] Today, you have to design targeted messages […]” (Es_Ei_PFCR_15/11/23)
Capitalizing on community spaces
In all regions of Cameroon, the physical gathering spaces known as community spaces were identified as the most influential spaces for communication. These were diverse, and included religious, residential, school, traditional (chiefdoms), community entertainment, hospital and commercial spaces. Although religious and traditional spaces were favored, residential spaces were more so, especially in rural areas.
“ I say that wherever there are gatherings, in churches, hospitals, mosques, public squares, even markets ”. (Ou_FGD_Fe_R1_16/11/23)
Moreover, communication in hospital spaces was identified as a preferred communication space by pregnant women and people living with comorbidities.
Schools were presented as influential communication spaces for children and teenagers.
Capitalizing on influential communication channels and tools
Some participants stressed the importance of capitalizing on all types of radio and TV (public, private, local, national, international).
“Uhhh to me I think the national station should not be used at a certain level because most people believe that the national station are just there to make money and just make stuff, so, there's a way we use private stations like equinox because most people believe in equinox more than they do believe in CRTV”. R3 (NW_FGD_AGE_15/11/2023)
Others pointed out that radio and television were more suitable for the elderly, as they had become accustomed to trusting the information they heard.
“ Now for the elderly, we know that they like to listen to the radio and television, so we can use them to raise awareness. … ” (Ou_R1_FGD_Fe_16/11/2023)
Most participants agreed that social networks had a huge influence today. They are often at the origin of rumors circulating within the community, because they are followed, and some people hardly trust the information given by contacts.
Young people were identified as the most influenced by social networks.
“...the age group most affected are those aged 20 and over ...... what they use today are social networks, so we need to do some really digital communication to be able to reach this target group... ” (Ce_EI_PF_15/11/2023)
Visual communication media, particularly posters, were the most popular among participants. In fact, according to the participants, they use images to capture attention and better fix ideas in the minds of the target audience.
“For example, if you organise an educational talk with visual aids, people get on board, because they see, you bring them in, you show them gravity, it starts here, it ends there, if you don't do this, you'll have to do this with supporting images, and people get on board.”. (Lit_EI_LC2_16/11/2023)