Identifying context-specific community understanding of COVID-19 and mental health in Haiti, Malawi, and Rwanda

Community health workers (CHWs) play a vital role in spreading health-related information in low-and middle-income countries. Assessing their knowledge is crucial to combat health misinformation.

To identify locally relevant COVID-19 and mental health-related information commonly held by CHWs and the misconceptions most prevalent in their communities in Haiti, Malawi, and Rwanda.

A card-sorting activity was conducted with 39 CHWs from rural communities in Haiti (n = 13), Malawi (n = 12), and Rwanda (n = 14), between February and April 2023. The activity involved free sorting, true/false sorting, and card ranking to assess CHWs' knowledge, beliefs, and misconceptions surrounding COVID-19 and mental health.

CHWs primarily categorized cards based on perceived truths, reflecting knowledge from trainings, media, and community beliefs. Overall, CHWs correctly identified 59% of true COVID-19 statements and 73% of false statements, with no statistical differences in COVID-19 knowledge rates among countries [correctly sorted as true: p = 0.421; correctly sorted as false: p = 0.128]. However, specific COVID-19 misconceptions varied across countries, such as beliefs about vaccine effectiveness and side effects. Mental health knowledge varied substantially across countries, with Haitian CHWs demonstrating the highest expertise in correctly identifying false mental health information [Haiti: median 86.0%; Malawi: median 21.0%; Rwanda: median 79.0%; p < 0.001)]. Significant misunderstandings about mental health causes and treatments were influenced by religious and spiritual beliefs.

CHWs have substantial gaps in information about COVID-19 and mental health. Knowledge of areas of misinformation can differ between countries. Constructing country-specific educational messages to address these areas can better inform CHWs and improve health literacy.