Making public health guidance trustworthy: Public Health Sensegiving under uncertainty

Public health emergencies confront officials with the challenge of communicating guidance that evolves as scientific evidence and institutional recommendations change. Although institutional trust is associated with adherence to public health measures, less is known about the interpretive and communicative work through which public officials seek to make changing guidance understandable, legitimate, and credible. Drawing on a comparative qualitative study of Brazil and Japan, this article examines trust-building communication among public officials involved in implementation, coordination, and policy oversight. The study is based on 122 semi-structured interviews and a 239-document corpus covering 2020-2022. Using abductive comparative analysis, we identify Public Health Sensegiving as the process through which officials interpret evolving scientific and institutional guidance and translate it into public-facing explanations. Empirical episodes show a recurrent sequence in which officials interpret ambiguous guidance, communicate workable explanations, and refine them in response to citizen questions. Four practices constitute this process: explaining and translating guidance, contextualizing risk and uncertainty, legitimizing recommendations, and encouraging voluntary cooperation. Comparisons within and across countries show that competing messages increased the need for reconciliation, whereas more consistent messaging allowed greater emphasis on continuity and shared responsibility. These differences reflect contextual communicative demands rather than fixed national types. Rather than demonstrating changes in citizens' trust or behaviour, the findings identify how officials perform trust-building communicative work under uncertainty and highlight interpretive capacity as a public health preparedness capability.