Challenges and recommendations for COVID-19 public health messaging: a Canada-wide qualitative study using virtual focus groups.

Objectives: To understand Canadian's attitudes and current behaviours towards COVID-19 public health measures (PHM), vaccination and current public health messaging, to provide recommendations for a public health intervention.

Design: Ten focus groups were conducted with 2-7 participants/group in December 2020. Focus groups were transcribed verbatim and analysed using content and inductive thematic analysis. The capability opportunity motivation behaviour Model was used as our conceptual framework.

Setting: Focus groups were conducted virtually across Canada.

Participants: Participants were recruited from a pool of individuals who previously completed a Canada-wide survey conducted by our research team.

Main Outcome Measure: Key barriers and facilitators towards COVID-19 PHM and vaccination, and recommendations for public health messaging.

Results: Several themes were identified (1) participants' desire to protect family and friends was the main facilitator for adhering to PHM, while the main barrier was inconsistent PHM messaging and (2) participants were optimistic that the vaccine offers a return to normal, however, worries of vaccine efficacy and effectiveness were the main concerns. Participants felt that current public health messaging is inconsistent, lacks transparency and suggested that messaging should include scientific data presented by a trustworthy source.

Conclusions: We suggest six public health messaging recommendations to increase adherence to PHM and vaccination (1) use an unbiased scientist as a spokesperson, () openly address any unknowns, (3) more is better when sharing data, (4) use personalised stories to reinforce PHM and vaccinations, (5) humanise the message by calling out contradictions and (6) focus on the data and keep politics out.