Exploring the role of community-based knowledge brokers in public health communication through the lens of self-determination theory: A qualitative study

Background: Encouraging people to change their behaviour through public health messaging is challenging, and during the COVID-19 pandemic, many communities reported barriers adhering to government regulations and guidance due to the accessibility, understanding or mistrust of information. Stakeholders within community organisations have been recognised as potential brokers between Public Health authorities and communities. This study took a theory-informed approach to explore the ways in which brokering may work, through the example of the communication of health protection messaging during the COVID-19 pandemic. Methods: We adopted a qualitative cross-sectional study design using semi-structured interviews with key informants from the voluntary, community, faith and social enterprise sector (VCFSE), local private sector, schools and parish councils in the South West of England. Interviews were conducted online, and interview transcripts analysed using inductive thematic analysis. Themes were then interpreted through the lens of Self-Determination Theory (SDT), identifying factors consistent with providing support for basic psychological needs (autonomy, competence and relatedness). Results: Three themes were developed to describe community organisation actions in communicating public health messages to their communities; i) the emergence of a brokering function as a response to mistrust and misinformation; ii) tailoring information according to hyper-local community needs and differences, and iii) a perceived need for power to be delegated to the local level. The descriptions stakeholders gave of their actions aligned with recommended techniques for supporting autonomy (e.g. providing choice, a tailored rationale, and recognising barriers) and relatedness (e.g. emphasis of shared values and benefits). Conclusions: Community-brokers play a vital role in public health communication during crises. The application of self-determination theory could help to identify generalisable mechanisms through which they contribute. Policy frameworks and preparedness for future public health emergencies should acknowledge the role of community-brokers and include appropriate mechanisms to enable enhanced support of their communities.