Building confidence in crises – the roles of Sierra Leonean religious leaders’ during the 2014-2016 Ebola outbreak

Abstract Background Religious leaders have been involved in risk communication campaigns for many years across West Africa such as their involvement in the HIV/AIDS pandemic response. Little is known about religious leaders' perceptions of their role in communicating Ebola risks during the 2014-2016 outbreak in Sierra Leone and the strategies they adopted to communicate these risks.  Methods In this qualitative study 10 semi-structured interviews were conducted with religious leaders in Freetown, Sierra Leone, to better understand their perceptions of their roles communicating risk during the outbreak. Five Christian and five Islamic leaders were recruited from multiple national religious organisations including male and female leaders. The data was analysed using thematic analysis.  Results Three themes were developed from the data which illustrate the different strategies religious leaders used when establishing public confidence in their role communicating risk and the messages they communicated during the outbreak. The religious leaders describe how they established themselves as non-political actors in the outbreak response, they provided support to their communities and used collaboration as a means to effectively communicate risk. The religious leaders adapted pre-existing roles and established new ones in order to build confidence among their communities. They flexibly and pragmatically utilised scriptural texts within these strategies to communicate risk and to establish confidence in their messages.  Conclusions Religious leaders were pragmatic in their approach to risk communication, leveraging political distrust and collaborating with other actors to strengthen their position. Interreligious unity as well as scripturally supported messaging helped establish confidence in the public health emergency response. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Sierra Leone Research and Scientific Review Committee granted ethical approval for this study in March 2019. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The underlying data will be made available from the authors on reasonable request.