When COVID-19 swept across Uganda in 2020, the country’s clinics did not just battle a virus. They battled rumors. Pregnant women who should have been walking through the gates of their local health center for antenatal care suddenly stopped coming. Women living with HIV, people whose survival depends on taking antiretroviral therapy every single day, quietly interrupted their medications, afraid of something that had never been confirmed by a doctor. The source of that fear was not always the virus itself; it was what they had read on their phones or heard on the radio. A new qualitative study published in BMC Public Health by Adelline Twimukye of Makerere University’s Infectious Diseases Institute and the University of Nairobi, together with Catriona Waitt of the University of Liverpool and Charles Owuor Olungah of the University of Nairobi, examines precisely how digital and media literacy shaped health communication for maternal and HIV care during the pandemic years of 2020 to 2022. Drawing on the perspectives of 136 participants across multiple Ugandan sites, the research offers one of the most granular portraits to date of how misinformation infiltrates the most vulnerable corners of a health system, and what a more resilient communication architecture might look like.
The study, conducted between March and July 2025, used a retrospective qualitative cross-sectional design, asking participants to look back on their pandemic experiences. The research team layered three complementary methods. They carried out 28 in-depth interviews with women living with HIV, the group with perhaps the most at stake when health services wobble, since uninterrupted antiretroviral therapy is the bedrock of viral suppression and prevention of mother-to-child transmission. They then convened 14 focus group discussions, two per study site with six participants each, gathering 84 HIV-negative community members to capture the wider social fabric in which health decisions are made. Finally, they conducted 24 key informant interviews with health workers, policymakers, Community Advisory Board members and HIV activists, the professionals who stood on the front lines of the information battle. This triangulated structure matters methodologically: by comparing what women experienced, what communities believed, and what officials observed, the researchers could cross-check accounts and build a picture more robust than any single vantage point could provide. Analysis followed Braun and Clarke’s six-phase thematic framework, a rigorous inductive approach in which codes emerge from the data rather than being imposed upon it. The team then mapped the resulting themes onto Kleinman’s explanatory model, a classic framework in medical anthropology that examines how patients, families and clinicians each construct their own understanding of illness. That theoretical choice is telling. It signals that the authors view pandemic misinformation not merely as a technical failure of message delivery but as a clash between competing explanatory systems, in which a WhatsApp rumor about vaccines causing infertility can carry as much explanatory power for a pregnant woman as an official Ministry of Health bulletin, particularly when the rumor arrives in her own language and the bulletin does not.
Six themes crystallized from the data. The first concerned access to maternal and HIV information through digital and media channels, revealing a landscape of stark inequality. Radio and television remained lifelines for many, but smartphone ownership and reliable connectivity were unevenly distributed, leaving some women dependent on secondhand information relayed by neighbors. The second theme explored how participants understood and evaluated health information, and here the study surfaced a critical gap: many respondents lacked the practical skills to distinguish credible sources from fabricated ones, to cross-check claims, or to recognize the hallmarks of manipulated content. Digital and media literacy, the capacity to access, analyze, evaluate and create media messages, was not a luxury in this context. It was the immune system of public health communication, and for many it was compromised. The third theme documented a more hopeful counterpoint: digital media as a tool for health communication and service continuity. Where connectivity existed, it kept care alive. Telephone calls, text messages and social platforms allowed health workers to check in on patients, remind them of appointments, and deliver antiretroviral refills through adapted mechanisms when lockdowns made clinic visits hazardous. The same devices that spread suspicion could also carry reassurance; the difference lay in who was speaking, in what language, and with what kind of trusted relationship already in place.
The fourth theme, however, catalogued the challenges in accessing, understanding and using health information, and it is here that the study’s most sobering findings reside. Participants described inconsistent messaging from authorities, content that arrived in English rather than local languages, and the sheer velocity of rumor compared with the deliberate pace of official correction. Misinformation about COVID-19 shaped risk perceptions, deterred care-seeking, and disrupted treatment adherence, particularly for antenatal care and HIV services, where continuity is everything. The fifth theme examined social and contextual influences on information use, and it underscores why health communication can never be reduced to broadcasting. Decisions about whether to attend an antenatal visit or continue therapy were filtered through household power dynamics, religious beliefs, cultural understandings of illness, and the opinions of trusted figures in the community. A message from a distant official voice competed against a message from a mother-in-law, a pastor, or a village health team member known personally for years. In Kleinman’s terms, the explanatory models of family and community often outweighed the biomedical model in determining behavior. Any communication strategy that ignores this social architecture, the study implies, is shouting into a storm. From the sixth theme emerged concrete recommendations, and they read like a blueprint for pandemic-resilient health communication. Participants called for strengthening digital and media literacy itself, so that citizens are equipped not just with information but with the evaluative skills to judge it. They urged improvements in digital access, recognizing that literacy without connectivity is hollow. They demanded local-language content, so that vital guidance about antiretroviral therapy or danger signs in pregnancy does not evaporate at the boundary of a language barrier. They asked for consistent messaging, since contradictory guidance from different authorities corrodes the trust on which all compliance depends. And they proposed integrating digital channels, mass media and community-based approaches, a hybrid model in which a radio broadcast, a WhatsApp reminder and a village health team visit reinforce one another rather than compete.
The study’s authors are candid about its limitations. Because participants reflected on experiences from 2020 to 2022 during interviews conducted in 2025, recall bias was possible; memories of a crisis period can blur or be reshaped by subsequent events. The team mitigated this through careful probing, contextual prompts and triangulation across the three data sources, but the retrospective design remains a constraint worth noting. Ethical safeguards were thorough: approval came from the Makerere University School of Public Health Research and Ethics Committee and the Uganda National Council for Science and Technology, written informed consent was obtained from all participants with thumbprint provisions for those unable to sign, and confidentiality was protected through anonymized identifiers and pseudonyms in group discussions. The research was supported by the Royal Society of Tropical Medicine and Hygiene, with additional funding from the NIHR Global Health Research Professorship. Why does this Ugandan study resonate far beyond its borders? Because its central finding is universal: misinformation does not merely spread false facts, it disrupts the continuity of care on which chronic conditions depend. HIV is the paradigmatic case. Antiretroviral therapy demands near-perfect adherence, and prevention of mother-to-child transmission demands that pregnant women remain engaged with services through pregnancy, delivery and breastfeeding. A pandemic that simultaneously overwhelms clinics and floods the information environment with noise strikes precisely at that continuity. The study shows that misinformation, social and cultural beliefs, and limited access to digital health information together influenced how Ugandans understood COVID-19 and used health services, eroding trust in health messages and deterring care-seeking for maternal and HIV care specifically.
The implications for future pandemic preparedness are direct. Low- and middle-income countries, where smartphone penetration is partial and health literacy varies widely, cannot rely on digital-first strategies alone. The study’s vision is instead one of layered redundancy: digital tools for those who can reach them, mass media for broad reach, and community health workers, including Uganda’s village health teams, as trusted human translators of official guidance. Investing in digital and media literacy before the next crisis, the authors argue, is as much a part of pandemic preparedness as stockpiling oxygen or training intensivists. Clear communication, reliable information and digital inclusion are not soft accessories to a public health response. They are the connective tissue that keeps a pregnant woman attending her antenatal visits and a woman living with HIV taking her tablets, day after day, even when the world outside the clinic has gone quiet and strange. The study’s title, Leveraging digital and media literacy for effective health communication in maternal and HIV care during pandemics in Uganda, sounds local, but its lesson is global. The next pandemic will not wait for us to build a better information system. It will simply begin, and the question will be whether we have learned that truth, delivered in a language people trust, by people they trust, is as critical as any vaccine.