Results
Table 1 displays the characteristics of 71 study participants.
Information sources, needs and barriers to accurate information
Participants’ narratives showed that most community members had good basic knowledge about COVID-19 and related prevention measures. Main information sources consisted of foreign television channels, information through family and friends, social media, and established community organizations. Some groups obtained information through media from their countries of origin rather than through official Belgian channels. This did not always reflect the local epidemic situation accurately, as illustrated by the following quote:
"The crisis has shown that … a large group in the immigrant community also follows the news in the country of origin. ...mouth masks for instance, we have noticed that immigrants started using them much faster than others. As it was required there [Morocco]." (KI, man, Moroccan community, civil servant)
Mainstream public health messages broadcasted in the national languages Dutch and French did not easily reach everyone. Participants mentioned both language and digital illiteracy as significant barriers:
" … there is a great deal of people of foreign origin living in Belgium and in the beginning very little attention was paid to them. People assumed 'okay, everyone watches the news and they'll follow it all', but nothing could be further from the truth." (KI, man, Turkish community, member of community organization)
In the beginning of the lockdown, translation of information through community initiatives took time. In addition, to respond to the needs of illiterate people of diverse foreign descent, prevention content had to be recorded and disseminated in audio format.
"The government has written messages in all languages: Arabic, Hebrew, Syrian, … that's good.
( …) but not everyone can read their language, there are Turkish people who are orally Turkish, but they can't read it. So, we have been working with audios …." (KI, woman, Moroccan community, member of community organization)
Family and friends were also mentioned as important information sources, often updating the constantly changing information.
"But, gosh. I would be surprised if people are not aware…Within families, there are children, young people, who often watch Flemish television and there are parents who watch Arabic or Turkish channels. But there is communication between the two, so I think that information usually reaches the parents. (KI, man, Moroccan community, civil servant)
Participants agreed that people belonging to established communities or religious networks were reached quicker than those with small social networks, who lived in social isolation, who had no access to digital information or who were illiterate.
"Most people are illiterate, so they ask other people ... and their church helps a lot in transferring information orally through announcements after services. The pastor did a lot at the beginning of the outbreak. He made a video and everyone got it… even translated in local languages the messages from government. ...People trust the church, because the way it is communicated."
(IDI, woman, Ghanaian church community)
The interviews and discussions showed that certain communities had difficulties in accessing nuanced information, such as newcomers with language problems, elderly first generation immigrants, and isolated or otherwise socially disadvantaged people. While these sub-groups reportedly were aware of the pandemic, they often could not keep up with the rapidly evolving scientific insights and acquire a nuanced understanding of transmission mechanisms and how this related to effective protection:
"People understand 'I have to stay indoors', ‘I have to put on a mask’, but thinking about how this virus spreads and what makes me have to adapt my behavior to the current situation, it is too difficult …. They can grasp direct guidelines, but the underlying idea of why those rules are there and how you can adjust your behavior to that, is difficult … some specific things are not getting through, like the coronavirus is in the air, not all these details were translated into other languages." (GD participant, woman, Belgian, social worker)
The follow-up key informant interviews showed that during the third lock-down, questions about constantly changing regulations persisted, while concerns shifted to COVID-19 vaccination. Key informants reported that mistrust in the health care system and particularly in the vaccine was fueled by community members’ negative experiences with health care provision. A community health worker targeting Moroccan youth explained how social exclusion and lack of trust in societal institutions posed a continuous challenge to keeping young people well informed:
“I tried to translate the measures to young people’s lingo, so that they knew what was allowed and what wasn’t...there is a lot of fake news online, and young people fall for it. They really believe that the vaccine renders girls infertile. Trust in the government and their policies is so damaged among these young people, not only because of corona, but of how they feel perceived by the society in general, especially those with migration background, they don’t feel that the government has their best interests at heart.” (KI, woman, community health worker, Moroccan community)
Previous negative experiences and mistrust were also coupled with COVID-19 prevention fatigue:
“People do not search for new information anymore, ... they don’t want even to look at it. People with low health literacy need to get information in a tailored, simple and slow way and they need to get opportunities to ask questions to a trusted source. But you will see, if someone poses questions to the staff at the reception, then the others will join in...” (KI woman, social worker, Belgian descent)
Risk perceptions
Most study participants perceived their communities to have about the same low risk of acquiring COVID-19 as the general population. At the beginning of the epidemic, people were said to have reacted with ignorance and denial, as shown by the following key-informant quote:
“... in the beginning this pandemic hit us so suddenly and we didn’t accept it, so some people are still in denial. They didn’t believe that it can happen to us, that was very interesting to see. People were still talking in big groups...because they thought ‘no it will not hit us, I will not get corona’. They were saying things like it can only happen to old people or maybe people who do not have good health and background.“ (KI, man, community health worker, Indian descent)
At the start of the first lockdown, some people of SSA origin perceived their risk as even lower compared with the white majority population due to a combination of reasons, as exemplified here:
“…yeah, but … it’s only happening to the European or Caucasian people’. … but also because the numbers weren’t very high in Africa … and because they are new in the country, they still get a lot of information from Africa … (IDI, woman, teacher at the integration classes, Somalian community)
The importance of feeling personally affected emerged as an important motivational factor for adopting prevention behavior. Being cut-off from mainstream information deferred this process. For instance, religious practice prohibits the use of mainstream media and social networks for some Orthodox Jewish communities:
"In the beginning everyone thought 'corona that's something in China, that's nothing for us'. Until it gets close... And if you have social media, and you follow mainstream media, it gets close faster. Because you see what's happening. If you don't have that, then you don't feel it until it really gets to yourself. Some Orthodox Jews didn't realize how close it already was until people they knew were infected." (IDI, man, Member of an Orthodox Jewish community)
Perceived negative impact of COVID-19
Several transversal themes emerged showing how the impact of COVID-19 was strongly intertwined with pre-existing social disadvantages. While the measures’ strongest effects were felt on income due to loss of job opportunities in informal economies, living circumstances were often described as extremely challenging for coping with the measures:
"Many people from our community, about 80%, are disadvantaged people. Sitting with three, four children in an apartment without a garden…for them it has actually been enough. Especially in big cities... This has a lot to do with their social situation: housing, income, problematic family situations, problems, debts,... people have other priorities: finding food for their children, for example, everything else takes a back seat." (KI, man, Moroccan community, social worker)
Socio-economic impact
Precarious working conditions were relatively common among study participants. Those working in uncertain conditions were not eligible to apply for temporary unemployment. Subsequently, many people kept on working whenever possible, even when experiencing symptoms of COVID-19:
"... so some just kept working [...] but imagine they are coughing and they would have to stay at home for two weeks, that is a disaster for us. Therefore they often try not to cough. … Those people can't do without work and always try not to cough like that. " (KI, man, Moroccan community, civil servant)
Many mentioned the bureaucratic complexities as a barrier to receive support, or needed help with the required administrative burden such as online submissions:
“It was also difficult for them to ask for temporary unemployment … some of them did that too late .. and we organized support groups to fill the form and send it online … and others had their identity card expired … they got many problems, so they could not get their money at the right time.” (KI, male, Community leader, Erithrean community)
People experiencing financial problems were also struggling to obtain prevention means such as mouth-masks, since only a limited number was disseminated for free by the City:
"... mouth-masks and hand sanitizers, they cost a lot of money. Mouth-mask sold at the market were a lot cheaper, but of which quality are they? It can make a lot of difference. They [the government] should make sure that these people have all the prevention means at their disposal" (IDI, man, community health worker, Belgian descent)
Psychosocial impact
For many participants, the pandemic created uncertainty towards the future, and the related measures triggered fears and chronic stress particularly among those who struggled to survive:
“People have fear. They are worried about the future: will we still be able to live as we used to? They wonder if social life will survive... the pandemic takes all our time, we have lost our social habits. Also, there is the economic crisis, the prices in supermarket have increased, many are jobless because many companies have closed.” (IDI, man, Cameroonian community)
The narratives also showed how COVID-19 impacted on family dynamics and relationships. Dealing with future uncertainties, financial struggles, and being confined to small homes with large families was experienced as quite demanding:
“…the lockdown itself is very bad for people’s physical and mental well-being (...) There are also a lot of separations. I've had to do three appointments this week for a divorce, ..., it's been difficult for everyone. And you know, in our culture a man is always outside and all of a sudden he has to stay inside. Psychologically it was heavy, very heavy. (KI, woman, Moroccan community, member of community organisation)
In addition, living with larger families – even when adhering to the social restrictions - could induce anticipated social stigma:
“I am a father of thirteen children. We are all locked-up, we cannot even go to the park because my car only has seven seats. Even if we do go out, I see other people looking at us, ‘does he take that many people?’, but they do not understand, they are all part of my family!” (IDI, male, Orthodox Jewish community member)
For some, anticipated stigma and the strict execution of the measures could lead to extreme social isolation. In particular those with limited access to updated information were said to be anxious and to isolate themselves more than needed, especially women and children:
“I heard from several people who didn't come out for six, eight weeks. Nobody in the family except the husband for errands. Kids and moms mostly stayed inside.” (GD participant, woman, social worker, Belgian)
However, other people felt targeted by the police and treated unfairly:
"Police presence like this has never been seen before and people really do fear the fines, that's why they follow the measures very strictly, they also literally say: "I'm not going outside, I don't want to risk a fine because I can't pay it"
(GD participant, woman, social worker, Belgian descent)
" ...measures were policed differently and that is not quite right. I observed this, I went to the square X [in a middle-class neighborhood], there are many outdoor pubs and benches, I see a slightly whiter target group. Then go to square Y, [neighborhood with high proportion of foreign-born population) ]. You see people coming outside as well, they are different. A lot more young people and families with migrant background, but there are a lot more fines issued there than in the other neighborhood. That's not the only incident, those are stories from youth workers who have seen that for themselves." (KI, man, Moroccan descent, social worker)
Disruption of social welfare services
During the first lockdown, social welfare services had discontinued or were only accessible online. The disruption of migration and integration services, such as reception centers where people register for first asylum applications, hit asylum-seekers hard. Many others, for instance those with irregular migration status, were illegible to obtain COVID-19 related support and they were cut off from support sources as well:
“For migrants, especially those without papers, corona is a catastrophe, a threat to survival.” (IDI , male, SSA communities)
To mitigate the measures’ adverse effects, social workers at youth-centers offering services for young people with immigration background were asking for more flexibility to offer continuous services while respecting the rules:
“Those young people don’t live in poverty, but they are vulnerable because of their cultural background, their networks, at school. They are often confronted with racism and discrimination. It’s already difficult for an adolescent to develop healthy, but these are additional barriers..’ (KI , woman, community health worker, Moroccan community)
For religious communities, the closing down of prayer-houses meant much more than not having the opportunity to pray, as shown by the following quote:
"It [closing the synagogue] feels like something is missing, yes.... First of all because of the social aspects. I meet friends there every day. We have breakfast together, drink coffee before or after prayers and study the Talmud. Of course it feels like something is missing.... when you can't do what you've been doing three times a day for your whole life." (IDI, man, community member of an Orthodox Jewish community)
Community response and participation
"So we did our best as much as we could and I think there is strength in that. We did this ourselves, we did not get it from above” (KI, man, Moroccan descent, social worker)
Many bottom-up initiatives at grass-roots level emerged right at the beginning of the COVID-19 epidemic to mitigate the measures’ negative consequences. They ranged from countering the lack of information (e.g. translation services, WhatsApp messaging), to practical support (e.g. food aid, administrative support, referral services) to psychosocial support (delivered by phone, through informal support networks). Existing social networks and community ties such as churches and faith-based organizations were essential in reaching people, yet often new dissemination tools were used:
“The mosque played an important role in communication to the communities, they have a special channel: a list of all members with data. These members can then be contacted and informed (...) in their own languages. Like, ‘This is the advice of the government and it must be followed’. Mosques have played a major role in the corona crisis, also through other channels such as Whatsapp”. (KI, man, Moroccan descent, social worker)
Respondents reported to have missed policymakers’ recognition for their engagement. They also felt that authorities did not trust communities to apply measures correctly, yet flexibly, at the community level to continue offering much needed support services. They lacked consultation with policymakers before issuing or changing control measures:
"We have no connections with the government, people are sitting at home, and it's really painful. If we had contact with the government ourselves, I'm sure we would have found a solution." (IDI, man, member of an Orthodox Jewish community, religious community worker)
Community volunteers felt the need for more inclusive communication, as put by one volunteer:
“It could be so much better. Involve your population and certainly the youth in decision-making. Sure, it's complicated to involve everyone, but there are already existing platforms and bodies that can be used to this end. They [the government] shouldn’t come up three days before the official communication of new measures so that everyone’s planning is messed up.” (KI, woman, Moroccan community, social worker)