{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:51:41Z","timestamp":1791525101852,"version":"4.3.4"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Rapid qualitative assessments and community feedback mechanisms are increasingly recognized as core components of risk communication and community engagement in public health emergencies, yet few documented examples exist of how this evidence has directly influenced outbreak response decision-making. This case study examines the 2023\u20132024 cholera outbreak in Zambia, analyzing how social and behavioral data generated through multiple rounds of rapid qualitative assessment, alongside national community feedback mechanisms, informed multisectoral response activities. Drawing on document review, consultations with response pillar members, assessment reports, feedback dashboards, and triangulation with epidemiological data, the study traces how community concerns, rumors, beliefs, perceptions and priorities were collected, analyzed and applied across health, water, sanitation and hygiene, and protection response pillars. Enabling factors included pre-existing technical capacity, strong partnerships between government humanitarian actors, and academia, and rapid feedback loops that supported near real-time adaptation. Challenges at different points in the response included delayed resource allocation, uneven subnational coordination, and limited capacity to process large volumes of feedback data. The Zambia experience demonstrates that community-generated evidence can meaningfully influence outbreak response when integrated across response pillars rather than confined to behavioral interventions alone, representing a broader shift in public health practice that positions community perspectives as central to decision-making. This, in turn, strengthens effectiveness, trust, accountability, and transparency by aligning interventions with community-identified priorities. While grounded in the Zambian context, the findings are relevant for preparedness, anticipatory action, and response across a range of public health emergencies.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1895133","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:30:19Z","timestamp":1791523819000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["From listening to action: how social and behavioral evidence informed multisectoral cholera response in Zambia, 2023\u20132024"],"prefix":"10.3389","volume":"14","author":[{"given":"Soha","family":"Karam","sequence":"first","affiliation":[{"name":"Anthrologica Ltd","place":["Oxford, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Butler","sequence":"additional","affiliation":[{"name":"Anthrologica Ltd","place":["Oxford, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tikulirekuti","family":"Banda","sequence":"additional","affiliation":[{"name":"UNICEF Country Office","place":["Lusaka, Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Woldemeskel","sequence":"additional","affiliation":[{"name":"UNICEF Country Office","place":["Lusaka, Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Mweemba","sequence":"additional","affiliation":[{"name":"Department of Health Promotion and Education, The University of Zambia","place":["Lusaka, Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mulanda Joseph","family":"Mulawa","sequence":"additional","affiliation":[{"name":"Department of Health Promotion and Education, The University of Zambia","place":["Lusaka, Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalangwa","family":"Kalangwa","sequence":"additional","affiliation":[{"name":"Ministry of Health","place":["Lusaka, Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie","family":"Jones","sequence":"additional","affiliation":[{"name":"Anthrologica Ltd","place":["Oxford, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasiia","family":"Atif","sequence":"additional","affiliation":[{"name":"United Nations Children\u2019s Fund (UNICEF) Global Programme Division","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth Ganter","family":"Restrepo","sequence":"additional","affiliation":[{"name":"International Federation of Red Cross and Red Crescent Societies (IFRC), Africa Regional Office","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yves","family":"Ngaleu","sequence":"additional","affiliation":[{"name":"International Federation of Red Cross and Red Crescent Societies (IFRC), Country Cluster Delegation for Zimbabwe, Zambia and Malawi","place":["Harare, Zimbabwe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"McKenna","sequence":"additional","affiliation":[{"name":"(Formerly of) Risk Communication Community Engagement (RCCE) Collective Service","place":["Geneva, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"James","sequence":"additional","affiliation":[{"name":"Anthrologica Ltd","place":["Oxford, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliet","family":"Bedford","sequence":"additional","affiliation":[{"name":"Anthrologica Ltd","place":["Oxford, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Smith","sequence":"additional","affiliation":[{"name":"Anthrologica Ltd","place":["Oxford, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"ref1","year":"2005"},{"key":"ref2","year":"2024"},{"key":"ref3","year":"2020"},{"key":"ref4","year":"2020"},{"key":"ref5","author":"Karam","year":"2024"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e008652","DOI":"10.1136\/bmjgh-2022-008652","article-title":"Risk communication and community engagement capacity in the eastern Mediterranean region: a call for action","volume":"7","author":"Samhouri","year":"2024","journal-title":"BMJ Glob Health"},{"key":"ref7","year":"2022"},{"key":"ref8","year":"2024"},{"key":"ref9","year":"2024"},{"key":"ref10","year":"2019"},{"key":"ref11","year":""},{"key":"ref12","volume-title":"Risk Communication and Community Engagement Strategy for Cholera Response","year":"2024"},{"key":"ref13","volume-title":"Collective Service Evidence Tracking Framework Project: Case Study of RCCE Evidence in the 2023-2024 Cholera Outbreak in Zambia","year":"2024"},{"key":"ref14","volume-title":"Zambia Cholera Situation Report: Situation Report Twenty-Nine as of 29th January 2024","year":"2024"},{"key":"ref15","volume-title":"Rapid Qualitative Assessment Report Two: Perceptions and Experiences of Cholera Patients and Families in Lusaka Hotpots","year":"2024"},{"key":"ref16","year":"2024"},{"key":"ref17","volume-title":"EMR Fast-Track Narrative: Collective Service Response to Acute Public Health Emergencies in Zimbabwe and Zambia","author":"McKenna","year":"2025"},{"key":"ref18","volume-title":"Zambia Multisectoral Cholera Outbreak 2023\/2024 Response Intra-Action Review Report","year":"2024"},{"key":"ref19","year":"2024"},{"key":"ref20","volume-title":"RCCE Weekly Meeting, 15th March 2024","year":"2024"},{"key":"ref21","volume-title":"Insights Brief: Drivers of Cases and Case Fatality Amongst Children in Lusaka Hotspots","year":""},{"key":"ref22","volume-title":"Zambia Flash Update #7 [Situation Report]","year":"2024"},{"key":"ref23","volume-title":"Zambia Interagency Community Feedback Database","year":"2024"},{"key":"ref24","volume-title":"ZAM Community Feedback Database Main Cholera Response","year":"2024"},{"key":"ref25","year":"2025"},{"key":"ref26","volume-title":"Collective Service (CS) Country-Level Risk Communication and Community Engagement (RCCE) for COVID-19 Response in Malawi, Kenya, Uganda, and Zambia","year":"2024"},{"key":"ref27","volume-title":"Collective Service Mid-Term Grant Report Zambia and Zimbabwe: Emergency Response to the Cholera Outbreaks","year":"2024"},{"key":"ref28","volume-title":"Cholera Key Messages for the General Public","year":"2024"},{"key":"ref29","volume-title":"Key Issues\/Insights from Lusaka RQAs, Round 3 February 1\u20133, 2024","year":"2024"},{"key":"ref30","volume-title":"Retrospective Study Validation Meeting","year":"2025"},{"key":"ref31","volume-title":"Re: UNICEF Zambia\u2014Questions","author":"James","year":"2025"},{"key":"ref32","volume-title":"Stakeholder Consultations","year":"2025"},{"key":"ref33","volume-title":"Zambia Interagency RCCE Action Tracker","year":"2025"},{"key":"ref34","volume-title":"Stakeholder Consultation","year":"2025"},{"key":"ref35","volume-title":"Rapid Qualitative Assessment of Community Perceptions towards Cholera: Summary Findings and Recommendations","year":"2024"},{"key":"ref36","volume-title":"Stakeholder Consultations","year":"2025"},{"key":"ref37","volume-title":"Stakeholder Consultations","year":"2025"},{"key":"ref38","volume-title":"RCCE Pillar","year":"2024"},{"key":"ref39","year":"2024"},{"key":"ref40","volume-title":"3Cs to Stop Cholera","year":"2024"},{"key":"ref41","year":"2024"},{"key":"ref42","volume-title":"Press Statement on the Cholera Situation in Zambia January 2024","year":"2024"},{"key":"ref43","volume-title":"Press Statement on the Cholera Situation in Zambia February 2024","year":"2024"},{"key":"ref44","volume-title":"Stakeholder Consultations","year":"2025"},{"key":"ref45","author":"Chipungu","year":"2020"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"19","DOI":"10.11604\/pamj.2024.48.19.43659","article-title":"Multisectoral approach for the control of cholera outbreak - lessons and challenges from Lusaka district - Zambia, October 2023 - February 2024","volume":"48","author":"Kateule","year":"2024","journal-title":"Pan Afr Med J"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1895133\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:30:24Z","timestamp":1791523824000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1895133\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":46,"alternative-id":["10.3389\/fpubh.2026.1895133"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1895133","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]},"article-number":"1895133"}}