Community interpretation in Ebola virus disease control: analysis of perceptions in Kasai, Democratic Republic of Congo

¹Department of Literature, Translation and Interpreting Sciences, Faculty of Literature, Languages and Arts, Université Pédagogique Nationale, Kinshasa, Democratic Republic of the Congo, ²African Forum for Research and Education in Health, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, ³Association of Professional Translators and Interpreters of Congo, Kinshasa, Democratic Republic of the Congo, ⁴Department of Phytotherapy and Traditional Medicine, Faculty of Medicine, Université Notre Dame du Kasayi, Kananga, Democratic Republic of the Congo, ⁵Kinshasa Provincial Coordination, National Program for Emergencies and Humanitarian Action, Kinshasa, Democratic Republic of the Congo

^&Corresponding author
Mineze Kwete Minga, Department of Literature, Translation and Interpreting Sciences, Faculty of Literature, Languages and Arts, Université Pédagogique Nationale, Kinshasa, Democratic Republic of the Congo

Introduction    

The Democratic Republic of the Congo (DRC) has experienced recurrent outbreaks of Ebola virus disease (EVD), a highly infectious and often fatal disease that requires effective public health interventions to control its spread, including the implementation of the Risk Communication and Community Engagement pillar [1,2]. The Kasai region, characterized by linguistic diversity and complex sociocultural dynamics, has been particularly vulnerable during recent outbreaks [3,4]. Effective communication with affected communities is essential to promote adherence to preventive measures, encourage early access to care, and combat misinformation [5-7] .

Language barriers in multilingual environments such as Kasai complicate health communication, making it necessary to rely on community interpreters who serve as cultural and linguistic mediators between health workers and local populations [8]. These interpreters do more than translate words; they contextualize health messages to align them with local beliefs and customs, thereby promoting better understanding and acceptance [9].

On a global scale, the experience of recent health crises-particularly the COVID-19 pandemic -has confirmed that linguistic minorities and underserved communities face increased risk when public health messages are not appropriately translated or communicated [7,10-13]. In many healthcare systems, community interpreters, language mediators, or bilingual staff play a crucial role in translating complex biomedical language into actionable and culturally relevant messages. Although the literature on the contribution of interpreters in public health focuses more on clinical medicine than on epidemics per se, it establishes a compelling foundation for understanding the role of interpretation in public health emergencies [14-16].

In Africa, responses to Ebola epidemics have gradually incorporated community-based approaches, collaboration with community leaders, local radio stations, survivors, faith-based organizations, and community health workers [6,17,18]. UNICEF's regional report on Ebola preparedness and response in countries neighboring the DRC shows that the effectiveness of interventions depended largely on their adaptation to cross-border dynamics, local languages, trusted figures, and community feedback mechanisms [19,20]. The same applies to Africa CDC and the DRC's other technical and financial partners, including the WHO African Region and UNICEF, which emphasize the institutionalization of Risk Communication and Community Engagement (CREC) mechanisms capable of addressing local concerns, rumors, vulnerabilities, and the sociocultural diversity of communities [21-24].

Studies carried out in the DRC on the tenth Ebola outbreak in North Kivu and Ituri revealed that communities were mainly involved in disseminating information, yet they would have been able to contribute more had they been fully involved in the response [2]. Further analyses during the epidemic showed that, whilst community and civil society organisations were genuinely involved, their efforts were hampered by persistent challenges, such as insecurity, low awareness and a failure to comply with certain safety measures [25]. Furthermore, research on dignified and safe burials, as well as on the perceptions of funeral staff, indicates that the acceptability of interventions increases when teams are supported by local stakeholders and community-based support mechanisms, particularly community health workers (community outreach workers) [26,27], reinforcing the idea that locally rooted linguistic and cultural mediation can improve the response.

It therefore remains essential to overcome linguistic and cultural barriers to successfully control epidemics, as communication problems can lead to mistrust, misinformation, and non-compliance with public health measures [3,6]. Community interpretation is therefore a promising approach for improving the effectiveness of communication in multilingual and multicultural epidemic contexts [14,28]. However, challenges such as inadequate training of community interpreters, limited resources, and the risk of misinterpretation can undermine its impact [29,30].

The importance of linguistic factors in the public's adherence to public health interventions during epidemics is now well established; by extension, so is the importance of community interpreting. One observation stands out, however: little research has specifically focused on community interpreting as a subject in its own right in the fight against Ebola virus disease (EVD), although some studies have examined the crucial role played by translators and interpreters during the COVID-19 pandemic [31]. This gap is particularly significant in Kasai Province, where linguistic diversity, coupled with the population's active search for information [32], necessitates effective communication to ensure community buy-in.

Little is known about how different stakeholders perceive the role, contribution, and effectiveness of community interpreting, or the barriers to its implementation in this context. Accordingly, this study aims to address the knowledge gap by exploring the perceptions of the relevant stakeholders and the challenges they face, in order to generate data that can inform the development of communication strategies and public health policies better suited to the cultural and linguistic realities of Kasai Province.

Methods     

Study design, setting, and period: this was an exploratory qualitative case study analyzing stakeholders' perceptions of the contribution of community interpretation to the fight against Ebola virus disease in Kasai Province, Democratic Republic of the Congo. The study was conducted in the Bulape and Mweka health zones over six months, from November 2025 to May 2026. In 2025, Kasaï had a population of approximately 6,631,024, with a population density of 69 people per km² and a predominantly young population, 58% of whom were under the age of 20. The province is characterized by significant cultural and ethnic diversity resulting from the coexistence of indigenous groups (Ndengese, Bushong, Kuba, Kete, Leele, Luba, Lulua, Pende, Tshokwe, and Lunda) and communities from neighboring provinces as well as from Angola. The main economic activities are based on agriculture, livestock raising, trade, artisanal diamond and gold mining, palm oil production, and logging. Geographically, the province features ecological diversity characterized by dense rainforest in the north and sub-equatorial forest and savanna in the south. Like the rest of the country, Kasai faces several health challenges, including recurrent outbreaks of Mpox, cholera, and measles, against a backdrop of persistent economic constraints. In September 2025, the Bulape rural health zone was the epicenter of the 16^th Ebola virus disease (EVD) outbreak in the DRC and the third recorded in Kasaï, following those in Luebo in 2007 and Mweka-Luebo in 2008-2009 [33] (Figure 1).

Data collection: data collection relied on two essential and complementary qualitative methods: in-depth interviews (IDIs) and focus group discussions (FGDs). The IDIs were conducted with stakeholders involved in the MVE response, particularly those engaged in risk communication, community engagement, and community interpretation. These interviews explored participants' perspectives on community interpretation, their experiences, the resources and training they had received, the languages used in health communication, as well as their perceptions of the usefulness, effectiveness, and challenges of this approach in combating MVE. Two FGDs were conducted, the first with men and the second with women from the affected communities. The third was with community leaders. These discussions provided deeper insights into collective perceptions, understanding of health messages, mechanisms for information uptake, observed behavioral changes, and the level of trust in the response teams. The in-depth interviews and discussions, conducted in French, Tshiluba, Lingala, or Kuba depending on the participants' preferences, were tape-recorded and supplemented by field notes focusing on nonverbal cues.

Study population, sample size, and inclusion criteria: purposive sampling was used to select 40 participants, divided between focus group discussions (FGDs) and in-depth interviews (IDIs). Three FGDs each included 12 participants-for a total of 36 people-comprising members of the affected communities who were directly exposed to the messages translated as part of the EVD response, as well as community leaders. The latter included religious leaders, village chiefs, representatives of community outreach teams, and registered nurses. The IDIs involved four key response actors: the Chief Medical Officer of the Bulape Zone, a representative of the Risk Communication and Community Engagement (CREC) team, a community interpreter, and an epidemiologist (also a member of the response team). These participants were selected because of their strategic roles in managing the epidemic. The study included members of the affected community who had experienced community interpretation during the Ebola epidemic, as well as stakeholders who participated in response activities during the study period and voluntarily agreed to participate.

Data analysis: data analysis followed Braun and Clarke's inductive thematic analysis approach [34], which prioritizes the emergence of categories and themes from the data rather than a pre-established theoretical framework. It unfolded in four main stages. First, the audio recordings were transcribed in full and translated into French when they were recorded in local languages, then reviewed several times to facilitate immersion in the data. Second, the transcripts were coded using Atlas.ti software by a team composed of public health experts with experience in qualitative research and community interpretation specialists. A common coding framework was developed by consensus. Third, the codes were grouped into categories and then into themes reflecting the participants' perceptions and experiences. Finally, thematic summaries were produced in line with the study's objectives. To strengthen the credibility of the results, triangulation of sources, methods, and analyses, as well as a reflective approach by the researcher, were applied throughout the research process.

Ethical considerations: the study protocol was approved by the Ethics Committee of the Kinshasa School of Public Health and assigned the following number: ESP/CE/47B/2025. An informed consent form detailing the objectives and nature of the study, the duration of the interview, and the option for free and voluntary participation was presented to all participants prior to the interviews in the participants' native language. The team consistently ensured respect for local customs during the focus group discussions. The confidentiality and anonymity of the participants were guaranteed throughout the study.

Results     

The sociocultural and linguistic context of the EVD outbreak in Kasai context of the EVD epidemic

The Ebola virus disease (EVD) outbreak in the Bulape health zone occurred at a time when the DRC was facing its 16th Ebola outbreak. The Mweka territory had already experienced two previous outbreaks, particularly in Kampungu in 2007 and in Kalamba in 2008. However, for the people of Bulape, this disease remained a new and little-known public health issue, requiring a tailored approach to raise awareness among the communities. In this context, the response prioritized the involvement of local community members to facilitate communication and understanding of prevention messages in local languages, particularly Tshiluba and Kete. Community engagement thus emerged as a central element of the response strategy, with local stakeholders integrated into field teams to ensure the interpretation and dissemination of messages to the population. "The DRC is experiencing its 16^th Ebola virus disease outbreak. And the Mweka territory is experiencing its third outbreak, since the first outbreak was in 2007 in Kampungu, the second in 2008 in Kalamba, and today we are in Bulapé. And for the Bulapé health zone, since this is a new and unfamiliar public health issue, that's how we had to approach this community regarding the disease," IDI_epidemiologist. "Among the response members, we always recruited people from the community. (...) Members of the local community here (...) can easily convey the message in Tshiluba-either in Tshiluba or in Kete," FGD-men.

Linguistic and communicative realities

The results show that the communities of Bulape and Mweka live in a multilingual environment characterized by the coexistence of several national languages and local dialects. Participants mention the use of Tshiluba, Tshikété, Tshikuba, Lingala, Tetela, and other local languages depending on the community groups present. Tshiluba, however, appears to be the lingua franca for the various communities, including Tshiluba and Lingala speakers. At the same time, participants emphasized the importance of the Kete dialect in local communication in Bulape. "We use Tshikété, Tshiluba, and Tshikuba as well," women's FGD. "People speak different languages. There are also those who speak Tétéla," women's FGD. "Tshiluba is our common language, so regardless of our origins or tribes, we all speak Tshiluba and are able to understand one another," women's FGD. The data revealed the existence of forms of nonverbal and symbolic communication, particularly in certain local cultural practices. Among the Kétés, certain signs and gestures serve as codified means of communication understood only by initiates. Participants also mentioned the presence of deaf and mute individuals in the communities, with communication relying primarily on gestures and the empirical learning of sign language. These gestures were also used to convey public health messages. "When we go there, we use key words. (...) I can only move (...), and I say, 'If I do this, that's already communication," FGD-men. "Yes, there are some in the community. We use gestures," FGD-women. "We approach them and make the same signs so they can understand. I take the soap (...) I wash my hands, and then with the sign, I can show them that this is a gesture they need to repeat several times a day," FGD-women.

The multidimensional role of community interpreters in the Ebola response

Selection and profile of community interpreters

The data shows that community interpreters were, in fact, ad hoc interpreters, generally chosen for their proficiency in local languages and their ability to communicate with response teams, which often consisted of personnel who did not speak the community's languages. Their selection was also based on their community ties and their knowledge of local sociocultural realities. In some cases, response teams directly identified community members capable of serving as language liaisons. Some interpreters were trained or formally involved in the activities of partners and health facilities. "So, what did he do? He could bring in a community member who knew the team's language to help the population understand these messages," FGD-men. "Actually, they're the transcribers. Translators are people with diverse linguistic backgrounds brought together and trained to bridge differences," IDI_MCZ. Participants also applied various descriptors and titles to interpreters, revealing the diversity of roles they played in the response. They were described as "facilitators," "bridges," "channels" of communication, or even "evangelists" tasked with convincing and raising awareness among communities. Some participants also likened them to intercultural mediators capable of bridging the gap between local communities, response teams, and expatriates. "Transcribers and translators are really the facilitators we have in mind," IDI_MCZ. "The community sees the community interpreter as the channel through which the message will be conveyed. The interpreter is the bridge that facilitates the task," IDI_interpreter. "An interpreter is an evangelist. Their job is to evangelize, to convert, to win souls," IDI_interpreter.

Operational functions and linguistic and cultural reflection

Community interpreters were heavily involved in Ebola virus disease response activities, particularly in awareness campaigns, community dialogues, home visits, religious activities, and information sessions led by RCCE teams. Beyond translating health messages, they helped adapt them to local sociocultural realities. Their participation-often regular or even daily-also extended to formulating and adjusting messages before they were disseminated to communities. "Every week, we held public forums (...) and even every day (...) we provided interpretation practically every day," IDI_ CREC team member. We had stepped up our awareness-raising efforts." "Awareness-raising didn't just take place in churches, but also in neighborhoods and on the streets," FGD-women.

Community interpreters as facilitators of multistakeholder collaboration in the response to MVE

The analyses highlight close collaboration between community interpreters and response teams, both during preparatory meetings and in the field and in risk communication activities. By facilitating the transmission of health messages and exchanges between health professionals, international partners, and local communities, interpreters played a key role in implementing interventions. They also served as cultural brokers between expatriates and the communities, despite some tensions related to the coordination of activities and the rush by international partners to collect data. "As a community interpreter, whenever there was planning with health authorities (...) we were always included in the meetings," IDI_interpreter. "A white person, someone who speaks English or French (...) will have problems. I was there as a conduit through which the message had to be passed on to the expatriates," IDI_interpreter. "There was always something being kept hidden. And the data-that was the battle," IDI_MCZ.

The perceived contribution and quality of community interpretation during the Ebola outbreak in Kasai

Community interpretation as a pillar of the response to Ebola

The analyses show that community interpretation was widely perceived as an essential component of the response to the Ebola outbreak in Kasai. Participants emphasized that translating health messages into local languages promoted understanding of the disease, strengthened trust in response teams, and encouraged the adoption of preventive measures. Similarly, some female focus group participants noted that the translations had helped bring about lasting changes in community behavior. "There was trust. We believe that when translations were provided, we came to understand that the Ebola virus was spreading in our community and that we needed to take the necessary measures to protect ourselves," FGD-women. "Yes, but other behaviors of ours had also changed, because the translation helped us understand that we needed to take health measures to protect ourselves against the epidemic and its spread," FGD-women.

Community interpretation as a tool for protecting community health

The perceived quality of the interpretation also depended on the sense that the messages were primarily aimed at protecting the communities. Outreach workers and interpreters were seen as key players in rebuilding trust between communities and health facilities. Community members also recognized that the quality of message delivery could have direct consequences for public health. One participant highlighted their role in supporting people who were afraid to visit health centers: "Most of what we were told was meant to protect us [...] everything was done to ensure our survival," FGD-women "Because if you don't get the message across properly, the population will be destroyed," IDI_interpreter.

Community interpretation as a means of fostering ownership of Ebola prevention messages

Similarly, a member of the RCCE team had also reported that interpretation was an asset that facilitated the adoption of the messages. As for the interpreters themselves, their role was seen as crucial to the success of the response. "As far as interpretation is concerned, we didn't encounter any resistance or refusal. [...] On the contrary, it was a plus for the community [...] the interpreter [...] almost makes the message their own," IDI_CREC team member. "The community really values community interpretation. [...] They truly view interpreters as their gods [...] because they make things easier for them," IDI_interpreter.

Community interpretation as a source of social and economic expectations

Perceptions of community interpretation were sometimes influenced by certain social and economic expectations associated with the presence of interpreters and outreach workers. In some communities, these individuals were seen not only as conduits for health information, but also as people who could provide material assistance or facilitate access to employment opportunities. "… They thought that people come to provide jobs," FGD-women.

Community interpretation perceived as a tool for enforcing response measures

According to accounts from some participants, communities sometimes viewed outreach workers as agents tasked with enforcing response measures rather than as community mediators. These perceptions could lead to misunderstandings, mistrust, or unmet expectations, which could affect the public's adherence to interventions to combat Ebola virus disease. "When you communicate, for example, you say, 'Don't eat bush meat.' It's not easy to understand, and people will say to you, 'But we all eat it; there's no problem-how come you're just… misleading us…" FGD-community leaders.

Challenges of community interpretation during the Ebola outbreak in Kasai

Linguistic and cultural barriers and community mistrust

Community interpretation efforts during the Ebola outbreak in Kasai faced significant linguistic and cultural barriers. Prevention messages, developed primarily in French, were difficult to translate into local languages such as Tshiluba, Kete, and Tshikuba. Many biomedical concepts lacked precise equivalents, leading to misunderstandings, omissions, or approximate rephrasings. One participant also reported difficulties related to proverbs, cultural expressions, and the ethnic and linguistic diversity of the communities. To overcome these obstacles, the teams sometimes used concrete examples or comprehension tests to assess whether the message had been correctly understood. "Translating certain terms into either Tshiluba, Kuba, or Kete posed some challenges," FGD-community leaders. "When we hit a wall with an interpretation [...] I skip that part [...] The main thing is, we know the key message has already been conveyed," FGD-community leaders. Response teams also faced significant community mistrust. Refusal to listen, insults, and even physical attacks-including stone-throwing at response vehicles-complicated awareness-raising activities. Several health messages also conflicted with local cultural practices, particularly funeral rites, the consumption of bush meat, and contact with the deceased. Added to this were concerns about vaccines, particularly the side effects reported by local communities. "People threw stones at us [...] to say, "No, your vehicles aren't allowed to pass through here; they're digging holes here," FGD-Men. "For him, kissing the deceased is an expression of genuine sympathy [...] and it wasn't easy to convince people from that culture," FGD-community leaders.

Organizational and logistical challenges

Community interpretation activities also faced significant logistical and organizational constraints that limited their effectiveness. The lack of supplies, personal protective equipment, and appropriate educational materials reduced the capacity to respond on the ground. This situation was exacerbated by the absence of prior terminological preparation and mechanisms for harmonizing health concepts in local languages. Training sessions for response personnel were conducted exclusively in French, without adequate linguistic adaptation, which led interpreters to improvise when conveying messages. Furthermore, the frequent use of translators recruited on an ad hoc basis from affected communities or households contributed to variations in the interpretation of messages and could compromise their consistency, accuracy, and comprehension by the target populations. "A single microphone had to be shared between the speaker and the interpreter," IDI_CREC team member. "We were coming into contact with households that were truly unprotected," FGD-community leaders.

Discussion     

This study analyzed stakeholders' perceptions and the challenges of community interpretation during the 16^th Ebola outbreak in Bulape (Kasai). The results provide useful insights into adapting communication strategies and public health interventions to local sociocultural and linguistic realities. The main findings are discussed below.

Community interpretation as a key driver of community engagement in the Ebola response

The results show that community interpretation served as an essential mechanism for risk communication and community engagement during the Ebola outbreak in Kasai. Participants unanimously emphasized that translating messages into local languages promoted understanding of the disease, strengthened trust in response teams, and facilitated the adoption of preventive measures. This observation aligns with the findings of Mwamba and Akilimali, who identify risk communication and community engagement (RCCE) as the backbone of the response to the 16^th Ebola outbreak in the DRC, supporting all other pillars of the response, including surveillance, infection prevention and control, vaccination, and case management [35]. This convergence suggests that community interpretation should not be viewed as a peripheral translation activity, but rather as a strategic determinant of the effectiveness of public health interventions. In contexts where communities are confronted with a new and poorly understood disease, as was the case in Bulape, understanding the messages is a prerequisite for community acceptance. Thus, interpretation appears to be a mechanism for reducing the information asymmetry between public health experts and local populations. The results also corroborate the work of Diarra et al. who showed that communities in North Kivu and Ituri were primarily involved in disseminating information during the Ebola epidemics. However, our study goes further by demonstrating that this dissemination did not rely solely on general community participation, but on specific actors capable of providing linguistic and cultural mediation tailored to local realities [2].

Beyond translation: the interpreter as cultural mediator and trusted actor

One of the main contributions of this study is that it highlights the multidimensional nature of the role of community interpreters. Participants describe them successively as facilitators, bridges, channels of communication, evangelists, and intercultural mediators. This plurality of functions goes far beyond the traditional conception of the interpreter as a mere neutral conveyor of information. These findings align with those of de Cotret et al. who demonstrate that interpreters in public services are not merely linguistic intermediaries, but proactive actors capable of adapting messages and fostering collaboration among different stakeholders. According to these authors, the interpreter's neutrality does not imply passivity, but rather the ability to intervene strategically to maintain mutual understanding and trust [36]. In the context of Kasai, this role appears particularly important given the linguistic diversity observed and the coexistence of multiple cultural frameworks. Interpreters played a decisive role in contextualizing public health messages and in translating biomedical concepts that were sometimes far removed from local conceptions of disease. The findings of Aguilar Muñoz [31] on the COVID-19 pandemic reinforce this interpretation. The author emphasizes that translators and interpreters served as bridges between cultures, enabling the effective transfer of essential information during the global health crisis. The results of our study demonstrate that this function of cultural mediation is just as fundamental in African epidemic contexts.

Language as a determinant of the acceptance of public health messages

The results reveal that the use of local languages, primarily Tshiluba and Tshikete, facilitated the adoption of prevention messages by communities. Participants directly associate translation with a better understanding of protective measures and behavioral changes. These observations are consistent with the findings of Seale et al. who demonstrated that community leaders consider the translation of public health messages essential for effectively reaching linguistic minorities. Their study also highlights the importance of shared responsibility between health authorities and community actors in disseminating messages [37]. The results of our study also confirm the work of Flores et al. [14], and Heath et al. [15], which demonstrate that interpretation services significantly improve the understanding of health information, the quality of communication, and health outcomes. Although these studies were conducted primarily in clinical settings, their conclusions appear applicable to the community-based public health interventions observed in Kasai [16]. Community interpretation thus emerges as a tool for health literacy that makes complex medical knowledge accessible to populations facing significant language barriers.

Community interpretation as a mechanism for building trust

Trust is one of the most important cross-cutting themes emerging from the findings. Participants believe that interpreters helped alleviate fears and bring communities closer to the response teams. This observation aligns with the findings of Nuriddin et al. in Sierra Leone, which show that improving community trust is a key factor in adherence to Ebola interventions. These authors emphasize that consistent messaging and the involvement of community stakeholders enhance the credibility of the public health response [38]. The results are also consistent with those of Harelimana [39], who identifies trust deficits as one of the main obstacles to preparedness and resilience in the face of filovirus diseases in Africa. Our results suggest that community interpretation can help reduce these deficits by creating a space for dialogue between communities and health institutions. This aspect is particularly important in contexts were external actors, especially expatriates, may be viewed with suspicion. The interpreter then becomes a key figure in lending social legitimacy to public health interventions.

The limitations of interpretation in the face of sociocultural resistance

Despite its positive effects, community interpretation has not eliminated resistance to response measures. The results show that certain health recommendations-particularly those concerning funeral rites or the consumption of bushmeat-conflicted with local cultural practices. These observations align with the analyses of Seytre [18], who criticizes the standardized communication approaches used during Ebola epidemics. According to this author, prevention messages become ineffective when they do not sufficiently consider the sociocultural realities of the affected populations. The suspicious reactions, refusal to listen, and attacks on response teams reported in our study illustrate the potential consequences of a gap between public health recommendations and local social perceptions. These findings show that linguistic interpretation alone is not enough; it must be accompanied by genuine cultural negotiation of public health messages.

Challenges related to the quality of interpretation and the professionalization of interpreters

The study also highlights several challenges related to the quality of interpretation. Difficulties in translating biomedical concepts, the lack of terminological equivalents in local languages, the omission of certain information, and the use of ad hoc interpreters are all factors that can affect the quality of the messages. These results are consistent with the findings of Flores [14], who shows that improvised interpreters make more errors and frequently omit important information. They also align with the observations of Karliner et al. according to whom professional interpreters produce higher-quality results than untrained interpreters [28]. Furthermore, the work of Pokorn and Čibej [40] highlights that service recipients may develop doubts about the accuracy of messages when they perceive that interpreters are not sufficiently qualified. Although this mistrust was not a dominant factor in our study, it underscores the importance of ensuring the quality and credibility of interpretation services. These findings support the gradual professionalization of community interpreting in public health emergency contexts, particularly through language, terminology, and intercultural training for interpreters.

Implications for epidemic preparedness policies and programs

The results of this study suggest several operational implications. First, community interpreters should be involved as early as the epidemic preparedness phase, not just during the response phase. Second, it appears necessary to develop multilingual glossaries tailored to local languages to reduce the terminological difficulties in future outbreaks. Third, continuing education programs should be established to strengthen interpreters' linguistic, communication, and intercultural skills. Finally, in accordance with the recommendations of Harelimana et al. [39] and the lessons learned from the 16^th Ebola outbreak in the DRC reported by Mwamba et al. [35], community interpretation should be recognized as a strategic component of public health preparedness and resilience systems. Its institutionalization could help to sustainably strengthen community trust, risk communication, and the overall effectiveness of interventions during future public health emergencies.

Model of community interpretation as a mechanism for linguistic mediation, trust-building, and promotion of community engagement in the response to Ebola virus disease in Kasai (DRC)

This model illustrates the role of community interpretation as a central mechanism for linguistic, sociocultural, and relational mediation in the response to Ebola virus disease in Kasai (Figure 2). In a context marked by linguistic and cultural diversity, the presence of national and international actors, as well as community mistrust and rumors, community interpreters facilitate the translation, cultural adaptation, and transmission of public health messages. Through these mechanisms, they help improve understanding of the messages, reduce language barriers, limit rumors, strengthen communication, and increase trust as well as the acceptability of public health interventions. These effects in turn foster community engagement, particularly through participation in risk communication and community engagement (CREC) activities, ownership of the messages, adherence to preventive measures, and collaboration with response teams. Community engagement, in turn, acts as a mechanism to strengthen interpretation and communication processes, creating a virtuous cycle of trust and participation. This entire process contributes to protecting community health, reducing resistance, strengthening community resilience, and improving the effectiveness of the response to the epidemic. However, its effectiveness remains influenced by cross-cutting moderating factors such as linguistic and cultural challenges, community mistrust, and organizational constraints.

Limitations

Although these perceptions are essential for understanding the contribution of community interpretation and the value placed on it, they do not allow for an objective assessment of its actual effectiveness based on indicators such as message comprehension, the adoption of preventive behaviors, or the performance of the response. Further studies combining qualitative and quantitative approaches would be needed to measure the actual impact of community interpretation on public health outcomes. Furthermore, while the study provided several useful insights, the generalizability of the results should be considered with caution, particularly in settings with different linguistic configurations, community dynamics, or response mechanisms.

Conclusion     

Overall, this study showed that community interpretation was a key pillar of the Ebola response in Kasai by facilitating the understanding of messages, the adoption of preventive measures, and the building of trust between communities and response teams. However, its effectiveness remains dependent on the quality of interpreter training, the cultural adaptation of messages, and the systematic integration of these actors into strategies for epidemic preparedness and response. These findings contribute to our understanding of community communication mechanisms in the context of public health emergencies and underscore the need to recognize community interpretation as a vital tool for public health governance and community resilience.

Competing interests     

The authors declare no competing interests.

Authors' contributions     

Mineze Kwete Minga designed the study, drafted the research protocol, conducted the in-depth interviews, and facilitated the focus group discussions. He analyzed the collected data, drafted the study report, and contributed to the drafting of the manuscript; Yannick Musawu Kabadi analyzed the data and contributed to the drafting of the manuscript; Charlot Mikobi Mikobi contributed to drafting the protocol, produced the map of the study site, and proofread the manuscript. Daniel Kakese Mungoy contributed to proofreading the manuscript. All authors have read and approved the final version of this manuscript.

Acknowledgments     

This study is the result of considerable sacrifice, both in terms of time and material resources. We are grateful to the Chief Medical Officer of the Mweka Health Zone, Dr Bukidi Bope Amitié, and that of the Bulape Health Zone, Dr Mbantshi Beya Jean Paul, who facilitated these interviews and focus group discussions in their respective health zones.

Figures     

Figure 1: map of the Bulape Health Zone in Kasai

Figure 2: model of community interpretation as a mechanism for language mediation, trust-building, and promoting community engagement in the response to Ebola virus disease in Kasai (DRC)

References