Community Barriers, Perceptions, and Health-Seeking Behaviors within the One Health Approach in Six Priority Districts of Rwanda: A Descriptive Qualitative Study

Abstract

Background: Rwanda’s health security can only be strengthened through integrated One Health approaches that link human, animal, and environmental health. Emerging health threats such as the Marburg Virus highlight the urgency, yet fragmented systems, weak coordination, and behavioral barriers continue to constrain resilience. Thus, we assessed behavioral, social, and systemic determinants influencing community resilience, outbreak preparedness, and response, using the Human Belief Model (HBM) and the Social Ecological Model (SEM) to generate actionable evidence for strengthening One Health integration, health system performance, and risk communication strategies for effective disease prevention and outbreak mitigation in Rwanda. Methods: Our descriptive qualitative assessment included participants from Rulindo, Kayonza, Nyanza, Rusizi, Rubavu, and Nyaruguru districts of Rwanda. We had six IDIs per district and two FGDs per district. Participants were selected from all domains of life, ensuring inclusivity, while data collection was carried out in October 2025. We conducted weekly debriefing meetings, which enabled us to familiarize ourselves with the data. Using Dedoose for data coding, results were presented according to themes, while indicating areas of convergence. We received ethical approval for this study from the Rwanda National Ethics Committee (IRB00001497 of IORG0001100). Results: A total of 143 participants took part in the FGDs; the majority were male (n = 82, 57.34%) and were aged between 31-40. Most participants were either working in the veterinary sector n=10 (7%) or simply community members n=9 (6%). In the IDIs of 36 participants, almost half of the participants were in the age group 31-40, n=15 (41.67%), and working as either Integrated Disease Surveillance and Response officers, Private Sector Federation members, or Environmental Officers with n=6 (17%) respectively. Several themes emerged; however, using the joint display method of comparing findings from IDIs and FGDs, we identified data convergent points to include access to services, economic and livelihood constraints, coordination and collaboration gaps, communication of health information, shared and collective norms, as well as practices. Conclusion: Findings from this assessment provide a critical foundation for identifying behavioral and systemic gaps and facilitators towards the One Health approach. Bottleneck challenges on resources and limited engagement of community members continue to promote health insecurity. Therefore, district-level coordination and accountability, as well as training of community health workers to listen and engage community members, will enhance the One Health sector of Rwanda.

Keywords: One Health, Rwanda, disease prevention, outbreak preparedness, community engagement, risk communication