Re-Imagining Participation with an Orthodox Jewish Community through the COVID-19 Pandemic: The Role of Culture at the Policy-Practice Interface

Traditional public health approaches to catastrophes, such as pandemics, have tended to reflect majoritarian or utilitarian views, manifesting in homogenized policies. Such an approach has disadvantaged already marginalized communities. This paper aims to explore how public health responses emerge as processes in response to public health appeals. Informed by the theory of deliberative democracy, we engaged an interdisciplinary approach to discern lessons from multidimensional aspects of infectious disease manifestation within an Orthodox Jewish community during the COVID-19 pandemic. We undertook blood sampling, researcher-led surveys, key informant and community member interviews, and extensive participant-observation. A sensitivity-specificity analysis of dried blood samples determined thresholds for the trimeric-spike assay, as well as the nucleocapsid assay. Hypothesized survey responses were analyzed in GraphPad Prism version 8.4.0 and R version 4.2.1. Semi-structured interview transcripts, and ethnographic fieldnotes of research meetings, were analyzed thematically. The intersection of serological, sociological and epidemiological data showed the centrality of culture-specific modes of meaning-making in response to the pandemic and government policies. Patterned infection rates by gender reflected gender roles and experiences, with gender being one example of differentiation. Findings showed important gender differences in the community, COVID-19 being experienced differently by gender, with sources of COVID-19 information also varying by gender. The research showed an intensification of community-reliant disease management through the community’s own medical resources. Findings also showed dissatisfaction with public health responses and messaging. Excessive and demonstrative policy enforcement weakened public trust. Cultural and religious identity was the main factor distinguishing “insider”/ “outsider” status and corresponding distinction between who was trusted and not trusted. Policy approaches need to reflect gender differences. A “one-size-fits-all” strategy of public health communication is ineffective, requiring consultation, negotiation and a degree of self-determination in health policy to understand distinctive cultures within societies and states for sustainable and equitable health policy.