Abstract
Traditional funeral practices were a significant factor in the transmission of Ebola virus disease (EVD) during the West African outbreak of 2014–2016. In Liberia, these practices often conflict with public health directives, resulting in noncompliance and secret burials. Understanding the barriers to and facilitators of adopting safe burial practices is critical for informing future epidemic responses. This mixed-methods study was conducted in Vai and Clara Towns, Monrovia, Liberia. Data collection included surveys (n = 200), in-depth interviews (n = 40), and four focus groups (n = 40) with family members and community leaders. The quantitative data was analyzed via descriptive statistics. Thematic analysis was applied to the qualitative data to identify major themes. The survey demonstrated high levels of EVD-related knowledge and perceived risk in 2024; however, these descriptive findings do not establish an association between knowledge and burial behavior. Qualitative findings identified cultural, emotional, social, informational, and logistical factors that influenced the adoption of safe burial practices during the outbreak. Qualitative analysis revealed seven major themes: cultural and traditional resistance, mistrust and stigma, misinformation, emotional and psychological distress, communication and logistical challenges, socioeconomic constraints, and facilitators of safe practices. Knowledge measured in 2024 cannot establish outbreak-era knowledge. Retrospective accounts identified cultural norms, mistrust, and systemic barriers to safe burials. Future responses should prioritize early community engagement, the involvement of traditional and religious leaders, culturally sensitive adaptations of protocols, and adequate psychosocial and logistical support.