What has COVID-19 shown us about the best ways to encourage people to adopt preventive health behaviours?

The COVID Health Related Behaviour Review project (COHeRe) has identified three key factors driving healthier and less risky behaviours – leading to recommendations for more effective public health messaging during the pandemic and beyond

Jennifer Hanratty and Martin Dempster

Over the last 18 months or so, the relationship between behaviours and health has been seared into the public consciousness as a result of COVID-19. The encouragement and enforcement of behaviours such as social distancing, wearing face coverings, handwashing and quarantining have been ever-present topics of debate in our homes and the media.

But what has been learned along the way about the most effective ways to encourage people to engage in these preventive behaviours? The COVID Health Related Behaviour Review project (COHeRe) has been established to better understand the evidence through a series of systematic reviews feeding into an ‘evidence and gap map’.

The initial stages of our work, based at Queen’s University Belfast, have already drawn some clear conclusions. For example, we have found only small and inconsistent relationships between age and engagement in these behaviours – which might seem at odds with a public perception of ‘irresponsible young people’. And while we did find that women are consistently more likely to engage in preventive behaviours than men, the gender difference is small.

Where we do see a strong correlation is between an individual’s perception of risk and their engagement with preventive behaviours. This is not surprising: most people will modify their behaviour if they fully understand how risky something is.

But it suggests that, as we begin to draw conclusions from the pandemic to inform future resilience strategies, a key question for policymakers should be: how do we get people to understand risk better? Furthermore, they need to understand what other factors might influence people’s engagement with these preventive behaviours.

Three key factors driving preventive behaviours

There has been a huge amount of research generated over the last 18 months to examine the determinants of preventive behaviours in the context of the COVID-19 pandemic. And of course, COVID-19 is not the first pandemic that has involved the spread of respiratory pathogens and where behaviours such as handwashing, wearing face coverings, social distancing, quarantining and avoiding touching the T-zone (eyes, nose and mouth) have been encouraged and/or mandated by governments to minimise the spread of the virus.

Our review of both pre- and during-COVID evidence about encouraging uptake of preventive behaviours in the context of an outbreak of a serious viral respiratory illness has highlighted three important factors:

  • Perceptions of how likely you are to get the illness and how serious you think the illness is. As your beliefs in susceptibility and seriousness increase, so does your perception of risk and, it appears, the likelihood of you engaging with these preventive behaviours.
  • Self-efficacy: how easy you think it is to carry out the recommended behaviours. Our research indicates the higher this level self-efficacy level, the more likely it is that you will comply with the request.
  • Knowledge of the disease. Our research shows people who have, or perceived themselves to have, good knowledge of the virus – such as how it is transmitted and common symptoms – are more likely to engage in preventive behaviours.

These findings come as no surprise to psychologists and other academics working in the area of health behaviours. There are several models that are used as the basis for interventions to encourage people to take up healthy behaviours, of which Protection Motivation Theory and the Health Belief Model seem to be most relevant in this context. These models suggest that health-related behaviours are likely to be determined by perceptions of susceptibility, seriousness, self-efficacy, barriers to performing the behaviour, and response efficacy – the belief the actions you take will be effective in preventing the illness.

Considerations for public health messaging strategies

COHeRe’s work to date highlights that public health messaging should consider the following strategies:

  • emphasise the potential seriousness of respiratory viruses to individuals to elicit appropriate concern;
  • strengthen realistic perceptions of risk or threat of diseases resulting from these viruses;
  • enhance self-efficacy about preventive behaviours; and
  • improve knowledge about respiratory viruses and how they are transmitted, and how preventive behaviours can reduce the risk of transmission.

These are crucial learnings for navigating the winter months in terms of COVID-19 and seasonal flu, and for increasing resilience to any similar future health crises. The UK Government’s winter lockdown ‘Plan B’ – to be introduced if the NHS comes under ‘unsustainable pressure’ – includes measures such as mandatory face masks.

What other influences should be investigated?

We now have the opportunity to interrogate the COVID-19 literature to determine what additional factors are at play in relation to preventive behaviours.

One of the key differences between COVID-19 and previous, similar pandemics is the increase in availability and usage of social media. This influences people’s thinking in an entirely new way, so there are likely to be related factors that are shown to be important – such as beliefs about social norms, and whether the influence of beliefs and emotions on preventive behaviours is moderated by age, given the differences in social media usage among different age groups.

Other factors likely to influence behaviour span both national and local policies, and specific interventions. For example, policies such as paid leave for people advised to isolate can remove barriers to adherence. Interventions that have tested different ways of improving adherence to protective measures, such as information campaigns or placement of hand sanitiser and signage in public places, can change how we behave.

In our rapid review, we found too few studies on these factors to allow us to draw any firm conclusions. However, we anticipate that in this next stage of our work, we will be able to say more about the influence of policy and interventions on behaviour, and to quantify how effective these interventions might be.

We have now identified 20,000 potentially relevant papers that need to be screened, and will shortly be launching a crowdsourcing screening challenge with Cochrane Crowd. Anyone can join the effort to help uncover new research on the factors that influence how we behave in a pandemic by signing up here.

Dr Jennifer Hanratty and Professor Martin Dempster both work in the School of Psychology at Queen’s University, Belfast.

  • COHeRe’s open access paper summarising the ‘non-COVID’ evidence is available here. Find out more about the project on the COHeRe website and via Twitter