By Shane Timmons, Economic and Social Research Institute, Ireland

Governments worldwide have mobilised to try to control the spread of the novel coronavirus, but the behaviour of individuals will be vital to their success. We – the Behavioural Research Unit at the Economic and Social Research Institute in Dublin – are working with Ireland’s Department of Health to inform their response to the COVID-19 pandemic. As part of this work, we’ve reviewed over 100 scientific papers and have begun testing ways to best communicate with the public, with lessons relevant for health psychology practitioners. In our review, we focus on literature relevant for three areas that have formed the basis for public health messaging in multiple countries: hand hygiene, face touching and isolation. We also address broader literatures on how to motivate helpful behaviour and communicate effectively in a crisis. 

Hand hygiene

Ways to improve hand hygiene in healthcare settings are well researched. There is strong evidence that education and awareness are not enough, but simple changes to the environment can be highly effective. Drawing attention to alcohol-based hand sanitisers, for example by placing them in common pathways and using brightly coloured signs, dramatically increases their use, much more than increasing the number of dispensers. Signalling that their use is an expected norm can have further benefits. Direct but polite questions – for example, asking “have you used the hand sanitiser?” as patients or visitors arrive – are a simple way to communicate these norms. Building these habits now and maintaining them once wider restrictions relax is important.  

Face touching

In contrast to hand hygiene research, we found no tests of interventions to reduce face touching. Awareness is unlikely to be effective: making people self-conscious about face touching may even increase the rate at which they do so. In the absence of established interventions, practitioners can rely on more general models of behaviour change, such as the Behaviour Change Wheel, Intervention Mapping, or the EAST Framework. We and others have recommended testing ways to replace face touching with alternatives (e.g., using a sleeve or tissue), rather than simply discouraging it.

Isolation

Self-isolation by individuals with symptoms or who have been in close contact with infected persons will save lives, but can have negative psychological effects. Social isolation and loneliness have effects on wellbeing comparable to well-known risk factors such as smoking. A review of 24 studies on people who were quarantined during previous infectious disease outbreaks highlighted risks beyond the isolation period, including increased incidences of depression up to three years later. Healthcare workers may be particularly at risk, as negative psychological effects of isolation can be compounded by concerns about failing to support co-workers or their patients during the outbreak. Authorities should provide additional mental health services that can be accessed remotely, particularly for vulnerable groups. Helping individuals to plan for self-isolation could help The World Health Organisations and many national health services, such as the UK’s NHS, have recommendations to help cope, which include keeping in contact with others via phone or online, exercising if you feel well enough and maintaining a routine. 

Motivating Helpful Behaviour

The consequences of contracting COVID-19 are not equal across individuals. Older people and people with underlying conditions face much greater risks than younger and healthier people. Yet the wellbeing of those most at risk depends not only on their own behaviour but also on the behaviour of others. There is good evidence for strategies that promote co-operation when actions that benefit the individual may not necessarily benefit the wider group. Effective communication is vital. Promoting group identity using language like “we are in this together” will make public-spirited action more likely, as will polite disapproval of unhelpful behaviour (e.g., panic buying). Experiments show that highlighting the sacrifices of others encourages helping. And a rapidly growing body of evidence directly testing COVID-19 communications shows that highlighting the risks to others and prosocial appeals to avoid “spreading” the virus are likely to be more effective than simply providing advice or messages on how to avoid “getting” the virus. 

Communicating Crisis Information

The psychology of risk communication highlights additional principles that will likely be useful for practitioners communicating with patients and clients about the COVID-19 pandemic. Speed, honesty and credibility are important. More generally, practitioners can acknowledge their own uncertainty and empathy for the difficulties people will face during the crisis, while stressing the usefulness of individual actions in order to balance the anxiety people will hold with optimism. 

Fighting the spread of COVID-19 requires contributions from multiple sciences. Theory and methods from behavioural science can play their part. Rapid pre-testing of behavioural science recommendations through high quality experiments will be important to maximise their benefit. 

Practical Recommendations

• Improve hand hygiene by combining awareness campaigns with sanitisers that stand out and polite signals that their use is an expected norm.

• Discouraging face touching is unlikely to be enough – alter the physical and social environments to change behaviour, for example by creating new norms for replacement behaviours such as face touching with a sleeve or having tissues readily available. 

• Helping people engage with social networks remotely and maintain a routine are likely to help address the negative psychological effects of isolation, but additional mental health supports are needed.

• Emphasise the collective nature of the problem we face and highlight the risks to those most vulnerable to promote helpful behaviour – but don’t let unhelpful behaviour go unchecked.

• Balance the anxiety people will hold with optimism over the effectiveness of individual actions in addressing the spread of COVID-19.