Corralling Covid
Behavioral Science Can Help Increase Social Mitigation Adherence
The CDC has recommended that, in response to the global coronavirus pandemic, everyone wash their hands often, stay at least 6 feet away from other people, wear face coverings in public and stay home if they’re sick, said Dr. William Riley. Adhering to these mitigation strategies is critical to slowing the spread of Covid-19.
Just telling people to follow these recommendations, however, won’t persuade them to do it, said Riley, director of NIH’s Office of Behavioral and Social Sciences Research. He spoke at a recent NIH Adherence Network Distinguished Speakers program webinar. Rather, health officials must use several strategies to encourage behavioral change.
One of the most important strategies, he said, is for public health officials to communicate credible and trustworthy information quickly, honestly and repeatedly. These officials must also refresh their messaging campaigns periodically to maintain adherence and acknowledge how hard it is to follow the CDC’s recommendations over time.
Exemplars of this approach include NIAID director Dr. Anthony Fauci, White House coronavirus response coordinator Dr. Deborah Birx and U.S. surgeon general Dr. Jerome Adams, Riley noted.
Next, public health should be treated as a collective issue, not an individual one. For example, those who are more likely to have milder cases of the disease must still change their behavior because they can still spread the virus to higher-risk populations.
“Being able to increase that sense of group identity and the idea that we’re all in it together is an important component of what we need to do,” Riley explained.
Before people can take concrete steps to reduce transmission, they must know how they can contribute. However, although knowledge is a necessary condition, it is seldom a sufficient one. To encourage people to change their behavior, officials must promote specific actions, like handwashing.
Research on handwashing has shown that reminding people to wash their hands can increase adherence, Riley said. Mass media handwashing campaigns have shown to be effective. When people know better when to handwash, they are more likely to do it.
Asking people to put up a sign in their bathroom that reminds them to wash their hands or putting a label with a handwashing reminder inside face coverings can help increase the frequency of handwashing after people use the bathroom or remove their mask.
Photo: CDC
“Simple prompts can lead to a more conditioned response over time,” he noted.
Most research on increasing handwashing adherence has been done in hospital systems and in developing countries where diarrheal diseases are common. Lessons can be adapted from this research to population-level handwashing adherence, reported Riley.
Physical-distancing measures are important tools for preventing the spread of Covid-19. During the 1918 influenza pandemic, such measures were introduced. Back then, said Riley, there was no research on its effectiveness and no one studied physical distancing as a means of slowing disease spread, or on whether people would adhere to distancing recommendations.
Physical distancing is, of course, easier for people who can work remotely, he noted. Those who cannot telework and must go to a physical workplace are regularly exposed to conditions where they can contract the virus.
While avoiding physical contact is effective, officials must be aware that physical distancing can affect people’s mental health. People are social animals who like to be around each other and develop physical connections. One challenge for officials is developing alternatives to in-person socializing that allow people to feel the benefits of physical proximity without being close to one another.
Another challenge is getting more people to wear face coverings. Riley said studies of health care workers have shown that availability of masks, training on how to use them correctly, whether other workers wear them and organizational support for wearing masks all influence face mask use. Other predictors include the perceived risk and seriousness of a disease.
Finally, asking people to stay home if they’re sick does not guarantee that they will do so. About 40 percent of U.S. workers don’t have paid sick leave.
“If you ask someone to stay home but the result of having to stay home is that you lose pay, in all likelihood people will still go to work under those circumstances,” Riley said.
Without paid sick leave, employees are three times more likely to forego medical and preventive care, including influenza vaccinations. Guaranteeing paid sick leave can reduce the spread of contagious diseases.
“We haven’t done enough research on adherence to mitigation strategies,” Riley said, “We need to get a better sense of how we can improve how well people adhere to such strategies.”
NIH is funding research on adherence to mitigation strategies and the social, behavioral and economic impacts of the pandemic.
Some preliminary findings may influence our response to the current pandemic, but, “it’d be really nice to have solid data about improving adherence for things like physical distancing, face mask use and handwashing in a future epidemic that will probably come along—hopefully many, many years after most of us are long gone,” Riley said.