In early March, the ESRI published Using behavioural science to help fight the coronavirus, an examination of psychologies around strategies to cope with and defeat the virus. The following is a digest of the salient points:
Habits operate mostly outside conscious awareness and are hence hard to break through improved education and knowledge. Attempts to improve hand hygiene and other infection control behaviours through education and awareness have limited and short-term impacts. A 2001 review of research in hospitals found that combining educational interventions with reminders and better facilities (e.g. automated sinks) can increase handwashing. A 2012 follow-up also concluded that multiple behavioural levers are required, including social influence, convenience, prompts, and cues. Messages linked to disgust tend to be effective, while evidence does not support messages that communicate social norms, such as “4 out of 5 people wash their hands every time.”
There are no proper scientific studies that evaluate interventions designed to reduce the frequency with which people touch their face. Observational studies suggest that people touch their mouth, nose or eyes perhaps 10-20 times per hour. When people are asked to self-record face touching, it increases rather than decreases it, meaning that making people self-conscious may backfire. Individuals have to be psychologically or physically able to undertake the behaviour, the environment that surrounds them needs to facilitate the behaviour. A physical intervention might be to place tissues in prominent locations, e.g. immediately before the keyboard for office workers, on lunch and coffee tables, so that people can use them and not their hands to scratch an itch, almost without thinking.
While self-isolation can help contain and control the spread of infectious diseases, isolation has negative psychological effects. It is well-established in the psychology and public health literature that social isolation has detrimental consequences for wellbeing, with effects comparable to other well-known risk factors such as smoking. Loneliness is also associated with increased risk for mental health problems, including depression and anxiety. A recent review of 24 studies indicate potential long-term effects, including depressive symptoms, and substance dependence, up to three years after quarantine ends, poorer mental health outcomes and increased anger. Extending isolation beyond initial suggestions can demoralise people and increase non-compliance. Protective behaviours in this situation include keeping alarms set to usual times, maintaining working hours similar to pre-COVID-19 and planning home-based exercise.
The US Center for Disease Control and Prevention previously distilled six guiding principles for crisis communication:
Be first: Provide information as soon as possible or how you are working to get it.
Be right: Tell people what you know when you know it, what you don't know, and if you will know later.
Be credible: Tell the truth.
Express empathy: Acknowledge what people are feeling.
Promote action: Give people relevant things to do.
Show respect: Involve stakeholders in decision making processes.
Compared to their assessment beforehand, people generally believe that the eventual outcome was always more likely once they know that it happened. Over months, or even weeks, this may lead to a perception that the authorities “should have known” where events were heading, when in reality uncertainty was great. Being clear about the extent of uncertainty and reminding people of that uncertainty may be important for credibility. The impact of COVID-19 is, and will remain, hard to assess. Hindsight bias is likely as the situation becomes clearer. Stating a cautious range is therefore, advisable. There is one important additional behavioural principle to keep in mind. Across multiple areas of behavioural science, there are often benefits to be had from keeping things simple.
One can make a reasonable case that during such a serious health crisis, the role of the media should change somewhat, as it does during other periods, such as elections. There are personal and societal benefits to giving more time than usual to advice, constructive personal actions and direct communications between authorities and their audience. This need not affect the media’s ability to fulfil its functions in faithfully reporting events and holding the powerful to account. Specific social groups perceived to be ‘associated’ with the virus might face discrimination or ostracization. People who feel more vulnerable express more negative reactions to out-groups. To combat this, strong messages are needed on understanding that different people face the same threat and share a common goal. Media reporting matters. Faithfully reporting that people are trying to follow advice, is as important as highlighting failures to follow it. Conditional co-operators need to know that others are co-operating. Negative responses including panic responses, undue expressions of anger towards officials or health workers, or xenophobia need to be managed. Research into swine flu coverage concluded that the bigger issue was the focus on reporting the threat - number of diagnoses, deaths, etc. - at the expense of communicating how best to fight the disease. There is also evidence from past crises that public authorities overestimate the likelihood of panic and public disorder. Social media has opened new avenues for communication and offers potential for rapid information dissemination. There is generally mixed evidence on the benefits of social media in crises. Following the 2015 MERS outbreak in South Korea, those exposed to information on social media were more likely to experience fear and anger, but both emotions were positively associated with the extent of subsequent preventive behaviours. In relation to the Zika and Ebola viruses, however, studies suggest social media messaging by authorities may not be beneficial for knowledge can reduce perceptions of credibility and increase focus on panic and uncertainty.