How behavioural science is helping in the fight against COVID-19

Thanks to COVID-19, just about every form of media we consume right now is focused on aspects of changing how we live. The science of human behaviour has never been more critical as we help the world stay safe and, most importantly, protect the vulnerable parts of our society from the pandemic virus that started in Wuhan, China.

Behavioural change is a science that is mostly focused on understanding why we find it difficult to change or follow medical and societal health directions.

As we have seen in recent weeks, just telling people to avoid contact with others does not work. While the world looks on from different stages of lockdown, people continue to visit bars, parks and other places that create close contact.

Even with the knowledge of how the virus is affecting other countries like China, Iran, Italy and now Europe and the USA, people are reluctant to change behaviour. To “flatten the curve” – a much spoken about strategy to minimise the spread of the disease and ease the impact on overstretched healthcare resources – there are many individual behaviours that need to change quickly across a whole population.

Some of the effective strategies countries are currently recommending include:

Social distancing
Hand washing
Coughing and sneezing and tissue use
Avoiding touching the T zone (eyes, nose & mouth)
Care of elderly and vulnerable populations
Homeschooling and self-isolation

“People need clear advice on how to change, be provided with the opportunity to change and be motivated to change. Change is unlikely if one or more of these elements is missing”

On their own, this list looks achievable, but we have to ask more in-depth questions – like how do we increase the frequency of handwashing, or how do we change how hands are washed to make the process more effective?

The reality of change is that it is hard for everyone. So what does it take to create change in individual and population-level behaviour?

Research groups around the world, and especially the centre for Behavioural Change at UCL in London, have built frameworks to understand behaviour and create interventions to promote change.

Take handwashing, for example. To be helpful as an intervention, we need not only to wash our hands more frequently but also to be shown how to wash our hands more effectively. Using factors like time (i.e. Singing happy birthday twice), temperature (most people use cold water) and technique (using black paint on gloves to show how to wash hands all over effectively) we can help improve overall behaviour.

To alter behaviour, people need clear advice on how to change, be provided with the opportunity to change and be motivated to change. Change is unlikely if one or more of these elements is missing.

Behavioural change programmes focus on creating strategies that help people understand how to change. These build new capabilities in people to help them follow medical advice.

Most often, you will see these as education, information and knowledge-based interventions. For example, someone may not remember to wash their hands for 20 seconds or be able to repeatedly count to or guess the 20 seconds needed to wash hands effectively. A better strategy is to tell people to sing happy birthday twice, which takes the same time.

People also need the opportunity to perform the behaviour. This may require places to have more soap and disposable towels. Seeing others perform the behaviour is critical for social acceptance.

Finally, we also need the motivation to perform the action. Together these three areas have been worked into a framework for change called COM-B (Capabilities, Opportunities, Motivation- behaviour) by Professor Susan Michie, Robert West and colleagues from the Centre of Behavioural Change at UCL.

The COM-B framework has been used effectively to improve behaviours associated with handwashing, smoking cessation, and diabetes management amongst others. They are now being applied to COVID-19 in an attempt to help fight infections rates around the world.^1,2

Humans are wired to resist change. This is something pharmaceutical companies have been battling against for years to improve behaviours associated with medication adherence, physical activity and the adoption of new therapies. All of these can improve outcomes for patients, but the industry has been fighting an uphill battle to make these behaviours stick. Digital interventions have recently become a common tool that companies hope can improve adherence, but it’s possibly still too early to say much on the long term efficacy of these approaches.

Perhaps during the pandemic, pharma will look at its change programmes in a new light to ask themselves if the patients and healthcare professionals have the capabilities, opportunity and motivation to change in the way they expected.

References

Michie S, West R & Amlôt R. Behavioural strategies for reducing COVID-19 transmission in the general population. BMJ Opinion, March 3rd 2020.
Michie S, Atkins L, West R. (2014) The Behaviour Change Wheel: A Guide to Designing Interventions. London: Silverback Publishing. www.behaviourchangewheel.com.

About the author

Mark Lightowler is CEO of behavioural change design agency phorix, based in Basel, Switzerland and London, UK.