A Guide to Promote Behavior Change During the COVID-19 Pandemic
During this time of global uncertainty, COVID-19 has highlighted a lack of understanding about how prevention and health messaging should be crafted to help people change their behavior — and to maintain that behavior over time.
Most people are staying home as much as possible, washing hands frequently and thoroughly for at least 20 seconds, not touching their faces with their hands, staying at least six feet away from people, and wearing a mask. There are, of course, additional behaviors for people who know they have been exposed and for those with symptoms.
To persuade people to adopt these behaviors, there are steps we can take that include:
Change social norms: Last week, I did not have any masks at home when the Centers for Disease Control and Prevention changed its recommendation. I tried to follow online instructions for a homemade mask, but realized I was more likely to adjust it and touch my face while out shopping, so I was probably safer not to wearing it. But when I drove to the grocery store and saw everyone had something covering their faces, I left. That’s social norms in action, and it is why the more people who are close to us or are like us do preventive behaviors, the more those behaviors will become widespread.
Consider emotions: People’s emotions led to different approaches to COVID-19 prevention behaviors early in the United States epidemic. Some people felt good about taking early action because it aligned with their sense of protecting their health and the health of their families. Others felt their freedom was being curtailed or wanted to have one last meal out or one last visit with their families before the policies changed. In some parts of the country, their beliefs about the New York and New Jersey areas, combined with their animosity toward government edicts, still appears to be keeping them from staying put (see, for example, the New York Times map based on 15 million people’s cell phone data).
Develop new habits: Habit and automatic processes are major drivers of our behaviors and are important to slowing down the spread of COVID-19. In particular, many people have a habit of touching their faces and don’t realize they are doing it. Now that I spend many hours a day on video-calls, I’ve tried to use that annoying picture of myself to make sure I’m not touching my face (or adjusting my glasses with my hands, a big way many people end up touching their faces).
Recognize and address barriers to behavior change: In addition to habit, other elements that interfere with a clear intention to behave in a particular way are environmental constraints, knowledge and skills, and salience (relevance) of the behavior. Too often in health education, there is a lot of focus on knowledge and skills and not enough on addressing barriers. In the COVID-19 pandemic, environmental constraints are probably the biggest barriers to people’s ability to engage in protective behaviors.
Emphasize relevance: I remember a conversation I had with someone in early March who asked me why Italy was getting hit so hard. When I said “because they are three weeks ahead of us,” the person looked startled, but here we are. Think about how much more relevant the prevention behaviors would be to the middle of the country if the message was “New York is your area in 21 days.”
Establish TEA: Trustworthiness, expertise and accessibility. There are lots of communication studies that show that unless a messenger establishes all three things, people don’t listen to them. Some people, such as medical doctors, are seen as having expertise, but they need to focus on adding messages to convey that they are trustworthy and accessible.
Let’s use lessons from solving previous health problems to help us fight the current pandemic.
