On 11 March 2020, the World Health Organization (WHO) declared COVID‐19 a pandemic. Government agencies across the world are attempting to promote preventative behaviours by raising the perceived risks to self and the wider community and to emphasise the effectiveness of behavioural responses to reduce the risk of contracting or spreading COVID-19 while researchers work to develop an effective vaccination. These behaviours include:
- Maintaining hygiene (e.g. frequently washing hands with soap and hot water for at least 20 seconds)
- Social distancing (e.g. staying at home)
- Help-seeking (e.g. not going to places like GP surgeries, pharmacies, or hospitals)
- Health promotion behaviours (e.g. engaging in daily exercise).
How people adhere and adapt to these behaviours and how they maintain them is key to controlling and reducing COVID-19 transmission, as well as maintaining their broader health and well-being. The science of behaviour change therefore plays a crucial role in our fight against this pandemic. Behavioural science is largely concerned with understanding behaviours (and what influences them) and developing effective interventions to change those behaviours (by targeting those influences).
Behavioural science, as applied by researchers at the Centre for Behavioural Science and Applied Psychology (CeBSAP) at Sheffield Hallam University, uses a structured and evidence-based approach to achieving behaviour change. We use the Behaviour Change Wheel (BCW) as a framework for understanding behaviours and developing new or modifying existing services, products, activities, or policies to change those behaviours.
At the centre of the BCW sits the COM-B model. This model proposes that for any behaviour (B) to occur, people need the capability, opportunity, and motivation. Capability (C) involves both the psychological (e.g. necessary knowledge and skills to perform the behaviour) and the physical (e.g. stamina). Opportunity (O) involves social (e.g. social norms) and physical opportunity (e.g. time and resources). Motivation (M) includes reflective (e.g. conscious decision-making) and automatic processes (e.g. emotion and habit).
For example, if we are trying to get people to stay at home, we will need to decide how to get them to want to do this (M) and how to make this easier for them to do, such as improving the resources needed, like access to food and medicinal supplies (O), and helping people plan work or social activities that do not involve physical contact with people outside of their household (C). Rebecca Webster and colleagues at King’s College London recently conducted a rapid review to identify factors associated with adherence to quarantine during infectious disease outbreaks, and identified issues of capability, opportunity, and motivation associated with adherence decisions.
By working out what needs to change via this COM-B diagnosis, we can then design interventions to change behaviour. The BCW approach matches the type of broad intervention strategy, its implementation, and its content (called behaviour change techniques) to those identified behavioural influences.
For example, if we are trying to get people to stay at home, we may want to:
- Increase their motivation by increasing their understanding of the benefits of social distancing for themselves and others (persuasion)
- Restrict the opportunity to have physical contact with others by closing public places such as parks, pubs and restaurants (environmental restructuring)
- Increase their opportunity to stay at home by increasing access to home delivery schemes (enablement)
- Use words and images to show that other people are staying at home in their community and it is the social norm (modelling).
Christina Atchison and colleagues at Imperial College London have identified significant socio-economic differences in the ability to adopt certain preventative behaviours, with those from more disadvantaged backgrounds less likely to be able to work from home or self-isolate if needed, emphasising the need for governments to implement appropriate policies to reduce the impact of these structural barriers.
Behavioural research is currently underway by colleagues worldwide, including our own research here in CeBSAP. We are conducting a survey to understand how people are responding to COVID-19 health recommendations and you can access the survey here. However, a multifaceted problem requires a multifaceted solution. In order to meet the complex challenges posed by COVID-19, it is essential that we work together with our colleagues from other fields of expertise, including epidemiology, immunology, and public health, in order to develop and implement carefully thought out and planned strategies to reduce the spread and impact of the pandemic.
Dr Rachael Thorneloe, Senior Research Fellow
Centre for Behavioural Science & Applied Psychology (CeBSAP)
Sheffield Hallam University