How can science and history help us to understand and change human behaviour during a #pandemic?
Part 2: The role of Governments
By Ellen Lambert and Emily Hayes
You might have caught part one of this blog series last week, where we introduced the subject of behavioural science. We defined a key model of behaviour change and reflected on what we have learned about human behaviour from past pandemics. If so, thanks for returning! And if not, you can check out what you missed here.
In part two of this series, we will review messages from government and public health authorities both in the UK and internationally in response to the current pandemic we are facing.
We are aware that government responses, in general, are a contentious and emotive issue. The scope of this article is, therefore to analyse these messages through the lens of behavioural science.
We also acknowledge that when we look back at the early phases of any outbreak or disaster scenario, we are commenting from a place of informational privilege… a place with more data, more graphs and more clues.
Therefore, it is easy to look back and say… “well, that was a silly idea!”, when in fact we did not have adequate information to know that it would have had such negative or unproductive consequences.
We are mindful of this retrospective bias, and hence attempt to pursue a reflective stance that draws on as much objective data available as possible.
Public beliefs and behaviours regarding the UK government’s coronavirus strategy — a look at the numbers
Many surveys have been carried out in the UK to help us better understand public beliefs and behaviours during the coronavirus pandemic. Our twitter feeds are absolutely full to the brim with invitations to take part.
Thankfully, what these surveys seem to show is that key messages are getting out there.
In a poll conducted by Ipsos MORI (a private research company) in late March, 97% of individuals aged 18–75 who took part said they had heard about how to protect themselves from coronavirus from the government.
More recently, in April (things move fast at the moment!), a similar poll was conducted by Ipsos MORI and King’s College London, with a larger sample of 2,250 UK residents. They found that:
58% thought the government had responded well to the shifting scientific advice and situation.
89% supported the current measures being used to contain the virus.
69% had at least ‘a fair amount’ of trust in the government’s ability to control the spread of coronavirus.
76% had at least ‘a fair amount’ of trust in the information the government is providing, though only 25% of these had ‘a great deal’ of trust.
The importance of government trust was discussed in detail in our blog last week and will be further discussed in our international case studies later on in this blog.
Interestingly, only 14% of respondents thought ‘too much fuss’ was being made about the risk of coronavirus, which contrasts with 55% who believed too much fuss was made about the swine flu outbreak in 2009.
This is encouraging since evidence from the swine flu epidemic tells us that if governments are seen to be making ‘too much of a fuss’ early on, this can undermine public confidence. In the case of swine flu, those who had less confidence in the government were less likely to accept the vaccine once it became available.
That being said, in the same April poll, 42% of respondents felt that the government’s response had been confused and inconsistent, whereas 31% disagreed with the statement.
The problem is that confusion can be created by just a few words. For example, on the 3rd of March the Government was rightly keen to emphasise the importance of handwashing.
However, the scientific guidance published on the same day also pointed to the avoidance of close-contact greetings, such as shaking hands, to avoid infection.
The video shows the potential source of confusion:
Boris Johnson said he was shaking hands with coronavirus patients just weeks before he tested positive for Covid-19. The prime minister confirmed he had ente...
Washing hands? Shaking hands? Washing before shaking? A clearer message would have been easier to follow.
In addition to this, on 16th March, 2020, the government recommended that “Everyone should avoid gatherings and crowded places, such as pubs, clubs and theatres”, and that “All ‘unnecessary’ visits to friends and relatives in care homes should cease”.
Despite this, these venues were not officially closed until the 21st March — 5 days later. This might have generated confusion as to what ‘avoiding gatherings’ or ‘unnecessary trips’ meant. These mixed messages may have created barriers to behaviour-change (social distancing) as we were not presented with clear instructions (capability), we were still able to access crowded places (opportunity) and being told to try and avoid places did not convey the importance of social distancing (motivation).
Of course, the other side of the ‘behavioral science’ coin is that the Government might have been worried that on the 16th of March it was ‘too soon’ to impose the full lockdown, as people might have not seen yet the intervention as proportionate to the threat, and thus not adhere fully, or not for long. This element also feeds in the ‘motivation’ process which brings the behaviour-change. In fact, according to the same April survey, a quarter of UK respondents believed the virus came from a laboratory (aka, was manmade!). Interestingly, these respondents were about twice as likely to break the lockdown measures by meeting up with friends, and to think too much fuss was being made about coronavirus.
This clearly demonstrates the importance of our beliefs (motivation) and knowledge (capability) when it comes to adhering to protective behaviours — concepts which were discussed in last week’s blog.
Simply put, it is just not that simple to change behaviour, or to plan how to best do it. Encouragingly though, most people appear to be following the measures and performing behaviours as advised by the government. The majority of respondents in April (87%) reported “leaving the house as little as possible” all or nearly all of the time.
On the other hand, some reported performing behaviours that have not been recommended, though it is unclear whether they are performing these as well as, or instead of, the ones that are recommended.
Particularly problematic amongst these statistics are the reports of individuals using antibiotics because they believe they may prevent the spread of coronavirus.
Only 7% reported doing so, this amounts to 157 individuals in this particular survey. However, we know that antibiotics do not work for viruses — like coronavirus — and that overuse of antibiotics causes resistance which is a serious global health issue. This is because a growing number of infections are becoming harder to treat as the antibiotics used to treat them become less effective.
So, let us use this blog to emphasise this one more time: do not take antibiotics unless prescribed by a doctor!
Using behavioural science to tackle the spread of COVID-19 — what are the other countries doing?
Governments around the world are taking a wide range of measures to tackle the current coronavirus outbreak, and their responses continue to vary widely both in timing and in stringency.
Academics from the University of Oxford have launched a tool to track government responses called the Oxford COVID-19 Government Response Tracker (OxCGRT).
This tool systematically tracks thirteen indicators such as school closures, travel bans, and public transport closures, to generate an index that compares the stringency of policy responses around the world.
Whilst the ‘Stringency Index’ is not a direct measure of “the appropriateness or effectiveness of a country’s response” to the pandemic, it’s a great first step towards understanding which measures have been effective in certain contexts and why.
From this “heat map” we can see that countries in red have the strictest policies to contain the spread of coronavirus according to the indicators considered in the research. On the 30th March, such countries included New Zealand, France, Italy, Mexico and Argentina, to name a few.
It will be interesting to watch this infographic change over the next few months, as selected countries move out of lockdown and begin to open up again.
In our previous blog, we talked about how government communication can support us to change our behaviours in protective ways by doing the following things…
letting us know what is expected of us to reduce the spread of COVID-19 in a clear and succinct format,
explaining why this is the case, and…
stating clearly what support is available.
An example of a country which seems to be ticking a lot of boxes is New Zealand; a country with so few deaths related to COVID-19 that the prime minister Jacinda Ardern still receives a personal phone call regarding each one.
As well as continuously keeping the public informed, many have noted that the language Ardern has used in her public communication has been simple and clear: the nation should stay home and have no contact with anyone outside of their household “bubble”.
Furthermore, “key workers” and “essential journeys” were clearly defined early on, which left very little room for interpretation.
The New Zealand prime minister also released and clearly explained the rationale behind an “alert level framework” for her government’s decision-making regarding coronavirus. The framework enables her citizens to make sense of what is happening at any given moment and why — helping to reduce any confusion or misinterpretation.
Such clarity and decisive action seem to have won her many fans. But more importantly it has won her public trust and confidence, and importantly high levels of behavioural compliance.
New Zealand’s prime minister has utilised other techniques from behavioural science too.
You might remember from our blog last week that behaviour can be influenced by drawing on emotions such as empathy and solidarity. For example, by highlighting how our behaviour can benefit others in our community — especially those more vulnerable — and by using language that centres around “we” and “us” rather than “I” or “you”.
Jacinda Ardern, has drawn on emotions such as empathy and solidarity, and has added a real personal touch to her formal and informal briefings.
Instead of declaring war on COVID-19 like many other countries such as the United States, the NZ government’s narrative was that of a country uniting against the virus, with Ardern repeatedly calling the country a “team of 5 million” and asking her citizens to come together and “be kind” in personal videos from her sofa at home.
After putting her daughter to bed, New Zealand prime minister Jacinda Ardern hosted a Facebook live Q&A focused on coronavirus. Ardern implored New Zealander...
A different country, a little closer to our home, that also communicated its strategy to its public very clearly and accurately is Germany.
In a speech which has since gone viral, Chancellor Angela Merkel (who holds a doctorate in quantum chemistry) was able to personally deliver to the public the science of transmission, and hence the rationale behind her lockdown strategy.
Similar to New Zealand’s leader, Merkel’s confident and clear leadership is believed to have contributed to recent approval and confidence in her approach to managing the pandemic.
The German chancellor, Angela Merkel. has been praised for her explanation of how the coronavirus spreads and why deciding when to lift a lockdown is such a ...
As two female scientists ourselves, it is really interesting and encouraging for us to see that female leaders appear to be “disproportionately represented to a rather startling degree” among countries successfully managing the crisis. You can read more about other female leaders in this Guardian article.
So, how are we doing in the UK?
Since we are both living here, we were able to more closely follow the timeline of communication as it has developed in this country.
As we noted earlier, initial communication had room for improvement. However, when looking at the UK guidance currently available on the gov.uk website (see screenshot below), we can see that it does well to spell out what is required of the UK population without using jargon like “social distancing” (WHAT & WHERE)
The message explains the reasons we should enact these behaviours: not spreading the virus, protecting NHS, saving lives (WHY)
And it explains two ways of preventing the spread — washing hands, staying at home (HOW)
If we are being picky, it could be more explicit about individuals who need to collect medicines, what the rules are about exercise, and what is expected of vulnerable people. But keeping things simple, concise, and easy to remember is best.
The unintended consequences of behaviour change
We should not forget that behaviour change interventions can have spill over effects beyond the health-related behaviours they intend to target.
A critical issue concerns how the measures taken to curb the spread of coronavirus are affecting mental wellbeing worldwide.
The April survey referenced earlier in this blog in relation to public opinion of government strategy also recorded information about public wellbeing and other health-related behaviours in UK citizens. It reported some negative changes in health-related behaviours as a result of the coronavirus.
For example, around a third reported eating more or unhealthier food than normal, and around a fifth reported drinking more alcohol (for more information on the nuanced ways our drinking behaviours are changing with coronavirus, check out this interesting report from Alcohol Change UK).
Regarding the psychological wellbeing of respondents, half of individuals surveyed felt more anxious or depressed than normal as a result of coronavirus, and 38% had problems with sleep.
Worryingly, 15% were already finding it extremely difficult to cope with the lockdown measures, and younger people aged 16–24 seem to be struggling the most according to this survey.
Positive behaviours were also found. For example, the majority of those surveyed were contacting friends and family more by phone, video or text, and were offering help to others during the lockdown.
However, a quarter of those surveyed reported checking social media several times a day for coronavirus updates, a behaviour believed to negatively affect psychological wellbeing. For example, a study conducted in China found that excessive social media use can take its toll on mental wellbeing, with higher rates of social media exposure associated with poor mental health during the pandemic.
It is thought that the pandemic may have a ‘profound’ and ‘pervasive impact’ on global mental health. To maintain motivation for the lockdown measures, appropriate support must be provided to those in need. For example, governments can invest in tools to provide us with an opportunity to support our wellbeing during the lockdown.
One example of a country thinking ahead and doing just that — as if we haven’t fangirled them enough already — is, again, New Zealand. Their government has diverted part of their Covid-19 response health package to fund three mental health apps to enable people to cope with the tremendous changes they are facing in their daily lives.
In the UK, the NHS Every Mind Matters campaign also offers great advice and varied support for mental wellbeing during the lockdown — covering mental and physical health, practicalities like employment and benefits, and advice on limiting social media and identifying trustworthy sources.
Finally, we already know that the virus will have the greatest impact on the most deprived in our society. This is due to things like the economic impact hitting hardest those on the poverty line and those living in cramped conditions where the virus can spread more easily. It is also expected that the virus will lead to wider inequality in society.
The United Nations are working on a global response to support the most vulnerable groups, “women, children, people with disabilities, the marginalized and the displaced“. Poignantly, the United Nations Network on Migration have stated: “COVID-19 does not discriminate, nor should our response”.
People need to know how and where to find food, appropriate shelter and safety from abuse — to name just a few.
Whilst the greatest responsibility sits with governments and relevant organisations, we can also play a part. For example, by supporting charities that protect the vulnerable — whether that’s through donations, fundraising, volunteering or spreading the word — and by looking out for the people around us.
Behavioural science can help us understand how to change behaviour — but only empathy can help us make sure that nobody is left behind.
Header Image Source: 10 Downing Street