This is part of a series of posts on behavioral science and COVID-19.
Recent news has focused strongly on how the U.S. and many European countries will cope with the newfound “way of life” in adhering to public health guidelines for COVID-19. Largely missing in this narrative are the significant global challenges yet to come—such as when the outbreak reaches the nearly 70 million displaced persons living around the world, many of whom are sheltering in densely populated camps. Or when it reaches informal settlements where water and sanitation infrastructure is extremely limited, communicable diseases have compounded health concerns, and frequent water shortages disrupt daily life. Or when it spreads to Syria, Gaza, Yemen and other areas where conflict has destroyed health for millions of people and blockades have made access to medical supplies impossible.
In these and similar settings, the structural challenges of responding to a pandemic are exponential. Social distancing? Try doing so with your neighbors two meters away. Handwashing? Sure, if the water taps are running that day, and only after waiting in densely packed lines for your turn. Quarantine? Only if it happens with the other eight members of your family, young and old, side-by-side in a single tent. Even in the best of humanitarian settings, minimum standards of living space (3.5 square meters per person), safe water (15 litres per person per day), and usage of communal water taps (up to 500 people per hand pump) are well below what people will need to adhere to public health guidelines for COVID-19. Similar challenges exist in resource-scarce settings, particularly in low- or middle-income nations which have weaker health, water, and sanitation systems.
What the world truly needs are political solutions to end humanitarian crises and a global commitment to ensure access to health, shelter, and water and sanitation, among other basic rights. But in the short-term, now it is more important than ever that governments, local authorities, humanitarians, and others responding to COVID-19 get programming and communications right. Two of the major lessons learned from previous public health emergencies in the past decade—including outbreaks of SARS, H1N1, and Ebola—is that effective communications and community engagement are crucial to mounting a successful response. Mitigation and response efforts will need to ask people to dramatically change their behavior. That’s why in complement to these lessons learned, behavioral science can offer additional valuable insights to strengthen communication and engagement.
Look beyond risk communication and awareness raising
Traditional approaches to emergency risk communication, used widely in these contexts, focus on what people can do to reduce risks or which actions to take if they are directly affected by an outbreak or other emergency. But behavioral science tells us that humans don’t follow the traditional linear model of behavior, which assumes that we weigh all available information, assess the costs and benefits of each option, make a choice that’s in our best interest, and then act on it. Rather, our human psychology and the context we find ourselves in often interrupt and derail this model-—meaning we may overlook information, make false assumptions, or fail to act on an intention.
For one, the human tendency toward present bias makes us largely susceptible to the immediate costs of an action (consider the immediate psychological and social consequences of further isolation in a camp setting), even if the benefits in the future are far more worthwhile (not contracting or spreading COVID-19 to your community). To combat present bias, we need to first accept that informing people about the risks alone may not sway people to form intentions or take action, particularly in humanitarian situations where the desired behaviors—such as physical distancing among family and neighbors—have immediate and salient consequences. However, reducing the immediate, salient, and visceral consequences associated with the desired behavior could help spur intention. For example:
- Where personal interactions among family and friends are part of the social fabric of camp communities, consider providing microincentives such as phone credit to encourage continuous social connection via mobile platforms.
- Where mobile phone use is not widespread, encourage people to establish “social isolation circles” and commit to collectively interacting with only their small communal circle. This allows a personal physical space to increase across a few households, and guardians can share responsibilities of engaging with children. [Assuming protection and risk analyses have been undertaken to reduce negative implications for vulnerable or stigmatized groups.]
Second, behavioral science demonstrates that people often fall prey to intention-action gaps; that is, we may be aware of how we need to adapt our behaviours to reduce risk, and even form an intention to act on that knowledge, but still not take the actions needed to be impactful. Breaking down behaviors into concrete steps and helping people achieve those actions can go a long way toward closing the gap between intention and action. While there are many structural constraints to physical distancing in humanitarian settings, mitigation efforts can focus on achievable actions and create a conducive environment to take these actions. For example:
- Rather than disseminating messaging on “avoiding large crowds,” break down the action into specific sub-behaviors that pose the highest risk, and then encourage an alternative action for each. For example, encourage washing laundry near home (rather than communal areas), praying/worshipping in solitude (rather than in groups), or postponing weddings and other celebrations.
- To complement this messaging, use programmatic tweaks to create a conducive environment for taking the desired action. For example, when organizing a relief commodity distribution, use behaviorally informed handwashing communications or programs and interventions at the distribution point to encourage formation of handwashing habits at the right moments.
Change the context, not the person
Behavioral science shows us that contextual features in our environment can have an outsized impact on the way we form intentions, make decisions, and act. Changes in the way a message is worded or framed, the order and way in which options are presented, or the number of steps required to complete a task can affect what we ultimately do. Traditional communication approaches in emergency contexts focus on identifying knowledge, attitude, and perceptions of populations in order to shift norms. Absent in this approach is accounting for (and leveraging) the influence of context. In solely focusing on knowledge and attitudes, mitigation efforts miss vital—yet simple and cost-effective—opportunities to redesign the context in which people are making decisions and taking actions to support better outcomes.
For instance, simply telling people to avoid crowded markets may not necessarily reduce crowding. One way to change the context: With mobile cash transfer programs that many populations use, consider staggering payment dates to reduce high-volume market days.
Another example is with combating rumors. Health organizations have learned that epidemics are driven by misinformation and rumors just as by weaknesses in the health system. To combat rumors, it’s important to consider the context in which they flourish—often beginning with a few individuals, spread between trusted sources, and then into the larger community. Behavioral science tells us that humans are extremely vulnerable to confirmation bias—the tendency to favor information that is consistent with our prior beliefs—which is why rumors are difficult to stop and why we can be easily tempted into forwarding news or texts before even finishing reading or checking sources.
This demonstrates that rumor spreading is just as much, if not more, about our propensity to pass on biased information and the time we devote to deliberating as it is about inherent attitudes and perceptions of the information itself. As such, wide-scale social behavior change communication (SBCC) campaigns attempting to shift attitudes may lack contextual relevance and are resultantly inefficient. But we can use human tendencies advantageously. Creating moments for people to deliberate and applying rumor-spreading characteristics to factual and relevant information—such as using two-way communications, coordinating with trusted sources, and beginning with several facts people already know and believe—can help spread truth.
Getting it right with communication
Learning from past epidemics, we know that one of the most important and effective interventions in a public health response to any event is to proactively communicate. Failure to communicate can lead to loss of trust in responding authorities and agencies, diminished reputation of public health measures, severe economic impacts, and even loss of life. As such, information, education, and communication (IEC) materials will always have value in these contexts; but like other interventions, behavioral science can help maximize impact.
In the days to come, getting new information—not only on social distancing, but when or where to access health care, what other social services will be provided, what movement restrictions will occur—to people across a spectrum of humanitarian settings will be crucial. But to summarize with a quote worth sharing: Information hygiene is as important as hand hygiene now. Best practices to optimize communication include:
- Reduce and simplify information whenever possible. Beware of information overload, as an excessive amount of information makes processing and decision-making difficult to achieve. Whatever is most salient, or prominent, in a person’s context is what they will focus their attention on; give focused and specific guidance that is broken down into actionable steps.
- Contextualize communications to be relevant to the lived experiences of individuals targeted. When people face choice overload, or are overwhelmed with choices, they often choose nothing. We can easily reduce the amount of choices by providing only what is relevant to the target populations; offer communications on achievable and contextualized choices. For example, rather than communicating “don’t leave your home” in settings where people are forced to leave their homes for subsistence, consider communicating a few key heuristics or choices such as: “postpone weddings and communal gatherings, choose a small group of people with whom to isolate and interact, travel to markets with a pre-identified list of items to last X number of days.”
Lastly, we know from the science on cognitive scarcity that having less safety, security, or cash to fulfill basic needs (not to mention the added fear and worry about the outbreak itself) dents any person’s ability to concentrate on information, make difficult decisions, and take productive actions. What people need right now is some help doing just that—putting aside the noise, focusing on the right information, making the most beneficial trade-off decisions, and acting on those decisions. Behavioral science can help people focus on the most important information and actions to protect themselves, their families, and their communities during this time.
Interested in working with us on applying behavioral science to tackle problems arising from COVID-19? Reach out to us at email@example.com.