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Centre for Behaviour Change's response to Covid-19



Responding to COVID-19: contributions from the Centre for Behaviour Change

By ucjubmc, on 18 June 2020

CBC staff have been busy applying their expertise to support the response to the coronavirus pandemic both nationally and internationally.

Why is behavioural science key to managing the COVID-19 pandemic?

Behavioural science needs to be at the heart of the COVID-19 response. Until there is an effective vaccine, it is only through behaviour change that the transmission of COVID-19 can be reduced. Behavioural science can help us to understand the individual, socio-cultural and environmental influences on behaviours relating to the transmission of COVID-19 so that policies and interventions to change those behaviours can be optimised to reduce the spread and decrease the harms associated with the virus (West, Michie, Rubin, Amlôt, 2020).

What behaviours are necessary to decrease the transmission of COVID-19?

Experts in behavioural science have identified 8 key behaviours that individuals need to adopt in order to decrease the transmission of COVID-19 (West, Michie, Rubin, Amlôt, 2020). These behaviours are best described as either personal protective behaviours or more upstream behaviours that aim to promote physical distancing between people (Michie, West, Rogers, Bonell, Rubin, & Amlôt, 2020).

Personal protective behaviours are “individual behaviours aimed to protect oneself or others” (Michie, West, Rogers, Bonell, Rubin, & Amlôt, 2020, p.2) and can include:

  • Cough or sneeze into tissues and then dispose of these
  • Wear face masks as appropriate
  • Maintain physical distance
  • Wash or disinfect hands
  • Disinfect surfaces and objects
  • Do not touch the T-zone of the face

More upstream behaviours that aim to promote physical distancing include:

  • Social distancing
  • Isolation of people who have symptoms or who are highly vulnerable

Each of these behaviours can be challenging to enact, and behavioural science models and frameworks can help us to understand why that is. For example, the COM-B model of behaviour change depicts behaviour as requiring capability, opportunity, and motivation; if one or more components are lacking, this will need to be addressed to increase the likelihood of a behaviour occurring.

The Behaviour Change Wheel, a framework for intervention and policy design, provides guidance on how to select appropriate intervention types and policy options based on whether capability, opportunity, and/or motivation are lacking. A preliminary behavioural analysis of each of the above behaviours can be found in West, Michie, Rubin and Amelot (2020). Figure One illustrates the possible influences on physical distancing behaviours using the COM-B model.

Figure One: COM-B model

How the Centre for Behaviour Change is generating new evidence to help manage the COVID-19 pandemic in health and home care settings

It is important that the general public adopt behaviours to protect themselves from COVID-19, but equally important that they are performed in the workplace, particularly in health and care settings. COVID-19 can spread quickly within both hospital and care home settings, placing both health and social care workers at greater risk of contracting COVID-19. Data published on the 5th of June revealed that 1.87% of healthcare and social care workers in a patient-facing or resident-facing role tested positive to COVID-19 (compared to 0.32% of respondents not in this role). It is therefore paramount that health and social care workers are protected against the virus through the use of personal protective equipment (PPE) alongside other personal protective behaviours outlined above.

To help decrease the transmission of COVID-19 within care settings, the CBC is leading the behavioural science components of a number of interdisciplinary research studies on COVID-19. We are collaborating with a range of disciplines, including but not limited to: data science, virologists, public health, epidemiologists, bio-ethicists, statisticians, geographers. Example of ongoing studies are listed below.

An In-Depth Virological Analysis and Behavioural Study of Health Care Workers During the Pandemic

Title: SARS-CoV-2 Acquisition in Frontline Health Care Workers – Evaluation to Inform Response (SAFER)

Funder: MRC

Duration: 18 Months (Starting March 2020)

PI: Dr Eleni Nastouli (Head of Virology at UCLH and a consultant at the UCL Great Ormond Street Institute of Child Health)

CBC Leads: Professor Susan Michie and Dr Fabiana Lorencatto

Health care workers based in hospitals in London and in Northern England will be invited to take part in a research project that will evaluate the risk of acquiring COVID-19 among healthcare workers who work in A&E, ICU, adult medical admission wards, hematology, and general medical wards. Researchers from the CBC are leading on a behavioural study that is running alongside this that seeks to:

  • understand healthcare workers’ experiences of working during the COVID-19 pandemic,
  • explore perceptions of risk, coercion, and staff well-being, and
  • examine what behavioural measures and practices healthcare workers have been taking to try and reduce risk of COVID-19.

We are particularly interested in exploring healthcare workers’ enactment of personal protective behaviours, such as use of PPE and physical distancing in the workplace. We are conducting surveys and qualitative interviews based on the COM-B model to identify the individual, socio-cultural, and environmental factors influencing these behaviours. This will help identify potential strategies to encourage enactment of personal protective behaviours, improve safety and working conditions, plus future preparedness and response.

Building Evidence to Support the Management Of COVID-19 in Care Homes

Title: COVID-19 Impact and Burden in Care Homes (CATCH-19).

Funder: UKRI- ESRC

Duration: 12 Months (Starting May 2020)

PI: Dr Laura Shallcross (Institute of Health Informatics, UCL)

CBC Lead: Dr Fabiana Lorencatto

COVID-19 has a disproportional impact on older adults and therefore residents in care homes are especially vulnerable to the virus. Between 13th March and 8th May, more than 21,000 excess deaths were reported in Care Homes across England and Wales (https://news.sky.com/story/coronavirus-the-number-of-excess-deaths-in-care-homes-and-hospitals-compared-with-normal-times-is-revealed-11991080). These statistics highlight the urgent need to better understand how COVID-19 has impacted care homes across the UK, to identify ways to improve working conditions, safety, and infection prevention and control.

As part of CATCH 19, care home staff will be invited to take part in qualitative interviews and surveys, which seek to understand how COVID-19 has impacted on care home staff, resident care, and ways of working. We are particularly interested in exploring the challenges care homes have faced in responding to COVID-19, and how non-COVID-19 related care has also been impacted. Topics we will explore include access to medicines and inter-professional working between care home staff and other health care services and professionals (e.g. GPs, pharmacists, palliative care etc). Like in SAFER, we will also explore the enactment of personal protective behaviours (e.g. physical distancing and PPE in the workplace), drawing on the COM-B model to identify key influences on these crucial behaviours.

How the Centre for Behaviour Change is generating new evidence to help manage the COVID-19 pandemic in the community

Examining the Public’s Adherence to Recommended and Non-Recommended Behaviours

Title: Evaluating and improving communication with the public during a pandemic, using rapid turn around telephone surveys

Funder: National Institute for Health Research

Duration: 2012-3; reactivated for 2020

PI: James Rubin (Kings College London)

CBC Lead: Prof Susan Michie

The initial project, funded in the wake of the swine flu pandemic, sought to develop a standard set of questions useful for national polling during a pandemic. Earlier this year, the Department of Health & Social Care (DHSC) started doing weekly online polling to track behaviour during the current COVID-19 pandemic. The questions are based on the researchers’ earlier work (published https://www.ncbi.nlm.nih.gov/books/NBK263566/), but has substantially evolved as the COVID-19 pandemic has continued. The questions ask about the public’s adherence to recommended and non-recommended behaviours, as well as how people are responding to the lockdown. A polling company gets responses from around 2,000 people living in England each week. These data are analysed regularly and sent to DHSC and other parts of the government. They are also used by SPI-B – the SAGE subcommittee on behaviour.

Understanding the Reasons Why People Touch their Eyes, Nose, and Mouth to Inform Intervention Development

 Title: Reducing T-zone touching to reduce SARS-CoV-2 transmission and COVID-19 infection

Funder: The Ottawa Hospital Foundation

Duration: 6 months

PI: Justin Presseau (nominated PI); Jeremy Grimshaw (co-PI) (University of Ottawa)

CBC Lead: Prof Susan Michie

The route into the body for SARS-CoV-2 is through the eyes, nose, and mouth (T-zone). People touch their face, including the T-zone, approximately 15-20 times per hour often without realizing, providing constant opportunities for transmission. Because people do not realize when they touch their T-zone, new strategies are needed. This project aims to identify determinants of stopping touching eyes, nose and eyes through qualitative interviews with a diverse sample of Canadians, drawing on the Theoretical Domains Framework (Cane et al., 2012). Findings will directly inform the development of a behaviour change intervention targeting the automaticity of T-zone touching to support people in reducing touching their eyes, nose and mouth.

Contributing to the public discussion on managing COVID-19

Professor Susan Michie has featured in numerous news and other radio and television broadcasts throughout the COVID-19 pandemic. A selection of her contributions can be found here:

Advice to Government and WHO

The Scientific Advisory Group for Emergencies (SAGE) provides scientific and technical advice to support government decision makers during emergencies. Professors Susan Michie and Robert West are participants in the Scientific Pandemic Influenza Group on Behaviours (SPI-B). Participants and published guidance can be seen here.

Professors Michie and West are also members of Independent SAGE, which aims to provide robust, independent advice to the UK Government to inform their response to COVID-19. Professor Michie is also a member of its Behavioural Advisory Group.

Reports produced by Independent SAGE are available online. They also engage in open debate which is live streamed on YouTube.

Professor Michie has provided expert evidence to:

  • House of Commons Science and Technology Committee Inquiry: Witness in session on COVID-19 and Immunity Passports, 2020
  • House of Lords Science and Technology Committee Inquiry: Witness in session on COVID-19 and Behavioural Science, 9th June 2020.

At the latter,  Professor Lucy Yardley (University of Bristol; University of Southampton) and Professor David Halpern (Behavioural Insights Team) also gave evidence; the session can be seen here.

Professor Michie and Dr Elizabeth Corker have acted as consultants to the World Health Organization’s Behavioural Insight team, developing a method for supporting countries to use survey and other data to inform policy and to generate actionable recommendations.

CBC Deputy Director, Dr Paul Chadwick is on the Behavioural Science and Disease Prevention Taskforce of the British Psychological Society. This group has published guidance on the use of behavior change frameworks to optimize policies and communications to improve adherence to personal protective behaviours and social distancing, and to improve uptake and use of digital contact tracing apps.

The CBC, like many other research institutes in the UK and globally, have worked at pace to respond to Government needs in a timely manner to help decrease the transmission of COVID-19. This has required us to adapt our methods and approaches to generating evidence and recommendations for policymakers. In collaboration with other behavioural and social scientists, Professor Michie outlined how the COM-B model and BCW could be used to structure thinking and recommendations for policymakers in a three-day timeframe, when specific evidence was not available (see https://onlinelibrary.wiley.com/doi/10.1111/bjhp.12428).

Dr Chadwick has been working with the Behavioral Insights Unit at Hertfordshire County Council to adapt the Achieving Behaviour Change Guides for Local Authorities to enable rapid response to requests for behavioural science support from teams across the local authority. The processes and tools developed in collaboration have enabled the rapid development of behavioural science briefings to inform a range of public health campaigns under the Stay Safe Hertfordshire umbrella such as; increasing resilience in lockdown, prevention of alcohol dependency, and maintaining social distancing in public spaces.

By working closely with both policymakers and care sectors in the UK, researchers in the CBC have and will continue to contribute to the global efforts to decrease the spread of COVID-19.

List of COVID-19 publications that have used the COM-B model of behaviour or the Behaviour Change Wheel framework

  1. West R, Michie S, Rubin GJ, Amlot R (2020) Applying principles of behaviour change to reduce SARS-CoV-2 transmission. Nature Human Behaviour, 4, 451–459. https://www.nature.com/articles/s41562-020-0887-9.
  2. Michie S, West R, Rogers B, Bonell C, Rubin GJ, Amlôt R (2020) Reducing SARS-CoV-2 transmission in the UK: a behavioural science approach to identifying options for increasing adherence to social distancing and shielding vulnerable people. British Journal of Health Psychology. https://onlinelibrary.wiley.com/doi/10.1111/bjhp.12428
  3. Bonell C, Michie S, Reicher S, West R, Bear L, Yardley L, Curtis V, Amlôt R, Rubin GJ (2020) Harnessing behavioural science in public health campaigns to maintain ‘social distancing’ in response to the COVID-19 pandemic: key principles Journal of Epidemiology & Community Health.
  4. Allison AL , Ambrose-Dempster E, Domenech R , ….. Michie S …Ward J (preprint) The environmental dangers of employing single-use face masks as part of a COVID-19 exit strategy. The environmental dangers of employing single-use face masks as part of a COVID-19 exit strategy. UCL Open: Environment. https://ucl.scienceopen.com/document?id=975516df-aa0e-4b79-b950-c54e5608a3e0
  5. Perski O, Simons D, West R, Michie S. Face masks to prevent community transmission of viral respiratory infections: A rapid evidence review using Bayesian analysis (preprint) https://www.qeios.com/read/1SC5L4
  6. Holmes EA, O’Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L, Ballard C, Christensen H, Cohen Silver R, Everall I … Michie S et al. (2020) Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry. https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(20)30168-1.pdf
  7. West R, Michie S, Amlot R, Rubin R (2020) Don’t touch the T-Zone—how to block a key pathway to infection with SARS-CoV-2.BMJ Opinion, April 3rd. https://blogs.bmj.com/bmj/2020/04/03/dont-touch-the-t-zone-how-to-block-a-key-pathway-to-infection-with-sars-cov-2/
  8. Yardley L, Amlot R, Rice C, Robin C, Michie S (2020) How can we involve communities in managing the covid-19 pandemic? BMJ Opinion, March 17th. https://blogs.bmj.com/bmj/2020/03/17/how-can-we-involve-communities-in-managing-the-covid-19-pandemic/
  9. Michie S, West R, Amlot R, Rubin J. (2020) Slowing down the covid-19 outbreak: changing behaviour by understanding it. BMJ Opinion, March 11th. https://blogs.bmj.com/bmj/2020/03/11/slowing-down-the-covid-19-outbreak-changing-behaviour-by-understanding-it/
  10. Smith LE, Yardley L, Michie S, Rubin J. (2020) Should we wave goodbye to the handshake? BMJ Opinion, March 10th. https://blogs.bmj.com/bmj/2020/03/10/should-we-wave-goodbye-to-the-handshake/
  11. Michie S, West R & Amlot R (2020). Behavioural strategies for reducing covid-19 transmission in the general population. BMJ Opinion, March 3rd. https://blogs.bmj.com/bmj/2020/03/03/behavioural-strategies-for-reducing-covid-19-transmission-in-the-general-population/
  12. Michie S, Rubin GJ & Amlot R (2020). Behavioural science must be at the heart of the public health response to covid-19. BMJ Opinion, February 28th. https://blogs.bmj.com/bmj/2020/02/28/behavioural-science-must-be-at-the-heart-of-the-public-health-response-to-covid-19/
  13. Lazzarino A, Steptoe A, Hamer M, Michie S (2020) Covid-19: Important potential side effects of wearing face masks that we should bear in mind. BMJ Letter, 21st https://www.bmj.com/content/369/bmj.m2003.full
  1. Gibson Miller, J., Hartman, T. K., Levita, L., Martinez, A. P., Mason, L., McBride, O., McKay, R., Murphy, J., Shevlin, M., Stocks, T. V. A., Bennett, K. M., & Bentall, R. P. (2020). Capability, opportunity, and motivation to enact hygienic practices in the early stages of the COVID-19 outbreak in the United Kingdom. British Journal of Health Psychology. https://doi.org/10.1111/bjhp.12426
  2. Michie S, West R (2020). Behavioural,environmental,social,andsystemsinterventionsagainstcovid-19. BMJ 2020;370:m2982. https://www.bmj.com/content/370/bmj.m2982/rapid-responses