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Story Publication logo April 17, 2020

Crushing Coronavirus Means ‘Breaking the Habits of a Lifetime.’ Behavior Scientists Have Some Tips

Volunteers from Indonesia's Red Cross prepare to spray disinfectant at a school closed amid the spread of coronavirus (COVID-19) in Jakarta. Image by REUTERS/Willy Kurniawan. Indonesia, 2020.

Veteran public health journalists from Science magazine explore what science knows—and is learning...

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No crowds in Times Square after self-quarantine and social distancing was put in place in New York City to slow the spread of the COVID-19 pandemic. Image by Shutterstock. United States, 2020.
No crowds in Times Square after self-quarantine and social distancing was put in place in New York City to slow the spread of the COVID-19 pandemic. Image by Shutterstock. United States, 2020.

With no vaccine or medication to cope with the novel coronavirus, people around the world have sought—or been ordered to seek—protection by changing the way they act in ways large and small, from their washing hands more frequently to avoiding almost all physical contact. Now, government and industry leaders are turning to behavioral scientists for advice on how to persuade their citizens and workers to abide by such dramatic changes.

To beat the pandemic, we need "a more rapid change of behavior than I can think of in recent human history," says Robb Willer, a sociologist at Stanford University. He recently helped recruit more than 40 top behavioral scientists to summarize their field's research on how to steer people into certain actions and how it might aid the response to the pandemic.

Politicians and executives are on the hunt for such advice. Facebook and Twitter have consulted Willer about ways to improve communicating coronavirus-related information and avoid pitfalls. Jay Van Bavel, a psychologist at New York University who led the review with Willer, shared insights from the work with approximately 700 people at an early April teleconference about pandemic misinformation hosted by the World Health Organization. Governments ranging from the United Kingdom to Sierra Leone have reached out to other behavioral researchers.

Their advice is already proving consequential, though not always successful. The government of the United Kingdom initially avoided closing schools and businesses, citing advice from its vaunted "Nudge Unit," which helps policymakers develop subtle ways to incentivize certain behaviors. The unit had reportedly warned that restricting movement too soon risked behavioral "fatigue." But the government reversed course in late March after novel coronavirus infections surged.

In their search for practical guidance, behavioral scientists are plumbing previous research into disease outbreaks such as the flu and Ebola, as well as seemingly unrelated subjects including cigarette warning labels and political campaigns. Meanwhile, they are rushing ahead with new studies aimed at improving measures during the current crisis.

Many of their recommendations might seem like common sense and can be distilled to this: Have a unified set of fact-based messages, tailor them to different audiences, and choose your messengers wisely. A common message can help give people confidence to take action, particularly at a moment when fear motivates people, says Shana Gadarian, a political scientist at Syracuse University who has studied how anxieties influence political action in the United States.

Political divides

Even robust messages can lose power, however, when leaders send contradictory signals, or when public health advice gets refracted through a political lens. In the United States, President Donald Trump has repeatedly contradicted recommendations from public health officials, notably saying he probably wouldn't wear a face mask on the day that both the Centers for Disease Control and Prevention and first lady Melania Trump urged people to do just that. Early in the pandemic, figures in conservative news outlets had derided calls for an aggressive response to the virus as a "hoax" or an attack on the Trump administration. "When you hear [health] experts saying one thing and the head of your [political] party saying another, that's a troubling kind of thing to decide," Gadarian says. In the United States, "What we're seeing evidence of is that Republicans are basically going with what the president says."

In a survey of 3000 people in the United States in mid-March, Gadarian found that political leanings were the strongest predictor of whether someone was likely to follow public health recommendations. Democrats were more inclined than Republicans to wash hands, buy hand sanitizer, and distance themselves from others. As COVID-19 has spread to more parts of the country, that partisan divide has shrunk but not vanished, according to a poll in late March by the Kaiser Family Foundation. More than 90% of people across the political spectrum reported engaging in some kind of social distancing. But Democrats were more likely to have stayed home, canceled plans for a group gathering, or fully sheltered in place. A survey in early April by Stanford researchers still found a partisan gap.

That ideological split is stronger in the United States than in the United Kingdom, says Gordon Pennycook, a cognitive psychologist at the University of Regina in Canada. He and collaborators surveyed approximately 650 people in each country to see what influenced misperceptions about the pandemic, such as the coronavirus being no worse than the flu. The study, published as a preprint this week, found that in the United States, misperceptions were correlated with whether someone got their information from conservative news outlets such as Fox News. Although the United Kingdom has conservative newspapers, there's no comparable TV broadcast station, Pennycook says. "Also, [Prime Minister] Boris Johnson is not treating [the pandemic] the same way that Trump is."

Whether people respond to public health messages depends partly on who delivers it. That was underscored in Liberia during the deadly Ebola outbreak of 2014 and 2015, which killed nearly 5000 people in the West African nation. There, efforts by government workers to get people to follow precautions such as social distancing were stymied by suspicions that the disease was a government ploy to win more aid money. But neighborhood volunteers recruited and trained by government officials experienced much more success, says Lily Tsai, a political behavioral scientist at the Massachusetts Institute of Technology who studied the Ebola response there. She concluded that residents found neighbors more credible partly because their connections to the community made them more accountable.

The identity of a trusted messenger depends on the situation. It could be local religious leaders, politicians, sports figures, or celebrities, Gadarian says. Governors leading their states' pandemic responses have enjoyed a surge in popularity. In a late March Instagram chat, basketball star Stephen Curry of California's Golden State Warriors discussed the disease and how to avoid it with Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. The video has had nearly half a million views on YouTube.

Small pushes, big results?

Messages can come in more subtle ways as well. Proponents of "nudges" emphasize the ways that small visual cues, brief reminders, or tiny changes in people's surroundings can change their actions. In the case of the coronavirus, it can be as simple as painting lines on a walking path to show what a 2-meter separation looks like, says Susan Michie, a health psychologist at University College London and director of its Centre for Behaviour Change.

She is contemplating how to break people of the habit of touching their faces, because the virus infects people through the mucus membranes that line the nose and airways. She wonders whether software on a person's camera-enabled computer or smartphone could alert them of a face touch. "It's about breaking the habits of a lifetime and setting up slightly different habits," she says.

It will take more than just messages to change behaviors on such a mammoth scale, says Ann Bostrom, who studies risk perception and communication at the University of Washington, Seattle. Often, compliance hinges on giving people the tools they need to easily follow new rules. "The physical context in which you make these decisions is often more important than grand ideological views," Bostrom says. "If there's a mask available from the dispenser at the front of the building, you're probably more likely to put it on." Ditto for easy availability of things like hand sanitizer, others say.

How to prevent backsliding?

Making behavioral changes easy to maintain could become particularly important as lockdowns stretch on and strains build, Michie says. Past research has found compliance during an epidemic can decline over time. The U.K. government, she adds, might need to take measures to avoid backsliding and make a lockdown tolerable, including opening golf courses and private sports fields so that people can get outside without being crammed together. The government could even provide people with tablet computers and videos to help them pass the time at home.

Tsai, whose behavioral research focuses on people in the developing world, says that in poorer nations, persuading people to obey a lockdown could come down to something as simple as ensuring access to drinking water. She's launching an ambitious project in the West African country of Sierra Leone that uses detailed behavioral data to figure out what tools can best promote social distancing and limited movement there. She's working with a science directorate within the office of the nation's president, for example, to combine cellphone movement data with surveys of almost 3000 people across this country of 6.6 million. The goal is to gauge what messages are most effective, and what incentives would encourage residents to stay home—whether it's information, money, water, food, or a combination.

Eventually, Tsai plans to create a dynamic map, down to the neighborhood level, showing potential hot spots where cooperation could be difficult, and what kinds of actions are likely to help ease acceptance of physical distancing and other measures. She is also hoping to expand the project to some of the continent's largest cities, Lagos, Nigeria, and Nairobi, Kenya, to help prepare them for when the virus gains a foothold there. When the disease arrives in these sprawling cities, she fears, "it's going to be awful."

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