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Under Pressure: Good Behavior in the COVID-19 Pandemic

The role of social factors in explaining positive behavior during the pandemic.

The COVID-19 pandemic has brought tragedy and hardship to many people. But it has also opened up opportunities for behavioral scientists to advance their understanding of behavior change.

In a recent BBC article, Mark Easton writes:

The behavioural science that forms part of the government's thinking on the lockdown warned before the restrictions came in that people would struggle to stick to the rules for prolonged periods.

However, experts have been struck by how compliant the British public have remained.

Why has there been no evidence of the “behavioral fatigue” that some people were initially worried about?

When it comes to behavior, good or bad, there is rarely an easy answer. Compliance is undoubtedly due to a combination of variables, including the high risks involved (for both individuals and society), information campaigns, threat of sanctions, cultural values, as well as many social factors.

In terms of the spectrum of concepts and tools behavioral scientists have identified, social factors may well be the most important dimension in explaining behavioral compliance during the current pandemic. I was reminded of a literature review related to hand hygiene that I wrote a few years ago, which prominently featured social factors, especially in healthcare settings.

My report highlighted research and initiatives drawing on the power of social influence by role models, peers, and patients. It also mentioned mobilizing social norms and social comparison, the power of observation and personal feedback, as well as using commitment devices.

In terms of role model effects, for example, one study found that hospital workers were less likely to wash their hands if a peer or higher ranking person who did not engage in hand hygiene was in the room with them. Research conducted in university restrooms found that female students were more likely to wash their hands when others were present in the restroom (91%) than when they were alone (55%). In hospital contexts, a study on hand washing showed that baseline hand hygiene rates were greater in high visibility areas located near nurses’ offices (45%) than low visibility rooms (29%).

Another hospital-based study measured hand hygiene compliance during periods in which they were either aware or unaware of being observed. Healthcare workers’ compliance rates improved by about 8% during periods in which staff was aware of the observation. A personal and direct feedback system was implemented by Beth Israel Hospital in Manhattan, where non-compliant workers got red-carded by their peers.

Elsewhere, an ICU unit observed staff for several weeks via video. Workers were informed about the cameras installed to monitor hand hygiene but were not given performance feedback. During this time, hand-hygiene compliance rates were below 10%. In a follow-up period during which the hospital workers received emails and hallway scoreboards with information about compliance rates, the rate rose to above 80%.

The powerful impact of peer pressure and social norms has also been demonstrated by research comparing the effectiveness of different types of messages in an English highway service station restroom. Results showed that some messages worked better on women than men, but one message performed well for both genders: the normative statement “Is the person next to you washing with soap?” Compared to a control condition, this message resulted in a 12% relative increase in hand-washing ratio among men and an 11% increase among women. The power of social influence was further evident when the researchers included data about restroom busyness. Effective messages became even more effective during busy periods.

Aside from using peers as a source of social influence, social pressure can also be introduced through patient empowerment. When patients become the source of pressure, they can trigger a heightened sense of obligation and ethical awareness in hospital staff. An early study in this domain tested whether asking patients to remind healthcare workers to wash their hands would increase hand hygiene compliance. The program was associated with a 34% soap usage increase.

While I don’t have any data about people’s hand hygiene compliance during the COVID-19 pandemic, all of these social factors should also apply to other behaviors, particularly social distancing. Whether it’s movie stars reminding us to stay at home, poignant stories in the media about COVID-19 patients who lost their lives, regular applause for front-line workers from our doorsteps, or peer pressure when we stand in line outside the supermarket, social forces are a crucial dimension that explains our positive behavior during the pandemic.

Behavioral science is sometimes accused of an excessive focus on what people get wrong. As we analyze people’s behaviors during the COVID-19 pandemic, let’s also continue asking why and how people have been getting it right.

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