Most of us in India will agree that there are two large parts to this pandemic: medical science and human behaviour. Universal vaccination will reduce infections, but with vaccine availability currently challenging, ‘herd immunity’ is still many months, if not years, away.
Lack of physical distancing and proper hand washing are among the reasons for daily new infections. But the biggest reason for the surge is that people are wearing masks inconsistently, incorrectly, or not at all. Data from a global survey of COVID-19 knowledge, attitudes and practices (KAP) produced by the Johns Hopkins Center for Communication Programs show that from July 2020 to March 2021, India saw a 5% drop in mask wearing. In the two-week period starting on March 15, 84% reportedly wore masks. However, the number varied sub-nationally and it was not measured whether the mask wearing was correct or consistent.
Nevertheless, this is discouraging. While there will always be a minority who do not believe in the virus, masks or vaccines, a great majority would like to do what it takes to put this pandemic behind us. Relying solely on medical science, especially treatment, takes the agency away from the average people to act.
Channels for communication
With behavioural data and strategic approaches, resources can be more efficiently used in reaching different audience segments with information through the channels they trust. Here are seven ways, rooted in behavioural science, that we can employ to improve mask wearing and other COVID-19 prevention measures.
First, we all need basic information on why masks are effective in preventing COVID-19 transmission. We also need to know who should wear them, when and where. We need clarity on what types of masks are most effective, how to wear a mask correctly, and when is it important to double mask. The COVID-19 KAP survey shows that scientists and health experts are the most trusted sources of information on COVID-19, followed by the World Health Organization, television, newspapers, radio, and local health workers. These trusted channels should be used together to share basic information. As new information becomes available that is different from, or that adds to, the baseline information that people have, it should be shared with everyone in a comprehensive and timely way. We should not discount or put down people’s beliefs or misconceptions, but counter them with credible facts (Limaye, Sauer 2021). Addressing those barriers creatively through expert testimonials, infographics and statistics that explain how masks have prevented infection transmission is important.
Second, not everyone has the same information needs. Some don’t believe that masks prevent COVID-19 infection whereas some know and agree that masks do prevent infection but don’t wear them consistently or correctly for various reasons. Communication to each group of people should be tailored accordingly. Generic messages saying ‘wear your mask’ can only serve as reminders at best; they will not help someone who, say, only wears a mask when she decides that she is in a risky situation. For that person, the message should convince her that any situation outside the home can pose a COVID-19 risk and that masking up any time you leave your house is critical.
Third, we need to communicate the benefits of mask wearing. We need to highlight stories that show how COVID-19 infections are low among communities where mask wearing is high. Sharing testimonials from people who wear masks regularly and explaining how they have managed to avoid getting infected could help. Making masks a symbol of being cool (for the image-conscious), a sign of being considerate and respectful (for people who have elders and vulnerable people at home), and a badge of being smart (for those who want to protect themselves) could all be ways of reaching out to different kinds of people.
Positive social norm
Fourth, we need to create a positive social norm around mask wearing. People are more likely to practise a behaviour if they believe that everyone else is also doing it too. Each audience segment has its own influencers, whether in their community or in the media. Those influencers should be routinely seen wearing a mask or heard talking about it. Advertisements, messages and visuals all positively reinforce mask wearing.
Fifth, we need to enforce correct and consistent mask wearing. Many people do not follow proper masking behaviour because there is no consequence for their inaction. We rely only on the police to enforce mask wearing. While that is needed, we should all take collective responsibility. We need language that shows us how to politely tell an unmasked or poorly masked community member to wear a mask. If each of us can influence the people around us, the positive multiplier effect of wearing masks will be significant in curbing infections.
Sixth, we need compassionate leadership. Leaders, at every level, can play a positive or negative role in influencing our behaviour. From the head of a family to the head of a country, leaders have to lead with empathy, and build and hold the trust of the people they lead. Religion, politics and profit have no role when we are in such a dire situation. These leaders should themselves consistently convey and enact positive behaviours like mask wearing and vaccinations.
The role of media
Seventh, we need responsible media. If fear of the threat (COVID-19 in this case) is stronger than our perception that we can do something about it, we will ignore the threat rather than trying to address it (EPPM, Witte et al. 1992). We look to the media for brave and honest reporting and there have been some great examples of that during the pandemic. However, when many channels sow more panic than positivity, the audience grows numb. People feel that there may be no point in them doing anything if it is all doom and gloom anyway. In their helplessness, people indiscriminately share information, misinformation and disinformation on social media. We need sections of the media to hold themselves to a high standard and report on much more than just burning pyres, struggling hospitals, the oxygen crisis and vaccine and drug shortages. When we see uplifting and inspiring stories of prevention efforts, ideas and innovations to promote masking, distancing and vaccination, we will feel inspired to do our bit for prevention.
If we want to finish this year being able to celebrate festivals, hug our loved ones and enjoy a real holiday, we need to invest in a comprehensive, behavioural approach to address COVID-19 behaviour. While no expense is being spared in engaging the best scientific experts from around the world to address questions and explain the pandemic, the human behavioural aspect has only been addressed in an ad hoc manner. Understanding, predicting and shaping human behaviour is a science too. Indeed, it is the less expensive way of digging ourselves out of the hole we are currently in.
Uttara Bharath Kumar is a Senior Technical Advisor for Social and Behaviour Change at the Johns Hopkins Center for Communication Programs which is part of the Bloomberg School of Public Health at Johns Hopkins University