Embedding Behavioural Science in Public Health During COVID-19: Successes and Challenges

Prof Maddy Arden, Professor of Health Psychology & Director of the Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University

Professor Arden presented the work they have been doing at Sheffield Hallam University Centre for Behavioural Science and Applied Psychology (CeBSAP) with Sheffield City council. The council were concerned about the lack of adherence to COVID-19 protective measures in certain groups and how to encourage uptake of these. In particular, they were wanting to find insights from 18–45-year-olds who had been socialising in other people’s homes, pubs, bars, restaurants and working in high-risk settings (excluding NHS / health settings). The COVID-19 protective behaviours focused on included handwashing, face coverings, physical distancing, testing and isolation and later included the vaccine.

A series of focus groups were conducted within different contexts: lockdown, during ongoing vaccine approval processes and during the vaccine rollout. There were six focus groups, two at each timepoint (shown in figure 1 below).

The focus group schedules were informed by the COM-B model. The key points participants raised were:

• People perceived their risk to be low e.g., thought their family and friends would be safe to socialise with because they knew what situations they have been in
• They had socialised in the previous lockdown with no negative consequences, so they felt it was safe to do so again
• People felt their symptoms had to be really severe before they would get tested / self-isolate
• Barriers to testing / self-isolation included the ability to get time off work and its impact on their finances
• People focused on the negative consequences of carrying out the COVID protective measures e.g., the impacts of physical distancing on their mental health
• They also expressed uncertainty about how effective these measures were
• The changes in guidance were very confusing e.g., what the ‘rule of six’ and ‘support bubbles’ meant practically. There was also confusion as to why these rules were in place and how they reduced the risk of COVID
• There were mixed views on vaccines: some people wanted to have it as soon as possible, some people were hesitant due to concerns about long term effects and the speed at which it was developed. Others were in the middle and would be willing to have it if it meant they could do more things e.g., go on holiday.

From conducting the focus groups, they were able to make a number of key recommendations with regard to the measures:

• Be clear on what you want people to do and why
• Acknowledge and communicate why the guidance has changed
• Emphasise that testing is for everyone, regardless of what symptoms they have
• Focus on collective benefits of adherence to measures

The researchers also made a number of key recommendations with regards to vaccine uptake:

• Communications from ‘people like me’ and from healthcare workers were considered to be helpful, especially hearing from people who had already had the vaccine without any issues
• Simple communications around the process of vaccine development and how it happened so quickly would also provide reassurance e.g., how many people it was tested on and what the funding was spent on it

The team acknowledged that some of the changes needed were beyond local authority control e.g., financial support needed for self-isolation.

Greg Fell, Director of Public Health, Sheffield City Council Public Health

Public Health and embedding behavioural approaches in Sheffield is a whole organisation and city wide effort. The key concepts in doing this are behaviour, consensus, understanding and consent – “supporting and enabling ‘good’ behaviour, building consent and understanding of why”.

Greg highlighted a number of successes with this joint piece of work with the university and CeBSAP. This included the teamwork between the council communications team and public health team and how they integrated behavioural approaches across the prevention workstream. Examples of work they did included working with minority and ethnic communities through trusted local messengers as well as targeting young people via social media. They utilised ‘people like me’ messaging and ‘Stay Safe Sheff’ branding to deliver effective and targeted messages to the public. They tried to influence the accessibility of local test centres (opportunity), provide consistent, clear local messaging about testing (capability) and motivational messages.

Greg also noted a number of challenges in this work, such as the pace of which there were changes in guidance and a lack of control at the local level. There were also difficulties with addressing behaviours within people’s households and workplaces. The project highlighted a prevalent belief amongst residents that if they were going to contract COVID-19, it would be from ‘outside’ or ‘a stranger’ and not from their own family or friends. It was crucial to tackle this false belief in order to increase the uptake of protective behaviours and the COVID-19 vaccine.

Greg outlined the next steps as this work progressed. As a council, they would continue working closely with communities to deliver effective and targeted messages. They would continue to increase awareness of the importance of planning for encounters in high-risk situations to help people mitigate risks at home and work. They would continue to support the test, trace and isolate programme and the vaccine roll out. Finally, Greg noted the importance of communicating hope and developing recovery plans to show residents they were planning for the future.