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      Institutional and behaviour-change interventions to support COVID-19 public health measures: a review by the Lancet Commission Task Force on public health measures to suppress the pandemic

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          Abstract

          The Lancet COVID-19 Commission Task Force for Public Health Measures to Suppress the Pandemic was launched to identify critical points for consideration by governments on public health interventions to control coronavirus disease 2019 (COVID-19). Drawing on our review of published studies of data analytics and modelling, evidence synthesis and contextualisation, and behavioural science evidence and theory on public health interventions from a range of sources, we outline evidence for a range of institutional measures and behaviour-change measures. We cite examples of measures adopted by a range of countries, but especially jurisdictions that have, thus far, achieved low numbers of COVID-19 deaths and limited community transmission of severe acute respiratory syndrome coronavirus 2. Finally, we highlight gaps in knowledge where research should be undertaken. As countries consider long-term measures, there is an opportunity to learn, improve the response and prepare for future pandemics.

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          The behaviour change wheel: A new method for characterising and designing behaviour change interventions

          Susan Michie, Maartje M. van Stralen, Robert H. West (2012)
          Background Improving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations. Methods A systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to meet these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity. Results Nineteen frameworks were identified covering nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). This forms the hub of a 'behaviour change wheel' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these conditions; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English Department of Health's 2010 tobacco control strategy and the National Institute of Health and Clinical Excellence's guidance on reducing obesity. Conclusions Interventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions.
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            Using social and behavioural science to support COVID-19 pandemic response

            Jay Bavel, Katherine Baicker, Paulo S Boggio … (2020)
            The COVID-19 pandemic represents a massive global health crisis. Because the crisis requires large-scale behaviour change and places significant psychological burdens on individuals, insights from the social and behavioural sciences can be used to help align human behaviour with the recommendations of epidemiologists and public health experts. Here we discuss evidence from a selection of research topics relevant to pandemics, including work on navigating threats, social and cultural influences on behaviour, science communication, moral decision-making, leadership, and stress and coping. In each section, we note the nature and quality of prior research, including uncertainty and unsettled issues. We identify several insights for effective response to the COVID-19 pandemic and highlight important gaps researchers should move quickly to fill in the coming weeks and months.
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              Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis

              Derek K. Chu, Elie A. Akl, Stephanie Duda … (2020)
              Summary Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. Methods We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047. Findings Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] −10·2%, 95% CI −11·5 to −7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; p interaction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; p interaction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD −10·6%, 95% CI −12·5 to −7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings. Interpretation The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance. Funding World Health Organization.
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                Author and article information

                Contributors
                Jong-Koo Lee
                Chris Bullen
                Yanis Ben Amor
                Simon R Bush
                Francesca Colombo
                Alejandro Gaviria
                Salim S Abdool Karim
                Booyuel Kim:
                ORCID: https://orcid.org/0000-0002-2991-4186
                John N Lavis
                Jeffrey V Lazarus
                Yi-Chun Lo
                Susan F Michie
                Ole F Norheim
                Juhwan Oh
                Kolli Srinath Reddy
                Mikael Rostila
                Rocío Sáenz
                Liam D G Smith
                John W Thwaites
                Miriam K Were
                Lan Xue
                Journal
                Journal ID (nlm-ta): Int Health
                Journal ID (iso-abbrev): Int Health
                Journal ID (publisher-id): inthealth
                Title: International Health
                Publisher: Oxford University Press
                ISSN (Print): 1876-3413
                ISSN (Electronic): 1876-3405
                Publication date (Electronic): 11 May 2021
                Electronic Location Identifier: ihab022
                Affiliations
                Seoul National University College of Medicine , Seoul, 03080, Republic of Korea
                Department of Family Medicine, Seoul National University Hospital , Seoul, 03080, Republic of Korea
                School of Population Health, University of Auckland , Auckland, 1142, New Zealand
                Center for Sustainable Development, Earth Institute, Columbia University , New York, 10115, USA
                Sightsavers , P.O. Box KIA 18190 Accra, Ghana
                OECD Health Division , Paris, 75016, France
                School of Economics, Universidad de los Andes , Bogotá, 111711, Colombia
                Centre for the AIDS Programme of Research in South Africa (CAPRISA) , Private Bag X7, Congella, 4013, Durban, South Africa
                Department of Epidemiology, Mailman School of Public Health , New York, 10032, USA
                Department of Environmental Planning, Graduate School of Environmental Studies, Seoul National University , Seoul, 08826, Republic of Korea
                Environmental Planning Institute, Seoul National University , Seoul, 08826, Republic of Korea
                Department of Health Research Methods, Evidence and Impact, McMaster University , Hamilton, Ontario, L8S 4K1, Canada
                Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona , Barcelona, 08036, Spain
                Taiwan Centers for Disease Control , Taipei, 100, Taiwan
                UCL Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London , London WC1E 7HB, UK
                Department of Global Public Health and Primary Care, University of Bergen , Postboks 7804 NO-5020, Bergen, Norway
                Seoul National University College of Medicine , Seoul, 03080, Republic of Korea
                Public Health Foundation of India , Delhi, Gurgaon, Haryana, 122002, India
                Department of Public Health Sciences, Stockholm University , Stockholm, 10691, Sweden
                School of Public Health, Universidad de Costa Rica , San Pedro Montes de Oca, San José, 11501, Costa Rica
                BehaviourWorks Australia, Monash University , Melbourne, 3800, Australia
                Monash Sustainable Development Institute, Monash University , Melbourne, 3800, Australia
                Champions of an AIDS-Free Generation in Africa , P.O. Box 63056 - 00200 Nairobi
                School of Public Policy and Management, Tsinghua University , Beijing, 100084, China
                Author notes
                Corresponding author: Tel: +64 21415267; E-mail: c.bullen@ 123456auckland.ac.nz
                Author information
                https://orcid.org/0000-0002-2991-4186
                Article
                Publisher ID: ihab022
                DOI: 10.1093/inthealth/ihab022
                PMC ID: 8136029
                PubMed ID: 33974687
                SO-VID: a3200f51-4f03-4606-b257-83eff5b01e87
                Copyright © © The Author(s) 2021. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@ 123456oup.com

                History
                Date received : 07 March 2021
                Date revision received : 01 April 2021
                Date accepted : 20 April 2021
                Page count
                Pages: 11
                Funding
                Funded by: Health Research Council of New Zealand, DOI 10.13039/501100001505;
                Funded by: Ministry of Education of the Republic of Korea, DOI 10.13039/501100002701;
                Funded by: National Research Foundation of Korea, DOI 10.13039/501100003725;
                Award ID: NRF-2018S1A3A2075117
                Funded by: Gilead Sciences, DOI 10.13039/100005564;
                Funded by: NIHR, DOI 10.13039/501100000272;
                Funded by: MRC, DOI 10.13039/501100011856;
                Funded by: CIHR, DOI 10.13039/501100000024;
                Funded by: PHA, DOI 10.13039/100002291;
                Categories
                Subject: Review Article
                Subject: AcademicSubjects/MED00390
                Custom metadata
                article-lifecycle PAP

                ScienceOpen disciplines: Medicine
                Keywords: behaviour change,covid-19,pandemic,public health
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: behaviour change, covid-19, pandemic, public health

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