UCL Minds


Transcript: Episode 12

How can behavioural science help us combat the virus?


behaviour, people, behavioural, situation, ucl, virus, government, pandemic, science, transmission, hand, hand hygiene, susan, rules, understanding, developing, measures, wear, important, smoking


Robert West, Susan Michie, Vivienne Parry

Vivienne Parry  00:00

Hello and welcome to Coronavirus The Whole Story. I'm Vivienne Parry, a writer, broadcaster, UCL alumna and now host of this podcast all about Coronavirus and its impact. If it is your first time tuning in them. Welcome to Episode 12 Episode 12. How do we get to Episode 12? If you want to catch up head to the UCL Minds websites to hear how UCL researchers have contributed to the Coronavirus effort in every way possible from getting stuck in on the front line to tracking the spread of the virus to developing new social distancing procedures. In this episode, I'm joined by two psychologists to continue our conversation on handling the pandemic using behavioural and social strategies. They'll be applying the expertise in behavioural science to discuss what is and isn't working in the way of anti COVID measures. My first guest will be familiar to many of you Susan Michie is professor of health psychology and the director to the Centre for Behaviour Change at UCL. Susan's research focuses on how best to measure the impact of interventions on behaviour in the realm of health. One good example is how best to get hospital staff to improve their hand hygiene, who better than to discuss the current guidelines and how to persuade the population to stay safe and alert. We're also joined by someone else who has become familiar to the public during COVID. Although many of us know him best for his work on smoking. Robert West is also a professor of health psychology in the Department of Epidemiology and Public Health at UCL. Both of my guests this week are contributing their understanding of behavioural science to managing the pandemic. They're both on the government committee on behavioural science, the famous spy Bee, and on independent sages behavioural advisory group. So first of all, I've got to ask you both. What is behavioural science?

Susan Michie  01:54

Well, why don't I start with that it's the scientific understanding of behaviour. behaviour in its context. So understanding the relationship between behaviour, emotions, cognitions, and how those interrelate with each other and also with the social and material environment around us. And in relation to COVID-19 One of the things that behavioural science has been working to do is to identify the key behaviours that are responsible for transmission, and the behaviours that are needed to change in order to block that transmission.

Vivienne Parry  02:33

But give me an example, Susan never have a behaviour likely to spread transmission of the sort that

Susan Michie  02:39

in terms of personal protective behaviours of citizens, there are four key ones. The first is covering your nose and mouth if you cough or sneeze with a tissue that you then dispose of, and safely and immediately or in certain situations wearing a face mask appropriately and this prevents the virus So from an infected person getting out to potentially infect others, then one has to think about the routes of transmission, which is why there's been such an emphasis on hand hygiene or hand cleansing, because those droplets, and aerosols coming from people's nose and mouths end up landing on surfaces that people then touch, and they then may touch their nose, eyes and mouth, which is actually how the virus gets into the body. So ensuring that not only hands are regularly cleaned every time one comes into a building before eating or preparing food, but also developing methods not to touch eyes, nose or mouth is incredibly important. And the fourth is the social distance. We know that nearly all the droplets land to the floor within two metres, which is why the two metre distance has been adhered to for so long, and I think still ought to as much as possible. So those four behaviours if we were able to get them whole population to adopt those at scale, we would be able to stop transmission of the virus. and in this situation where it doesn't look like we're going to be getting a vaccine or effective medication soon, the behavioural route is the only one we have.

Vivienne Parry  04:16

But Robert, those are, you know, they kind of, I guess the things that we all know that we have to do. But what role does behavioural science play in understanding why people don't do those things? The

Robert West  04:31

role that it plays is to allow people to go beyond the obvious the the sort of things that people would normally expect, that you would need to do to get these behaviours going and tackle this in that way are educating people and telling them how important it is and persuading them to do it. But of course, behavioural science tells us that there's a lot more More to getting people to do things than just educating and persuading people. And so it allows you to take a broader perspective. For example, looking at how you, for example, can best train people in whatever skills may be required, for example, in the safe handling of face masks, but also in things like environmental measures, how can you? How can you adapt and can construct environments, which are more conducive to the sorts of behaviours that we need to see in operation?

Vivienne Parry  05:38

So are we talking nudge here?

Robert West  05:41

We're talking beyond nudge. Because nudge is an approach that takes as the label suggests a sort of quite a subtle way of dealing with behaviours and trying to shape behaviours, using our Kind of interventions that are barely in consciousness. Sometimes that is enough. But in a lot of cases and that's largely true here, you've got to go far beyond that. For example, if you're a government and you're trying to enforce or trying to get people to engage in appropriate social distancing measures, behavioural science will be able to help you to determine to what extent you know, punitive measures to what extent your communication strategy, to what extent the use of visual cues in the environment can be helpful in ensuring that the behaviour takes place nudge would be one part of that but it would only be a small part

Vivienne Parry  06:48

Okay. So for instance, with mask wearing, if everybody else is wearing the mask, you feel that you ought to be wearing a mask of I guess that's a kind of nudge bit but the you know, the addition of a big fine if you don't wear a mask would be the extra thing that really made you make to wear a mask.

Susan Michie  07:06

Also, the key thing is actually the skills of how you wear a mask. Because if you don't wear a mask properly, and you as well as we have seen how people wear masks out in the back, they touch them, they fiddle them, they put them up and down, run their neck ran their forehead. And the problem is if you are infected the mask is a great way of bringing lots of viruses together, you then touch then touch other surfaces, and so you can become a contaminant. So what's really important is to train people in how to put on masks, how to wear them, and how to take them off. So for example, and much better to have, say two bags in different pockets or in a bigger bag, one with a clean mask. And one way you put a used mask and or you fold it up very carefully. Put it in your bag into a separate place and then sanitise your hands after wearing it, and much better just to wear it in the enclosed confined spaces where we know risk of transmission of many, many times higher than wear it all the time, but keep putting it on and off. So wearing it for short times in particular situations, and not fiddling with them when they're on taking them on and off in particular ways. Now, that all needs actual training. And one of the things that I have felt throughout this pandemic is that a lot of what we're talking about, which is adopting new routines and habits does require training and different ways of enabling people to do that. And I so wish the government has sponsored a behavioural science programme every day on television, really to explain to people how they can develop these protective behaviours, because if we can get these done at scale and maintain them, we've Got a very different risk situation in our society than we have currently.

Vivienne Parry  09:04

and developing those new habits is very important, isn't it? I was just thinking, Robert, looking back at your smoking work, where some of the things about smoking cessation are about breaking the old habits of smoking. So for instance, people automatically reaching for a cigarette after a meal,

Robert West  09:22

that there are actually some striking parallels between smoking and the kind of behaviours that we're talking about here. For example, if we look at touching your eyes, nose and mouth, this is an extraordinary ingrained behaviour. And the research has shown that people do it on average about 20 or more times an hour. And there are a number of reasons for it. There hasn't been enough research done, but it looks as though you know, there's a number of factors that come into play one of them is just it's done automatically. Another one is that especially when you start thinking about it, your face starts to itch. And so an itch is designed to get you to scratch them, you know that there's sort of the you're programmed to, to have this urge to scratch the itch. So you've got the automatic component, and you've got this need to, to suppress or cope with an urge. Well, that's very similar to what you see with smoking. And so this is speculation, but it occurs, it does occur to me that there may be some things that we've learned to how to control, smoking urges, and to apply those to these sorts of situations. One idea that Susan has had, which I think is important, potentially, is that when you're trying to deal with a highly automated habit, you can't just kind of not do it. It's much better or easier if you can build in a competitive behaviour that you can do instead. And so Susan's idea is if you just make sure and build a habit of keeping your Hand below shoulder height, then that will obviously conflict. And if you find yourself with your hand moving up to your face, then it's much more noticeable. You see that you're doing it, and you can stop it.

Susan Michie  11:14

So just to add to what Robert said, it's a very different kind of behaviour than say developing a routine for hand hygiene. I have to say, when I was a child, everybody washed their hands before sitting down for a meal, you know, it was just a done thing. There is no reason why we can't get back to that again. But what the powerful approach there is, is to use sort of top down rules and and the kind of rules that we know from the literature are effective, are called if then rules. If I'm in this situation, then I do that and you can back it up with all sorts of visualisations, rehearsals, writing down contracts that really cement that, bring it into routine, bring it into a habit, but falling from what Robert was saying about the automatic sort of unconscious nature of this face touching behaviour, and a rule just wouldn't cut it. And that's where an incompatible behaviour needs to come in. And the competitive behaviour can include things like balding your hands on your lap, sitting on your hands, putting your hands in your pockets. And this is an example, that you really do need to understand the nature of the behaviour in its particular situation before you can move on to understand what is likely to be effective in terms of changing that behaviour. And, sadly, that isn't done, and we don't see that very much in government. So if I can just take an example of that, you probably remember, early on in the pandemic, the first sunny weekend when we and most of the rest of Britain went when tied to the local park, which is indeed what we're being encouraged to do. But suddenly there were a lot of people in that situation. And so it was quite crowded and looked even more so when the media photographed it Not aerially but with telescopic lenses. But the response from government rather than to look at the evidence and show that around 90% of people were highly motivated to keep socially distanced. And it wasn't a motivational issue, but rather was an opportunity issue. What they did was respond as if it was a motivational issue with threatened punishment, say, if this happens again, we will close down the parks. And what I got onto the media very quickly to say was that the response should have been, there's not enough opportunity, you are motivated to keep distance, but you also want to go outside and we're encouraging people to go outside. So therefore, for example, in London, let's open the 45,000 acres of golf courses and all those playing fields that are unused in the Independent School sector. And this is an example where Even a very simple model of understanding behaviour and one that Robert and I and many others use frequently is called combi. C-O-M-B standing for capability, opportunity, motivation and behaviour. So in these circumstances one has to say is the going to the park and not being always able to keep two metres distance to do with motivation to do the capability IE they didn't know they weren't meant to, or to do the opportunity. And if you use that sort of even, that's the simplest framework and the frameworks we use a more elaborated than that, but at least that gives a framework for beginning to think, how do I understand this behaviour and pointing the direction of what needs to be done to most effectively change that behaviour?

Vivienne Parry  14:47

Yeah, understanding behaviour has been a key thread that's run right through this whole pandemic. And, and it's not been understood, but I want to turn Last night out to turn now to the evening of the lockdown, because we're looking particularly, we're recording this, as we come up to the weekend with we're seeing the first opening of pubs. There's a lot of anxiety about the number of people that might go out and and binge. What can behavioural science do to help us?

Robert West  15:22

Yes. So I think I think that this is, as you rightly say, a potentially risky situation in all sorts of ways. And, you know, it's hard to predict exactly how people are going to operate. But I think there's a few principles that we can put into place. One is that not everyone's going to act in the same way and we have to recognise there's going to be a wide range of responses from people who are frightened to go out into situations and will feel in a way more isolated because they see other people going out and they feel excluded to people who will take full advantage of it, and will, whatever rules that might be in place, they will bend or break those rules, because they feel confident and comfortable in potentially risky situations. So we need to understand that diversity and we need to be able to help people in all of it across that diversity to behave in ways that are adaptive for them, and enable them to live the best lives they can in this situation, but also safely, and, and so that that's obviously a very important factor. I think in terms of the kinds of rules that we're going to have to put in place, we already see that we've moved on way from the stay at home rule, which was clear, had good boundaries and was well adhere to, to much more nuanced rules. And I think this brings into play what we know from behavioural point of view around how you build a safety culture in society, which is what we're going to have to do for the foreseeable future with this virus. And there are three elements to it. One is you create environments that are as safe as they can be. Make them as protective as you can make them. That will take you so far. The second one is that you have rules you do need rules and they do need clear boundaries. But the third thing, which is something that Susan alluded to a bit earlier, was around understanding and people's mental models people have to have an accurate understanding of how the virus is transmitted, how safe or risky particular environments are. To give you an example of this, we now have a much better understanding that it's probably a lot safer outside than we originally thought it was, and probably a lot more risky inside than we thought it was in the sense that we originally thought that the virus is transmitted almost exclusively or exclusively in the community through large droplets through coughs or sneeze we now I think, have a better understanding that there are various sizes of droplets and they can travel further and last for longer in the environment. What that means is that if you are with a number of other people in an unventilated enclosure, enclosed space, you could be two metres away, you could be three metres away and you're still potentially going to be at risk if you're in that environment for a period of time. Now, the parallel here is road safety, which of course we have developed over the decades. That kind of safety culture we have roads that are designed with safety built in We have rules, the highway code that tells us what we need to do in particular situations. But we also through the process of learning to drive and gaining driving experience, learn to anticipate and understand what kind of situations are more or less risky. And you put those three things together. And that that builds your ideally, you build your maximally protective environment, realising that you're not going to get the risk back down to zero.

Vivienne Parry  19:28

And one of the problems about risk perception in this whole thing, particularly by young people who do not perceived themselves and indeed are not at the risk from the virus that older people are. And so they, they think that they can do anything and feel increasingly constrained. And there's a wedge being driven between older, more vulnerable members of society and younger people who Who in some ways are both least impacted by the virus but most impacted because they're the ones whose livelihoods perhaps are at greatest risk? So how do we cope with that? Susan?

Susan Michie  20:12

I think that's a very good question. One of the things that we really encouraged in the early part of the pandemic, is to really stress that the risk isn't just about you. The risk is for others. It's for your family members, it's for your community, it's for your society. And I think the first message that the government used was excellent in really encompassing that so stay home, this is what you should do save lives. This is why you should do it and protect the NHS. This is a consequence of you doing that. And we did see that the overwhelming majority, including of young people, who I think suffered most from it did stay at home for many, many weeks. And these are the same people that are now in a very different situation. And one of the things that is really important to keep everybody together to keep that feeling of collective solidarity, there were so well built up at the beginning of the pandemic, is to have trusted leadership is to have moral authority that people can identify with, and trust and understand and follow. And we are in a difficult situation, because when the messaging got very mixed and actually muddled around the Stay Alert business, and then that was followed by the Dominic Cummings business, when you look at the evidence and the polls, trust in the government's handling really has plummeted and trust is something that's incredibly important in the situation, but quite difficult to build up again. So I think the strategy going forward needs to be a very new approach from the government, which includes much more consultation and partnership and listening with all communities. The elderly who have their own challenges and difficult situations, and young people. Similarly, we've known for months that it's younger people, and especially younger men, who were the groups were likely to find this most challenging. And so communication, and enabling strategies should really be targeted at those groups that find it most challenging. And for example, I'm very surprised that it hasn't been more use of role models that young people would identify with. And, you know, famous sports people, singers, film stars, etc. Because we know that that can be very persuasive. So I think that that collective solidarity is what needs to be built up, but it's not going to be done without really understanding who we need to bring together. And I think there's also to regain trust and necessity to actually hold one's hand up and say, actually haven't done everything right. And we are learning lessons, and including everybody in that discussion and in decision making. So for example, there was a real problem over the schools opening where the schools themselves, the local authorities, governing bodies, etc, weren't properly involved and consulted in advance with all the model we saw. So I think these are lessons that we can learn going forward. But you're absolutely right, that what we have, I mean, the lifting of lockdown was always going to be more challenging than bringing it about. Because at the beginning, everybody was essentially being asked to do the same thing, even though some people are very frightened as well. Yeah, it's true, whereas lifting it, you know, it means different things for different sections of the population. And, as you say, it's a frightening situation. I think the government's slightly lost the narrative that we are in a crisis situation, you know, the the level of viral transmission Across the country, so especially across England, let's cross some parts of it is high, and people are still dying in their hundreds, readily. So, we are in a crisis situation. And we need to find ways of how we develop ways of being ways of doing things that recognise a crisis situation. And I have to say, giving a message of opening pubs on a Saturday night is not a way of really communicating the seriousness of the situation we're in.

Vivienne Parry  24:32

And there doesn't need to be a real understanding of why people do what they do. I feel very strongly that for now, just to wag your finger and tell people that they're what's the phrase COVIDiots and all those kind of things that doesn't actually change their behaviours and if anything, it makes them more determined to go on and do what they perceive as as perfectly acceptable, but I want To close this by talking to you both about giving advice to government and how difficult that is, and whether behavioural science is the advices followed in your opinion, and we've we've seen quite a lot of the behavioural sciences being dissed in print. And you can imagine that there's quite a lot of that also going on in government. How difficult is it giving a behavioural science advice?

Robert West  25:35

There's two problems really. One is that the way that the system operates within the advisory body that we sit on – we’re in response mode, so we get asked questions. And then to be perfectly frank, those questions aren't always necessarily the best questions or the most important questions or framed in a way that That you can give a good answer to that would make a difference. So we're not in a position, really to be able to say, Well, this is what we really think you should be paying attention to right now, and tell us what you're proposing. And we'll try to give you the best possible advice we can on it. So it's a bit of a mismatch there. The other problem we face, I think, is that there is a bit of a lack of transparency about what happens to that advice. And so I can't put my hand on my heart and say, I know whether the advice is going anywhere or not. I mean, I know that it goes somewhere. I suspect from obviously the way the government's been operating over the latter part of this crisis, that they have not been paying a huge amount of attention because even right at the beginning, we were setting out some rather broad behavioural principles around the need for trust and the needs to explain what you're doing. And and the reasons why you were doing things and to have a strategy. And and, you know, unfortunately, that doesn't seem to have, you know, should we put it this way, you know, in terms of what they're doing and what they're saying, I can't see evidence of, you know, whether behavioural advice have gone in. On the other hand, I think that what we can do, even if we're not being successful in having an impact on what the government itself is doing, and saying, we're getting a lot of exposure in the media, and I think people have a much better understanding now about what behavioural science is, and it's more than just nudge and it's more than just finger wagging in it or just providing information. And so I think there is an opportunity here to speak directly to people about behavioural science and for them to be able to use it. And of course there's lots of other organisations and bodies that are involved in this and local governments and the health service and so on who can also make use of that kind of advice?

Susan Michie  28:10

Well, I would add, add to that, that one thing to remember is that there's not just a paper science advisory group in SAGE, but also there's the Cabinet Office have behavioural scientists advising them, PHE does, different government departments do. But I think that, again, has has led to a very confused situation. And I think this was most illustrated by the very unfortunate use of the word that is not a scientific term behavioural fatigue. Now, this was, because it's not a scientific term, because none of us had ever heard of it before, it was never discussed on our committee. It's not, you can see in all of our published reports and minutes, it's not there. I gather that somebody used the word on SAGE. So it's come from somewhere, but there are people from Cabinet Office and other government departments who sit on SAGE, so we just I don't know where it's come from. But that caused a lot of harm to the perception of behavioural science. Why do I say it's not a term, it doesn't exist in the literature, there's no theoretical explanation for it, there is no measure for it. It's probably being used in a loose sort of mishmash to bring a whole load of very, very different concepts together. But the problem is it appeared that it was being used for a political purpose to justify delaying lockdown that we know from what the model is, say it lost 10s of thousands of lives. And so I really want to use this and I use every platform to absolutely say, this is not behavioural science. These are two words that's come from somewhere else. And the other thing to say is that I think it's so important that behavioural science is in a proactive, not just reactive role. So at the moment in the UK, the thing that is most urgently needed if we are to get rid of this virus is to get a really good functioning, test trace and isolate system in place or as independent SAGE call it, find test, trace, isolate and support. In order to do that, one absolutely has to have a behaviour understanding of key parts of that process. For example, people need to be willing to give contacts and knowing that those contacts may be asked to self isolate with negative consequences for their, for their life and their and their work. And also people are asked to isolate. There's a lot of psychological, psycho-social and economic issues that go along with that. And so, people will need to be financially compensated and will need to have accommodation provided and if they can't isolate themselves in their own houses, which most people can't. And I think this is a very good example of behavioural science involved in whole systems and showing where people's behaviour is going to be crucial for systems to work. And it's not just about changing the way people, you know, think and feel, but it's also about ensuring the material and social circumstances are in place that enable people to behave in certain ways.

Vivienne Parry  31:20

I think but what both of you have done is you've shown how critical the role of behavioural sciences in all of this. I have a suspicion that there may be some people in some quarters, who think it's a kind of fluffy add on, but actually, it as you've so well illustrated, it is essential and a real foundation of what we need to do for the future. Sadly, we've come to the end of our time, you've been listening to Coronavirus The Whole Story. This episode was presented by myself Vivienne Parry produced by UCL with support from the UCL health of the public and UCL grand challenges and edited by the lovely Cerys Bradley, our guest today were professors Susan Michie and Robert West. And if you'd like to hear more of these podcasts from UCL Minds, you can subscribe wherever you download your podcasts, or visit ucl.ac.uk forward slash Coronavirus. While you're there, why not fill out our survey that would be very helpful. Thank you. This podcast is brought to you by UCL Minds, bringing together UCL knowledge, insights and expertise through events, digital content, and activities open to everyone. Hope to be with you again soon. Bye for now.

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