What influences people’s responses to public health messages for managing risks and preventing infectious diseases? A rapid systematic review of the evidence and recommendations

BackgroundIndividual behaviour changes, such as hand hygiene and physical distancing, are required on a population scale to reduce transmission of infectious diseases such as COVID-19. However, little is known about effective methods of communicating risk reducing information, and how populations mi...

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Published in:	BMJ open Vol. 11; no. 11; p. e048750
Main Authors:	Ghio, Daniela, Lawes-Wickwar, Sadie, Tang, Mei Yee, Epton, Tracy, Howlett, Neil, Jenkinson, Elizabeth, Stanescu, Sabina, Westbrook, Juliette, Kassianos, Angelos P, Watson, Daniella, Sutherland, Lisa, Stanulewicz, Natalia, Guest, Ella, Scanlan, Daniel, Carr, Natalie, Chater, Angel, Hotham, Sarah, Thorneloe, Rachael, Armitage, Christopher J., Arden, Madelynne, Hart, Jo, Byrne-Davis, Lucie, Keyworth, Christopher
Format:	Journal Article
Language:	English
Published:	London British Medical Journal Publishing Group 11.11.2021 BMJ Publishing Group LTD BMJ Publishing Group
Series:	Original research
Subjects:	Community involvement Coronaviruses COVID-19 Disease spread Disease transmission Epidemics Health risks Heterogeneity infection control Infectious diseases Pandemics Public Health Social responsibility Systematic review
ISSN:	2044-6055, 2044-6055
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Abstract	BackgroundIndividual behaviour changes, such as hand hygiene and physical distancing, are required on a population scale to reduce transmission of infectious diseases such as COVID-19. However, little is known about effective methods of communicating risk reducing information, and how populations might respond.ObjectiveTo synthesise evidence relating to what (1) characterises effective public health messages for managing risk and preventing infectious disease and (2) influences people’s responses to messages.DesignA rapid systematic review was conducted. Protocol is published on Prospero CRD42020188704.Data sourcesElectronic databases were searched: Ovid Medline, Ovid PsycINFO and Healthevidence.org, and grey literature (PsyarXiv, OSF Preprints) up to May 2020.Study selectionAll study designs that (1) evaluated public health messaging interventions targeted at adults and (2) concerned a communicable disease spread via primary route of transmission of respiratory and/or touch were included. Outcomes included preventative behaviours, perceptions/awareness and intentions. Non-English language papers were excluded.SynthesisDue to high heterogeneity studies were synthesised narratively focusing on determinants of intentions in the absence of measured adherence/preventative behaviours. Themes were developed independently by two researchers and discussed within team to reach consensus. Recommendations were translated from narrative synthesis to provide evidence-based methods in providing effective messaging.ResultsSixty-eight eligible papers were identified. Characteristics of effective messaging include delivery by credible sources, community engagement, increasing awareness/knowledge, mapping to stage of epidemic/pandemic. To influence intent effectively, public health messages need to be acceptable, increase understanding/perceptions of health threat and perceived susceptibility.DiscussionThere are four key recommendations: (1) engage communities in development of messaging, (2) address uncertainty immediately and with transparency, (3) focus on unifying messages from sources and (4) frame messages aimed at increasing understanding, social responsibility and personal control. Embedding principles of behavioural science into public health messaging is an important step towards more effective health-risk communication during epidemics/pandemics.
AbstractList	BackgroundIndividual behaviour changes, such as hand hygiene and physical distancing, are required on a population scale to reduce transmission of infectious diseases such as COVID-19. However, little is known about effective methods of communicating risk reducing information, and how populations might respond.ObjectiveTo synthesise evidence relating to what (1) characterises effective public health messages for managing risk and preventing infectious disease and (2) influences people’s responses to messages.DesignA rapid systematic review was conducted. Protocol is published on Prospero CRD42020188704.Data sourcesElectronic databases were searched: Ovid Medline, Ovid PsycINFO and Healthevidence.org, and grey literature (PsyarXiv, OSF Preprints) up to May 2020.Study selectionAll study designs that (1) evaluated public health messaging interventions targeted at adults and (2) concerned a communicable disease spread via primary route of transmission of respiratory and/or touch were included. Outcomes included preventative behaviours, perceptions/awareness and intentions. Non-English language papers were excluded.SynthesisDue to high heterogeneity studies were synthesised narratively focusing on determinants of intentions in the absence of measured adherence/preventative behaviours. Themes were developed independently by two researchers and discussed within team to reach consensus. Recommendations were translated from narrative synthesis to provide evidence-based methods in providing effective messaging.ResultsSixty-eight eligible papers were identified. Characteristics of effective messaging include delivery by credible sources, community engagement, increasing awareness/knowledge, mapping to stage of epidemic/pandemic. To influence intent effectively, public health messages need to be acceptable, increase understanding/perceptions of health threat and perceived susceptibility.DiscussionThere are four key recommendations: (1) engage communities in development of messaging, (2) address uncertainty immediately and with transparency, (3) focus on unifying messages from sources and (4) frame messages aimed at increasing understanding, social responsibility and personal control. Embedding principles of behavioural science into public health messaging is an important step towards more effective health-risk communication during epidemics/pandemics. Individual behaviour changes, such as hand hygiene and physical distancing, are required on a population scale to reduce transmission of infectious diseases such as COVID-19. However, little is known about effective methods of communicating risk reducing information, and how populations might respond.BACKGROUNDIndividual behaviour changes, such as hand hygiene and physical distancing, are required on a population scale to reduce transmission of infectious diseases such as COVID-19. However, little is known about effective methods of communicating risk reducing information, and how populations might respond.To synthesise evidence relating to what (1) characterises effective public health messages for managing risk and preventing infectious disease and (2) influences people's responses to messages.OBJECTIVETo synthesise evidence relating to what (1) characterises effective public health messages for managing risk and preventing infectious disease and (2) influences people's responses to messages.A rapid systematic review was conducted. Protocol is published on Prospero CRD42020188704.DESIGNA rapid systematic review was conducted. Protocol is published on Prospero CRD42020188704.Electronic databases were searched: Ovid Medline, Ovid PsycINFO and Healthevidence.org, and grey literature (PsyarXiv, OSF Preprints) up to May 2020.DATA SOURCESElectronic databases were searched: Ovid Medline, Ovid PsycINFO and Healthevidence.org, and grey literature (PsyarXiv, OSF Preprints) up to May 2020.All study designs that (1) evaluated public health messaging interventions targeted at adults and (2) concerned a communicable disease spread via primary route of transmission of respiratory and/or touch were included. Outcomes included preventative behaviours, perceptions/awareness and intentions. Non-English language papers were excluded.STUDY SELECTIONAll study designs that (1) evaluated public health messaging interventions targeted at adults and (2) concerned a communicable disease spread via primary route of transmission of respiratory and/or touch were included. Outcomes included preventative behaviours, perceptions/awareness and intentions. Non-English language papers were excluded.Due to high heterogeneity studies were synthesised narratively focusing on determinants of intentions in the absence of measured adherence/preventative behaviours. Themes were developed independently by two researchers and discussed within team to reach consensus. Recommendations were translated from narrative synthesis to provide evidence-based methods in providing effective messaging.SYNTHESISDue to high heterogeneity studies were synthesised narratively focusing on determinants of intentions in the absence of measured adherence/preventative behaviours. Themes were developed independently by two researchers and discussed within team to reach consensus. Recommendations were translated from narrative synthesis to provide evidence-based methods in providing effective messaging.Sixty-eight eligible papers were identified. Characteristics of effective messaging include delivery by credible sources, community engagement, increasing awareness/knowledge, mapping to stage of epidemic/pandemic. To influence intent effectively, public health messages need to be acceptable, increase understanding/perceptions of health threat and perceived susceptibility.RESULTSSixty-eight eligible papers were identified. Characteristics of effective messaging include delivery by credible sources, community engagement, increasing awareness/knowledge, mapping to stage of epidemic/pandemic. To influence intent effectively, public health messages need to be acceptable, increase understanding/perceptions of health threat and perceived susceptibility.There are four key recommendations: (1) engage communities in development of messaging, (2) address uncertainty immediately and with transparency, (3) focus on unifying messages from sources and (4) frame messages aimed at increasing understanding, social responsibility and personal control. Embedding principles of behavioural science into public health messaging is an important step towards more effective health-risk communication during epidemics/pandemics.DISCUSSIONThere are four key recommendations: (1) engage communities in development of messaging, (2) address uncertainty immediately and with transparency, (3) focus on unifying messages from sources and (4) frame messages aimed at increasing understanding, social responsibility and personal control. Embedding principles of behavioural science into public health messaging is an important step towards more effective health-risk communication during epidemics/pandemics. Background Individual behaviour changes, such as hand hygiene and physical distancing, are required on a population scale to reduce transmission of infectious diseases such as COVID-19. However, little is known about effective methods of communicating risk reducing information, and how populations might respond.Objective To synthesise evidence relating to what (1) characterises effective public health messages for managing risk and preventing infectious disease and (2) influences people’s responses to messages.Design A rapid systematic review was conducted. Protocol is published on Prospero CRD42020188704.Data sources Electronic databases were searched: Ovid Medline, Ovid PsycINFO and Healthevidence.org, and grey literature (PsyarXiv, OSF Preprints) up to May 2020.Study selection All study designs that (1) evaluated public health messaging interventions targeted at adults and (2) concerned a communicable disease spread via primary route of transmission of respiratory and/or touch were included. Outcomes included preventative behaviours, perceptions/awareness and intentions. Non-English language papers were excluded.Synthesis Due to high heterogeneity studies were synthesised narratively focusing on determinants of intentions in the absence of measured adherence/preventative behaviours. Themes were developed independently by two researchers and discussed within team to reach consensus. Recommendations were translated from narrative synthesis to provide evidence-based methods in providing effective messaging.Results Sixty-eight eligible papers were identified. Characteristics of effective messaging include delivery by credible sources, community engagement, increasing awareness/knowledge, mapping to stage of epidemic/pandemic. To influence intent effectively, public health messages need to be acceptable, increase understanding/perceptions of health threat and perceived susceptibility.Discussion There are four key recommendations: (1) engage communities in development of messaging, (2) address uncertainty immediately and with transparency, (3) focus on unifying messages from sources and (4) frame messages aimed at increasing understanding, social responsibility and personal control. Embedding principles of behavioural science into public health messaging is an important step towards more effective health-risk communication during epidemics/pandemics.
Author	Stanulewicz, Natalia Hotham, Sarah Westbrook, Juliette Hart, Jo Stanescu, Sabina Scanlan, Daniel Keyworth, Christopher Tang, Mei Yee Arden, Madelynne Kassianos, Angelos P Watson, Daniella Byrne-Davis, Lucie Armitage, Christopher J. Howlett, Neil Thorneloe, Rachael Jenkinson, Elizabeth Chater, Angel Guest, Ella Ghio, Daniela Epton, Tracy Sutherland, Lisa Carr, Natalie Lawes-Wickwar, Sadie
AuthorAffiliation	9 Department of Applied Health Research , University College London , London , UK 15 Faculty of Health , Psychology, and Social Care, Manchester Metropolitan University , Manchester , UK 3 Department of Primary Care and Population Health , University College London , London , UK 1 Department of Psychology , Faculty of Health and Society, University of Salford , Manchester , UK 13 Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England , Bristol , UK 19 Manchester University NHS Foundation Trust , Manchester Academic Health Science Centre, Manchester; and NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester , Manchester , UK 7 School of Psychology , University of Southampton , Southampton , UK 8 Department of Psychology , University of Bath , Bath , UK 2 Manchester Centre for Health Psychology , University of Manchester , Manchester , UK 18 Centre for Behavioural Science and Applied Psychology , Sheffield
AuthorAffiliation_xml	– name: 5 Department of Psychology , Sports, and Geography, School of Life and Medical Sciences, University of Hertfordshire , Hertfordshire , UK – name: 8 Department of Psychology , University of Bath , Bath , UK – name: 15 Faculty of Health , Psychology, and Social Care, Manchester Metropolitan University , Manchester , UK – name: 12 Faculty of Health and Life Sciences , School of Applied Social Sciences, De Montfort University , Leicester , UK – name: 2 Manchester Centre for Health Psychology , University of Manchester , Manchester , UK – name: 6 Department of Health and Social Sciences , University of West England , Bristol , UK – name: 19 Manchester University NHS Foundation Trust , Manchester Academic Health Science Centre, Manchester; and NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester , Manchester , UK – name: 16 Centre for Health , Wellbeing and Behaviour Change, University of Bedfordshire , Bedfordshire , UK – name: 1 Department of Psychology , Faculty of Health and Society, University of Salford , Manchester , UK – name: 17 Centre for Health Services Studies , University of Kent , Canterbury , UK – name: 3 Department of Primary Care and Population Health , University College London , London , UK – name: 9 Department of Applied Health Research , University College London , London , UK – name: 7 School of Psychology , University of Southampton , Southampton , UK – name: 10 Human Development and Health , Faculty of Medicine, University of Southampton , Southampton , UK – name: 4 Behavioural Science Policy Research Unit, Population Health Sciences , Newcastle University , Newcastle upon Tyne , UK – name: 13 Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England , Bristol , UK – name: 18 Centre for Behavioural Science and Applied Psychology , Sheffield Hallam University , Sheffield , UK – name: 11 Behavioural Insight for Public Affairs, Ipsos Mori , Edinburgh & London , UK – name: 14 Department of Communication , Policy, and Research, Education Support , London , UK – name: 20 School of Psychology , University of Leeds , Leeds , UK
Author_xml	– sequence: 1 givenname: Daniela orcidid: 0000-0002-0580-0205 surname: Ghio fullname: Ghio, Daniela organization: Manchester Centre for Health Psychology, University of Manchester, Manchester, UK – sequence: 2 givenname: Sadie surname: Lawes-Wickwar fullname: Lawes-Wickwar, Sadie organization: Department of Primary Care and Population Health, University College London, London, UK – sequence: 3 givenname: Mei Yee surname: Tang fullname: Tang, Mei Yee organization: Behavioural Science Policy Research Unit, Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK – sequence: 4 givenname: Tracy surname: Epton fullname: Epton, Tracy email: tracy.epton@manchester.ac.uk organization: Manchester Centre for Health Psychology, University of Manchester, Manchester, UK – sequence: 5 givenname: Neil orcidid: 0000-0002-6502-9969 surname: Howlett fullname: Howlett, Neil organization: Department of Psychology, Sports, and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK – sequence: 6 givenname: Elizabeth surname: Jenkinson fullname: Jenkinson, Elizabeth organization: Department of Health and Social Sciences, University of West England, Bristol, UK – sequence: 7 givenname: Sabina surname: Stanescu fullname: Stanescu, Sabina organization: School of Psychology, University of Southampton, Southampton, UK – sequence: 8 givenname: Juliette surname: Westbrook fullname: Westbrook, Juliette organization: Department of Psychology, University of Bath, Bath, UK – sequence: 9 givenname: Angelos P surname: Kassianos fullname: Kassianos, Angelos P organization: Department of Applied Health Research, University College London, London, UK – sequence: 10 givenname: Daniella surname: Watson fullname: Watson, Daniella organization: Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK – sequence: 11 givenname: Lisa surname: Sutherland fullname: Sutherland, Lisa organization: Behavioural Insight for Public Affairs, Ipsos Mori, Edinburgh & London, UK – sequence: 12 givenname: Natalia surname: Stanulewicz fullname: Stanulewicz, Natalia organization: Faculty of Health and Life Sciences, School of Applied Social Sciences, De Montfort University, Leicester, UK – sequence: 13 givenname: Ella surname: Guest fullname: Guest, Ella organization: Centre for Appearance Research,Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK – sequence: 14 givenname: Daniel surname: Scanlan fullname: Scanlan, Daniel organization: Department of Communication, Policy, and Research, Education Support, London, UK – sequence: 15 givenname: Natalie surname: Carr fullname: Carr, Natalie organization: Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Manchester, UK – sequence: 16 givenname: Angel surname: Chater fullname: Chater, Angel organization: Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedfordshire, UK – sequence: 17 givenname: Sarah surname: Hotham fullname: Hotham, Sarah organization: Centre for Health Services Studies, University of Kent, Canterbury, UK – sequence: 18 givenname: Rachael surname: Thorneloe fullname: Thorneloe, Rachael organization: Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK – sequence: 19 givenname: Christopher J. surname: Armitage fullname: Armitage, Christopher J. organization: Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester; and NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK – sequence: 20 givenname: Madelynne surname: Arden fullname: Arden, Madelynne organization: Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK – sequence: 21 givenname: Jo orcidid: 0000-0001-9985-5137 surname: Hart fullname: Hart, Jo organization: Manchester Centre for Health Psychology, University of Manchester, Manchester, UK – sequence: 22 givenname: Lucie surname: Byrne-Davis fullname: Byrne-Davis, Lucie organization: Manchester Centre for Health Psychology, University of Manchester, Manchester, UK – sequence: 23 givenname: Christopher surname: Keyworth fullname: Keyworth, Christopher organization: School of Psychology, University of Leeds, Leeds, UK
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Snippet	BackgroundIndividual behaviour changes, such as hand hygiene and physical distancing, are required on a population scale to reduce transmission of infectious... Individual behaviour changes, such as hand hygiene and physical distancing, are required on a population scale to reduce transmission of infectious diseases... Background Individual behaviour changes, such as hand hygiene and physical distancing, are required on a population scale to reduce transmission of infectious...
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SubjectTerms	Community involvement Coronaviruses COVID-19 Disease spread Disease transmission Epidemics Health risks Heterogeneity infection control Infectious diseases Pandemics Public Health Social responsibility Systematic review
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Title	What influences people’s responses to public health messages for managing risks and preventing infectious diseases? A rapid systematic review of the evidence and recommendations
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Volume	11
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