The pandemic and the challenge of behaviour change

S.N. Srikanth

S.N. Srikanth  

A well-crafted social marketing campaign can help address the crisis and even prepare for future disease outbreaks

The COVID-19 crisis is far from over, but governments everywhere appear to have either relaxed lockdown parameters or will do so soon. The curve may have been flattened, but there will be a greater risk now of being infected.

Containing COVID-19 and restoring our economies requires not just good policy decisions and medical advice; it also needs continued compliance with the recommended behavioural changes that in many ways go against social and cultural conventions. Daunting as they may seem, the drastic changes in behaviour being called for can indeed be brought about. The science of social marketing uses known marketing principles and behaviour change theory to influence people’s behaviour for the benefit of both the target audience and of society. Public health, safety and environmental concerns are some of the areas where social marketing can have huge impact.

The Health Belief Model (HBM), developed by Irwin M. Rosenstock others suggests that a person’s health-related behaviours ultimately stem from the desire to avoid illness. The two most important constructs of the model are: perceived benefits — the effectiveness of actions available to reduce the threat of the disease, and perceived barriers — the obstacles to performing a recommended health action. The model also recognises the importance of “cues to action” or triggers which set into motion the process of adopting the desired behaviours. These cues, typically, are emotional, not just informative or educational. The HBM presumes that knowledge or education alone is grossly insufficient to change a person’s behaviour. Cigarette sales, for example did not decline significantly for years despite the ills of smoking having been widely publicised.

The Indian example

India is one of the few countries that appears to have recognised the power of deliberately crafted emotive cues to action such as the Prime Minister’s call for a voluntary “Janata Curfew”, exhorting citizens to show that they care for themselves and their loved ones, and to display their patriotism. People were asked to stay indoors but, at 5 p.m., to also applaud health-care workers and others who are a part of the pandemic battle. The blend of fear, patriotism and gratitude extolled by the Prime Minister appeared to have been just the right buttons to push and people did stay indoors. Yet at 5 p.m., while many applauded from their balconies, hordes of others congregated in large groups, throwing social distancing to the winds. Fear, patriotism and gratitude, even if they were effective as “initiating” cues to action, were insufficient to sustain behaviour change and needed to be periodically rekindled. The Prime Minister later called upon citizens to switch off lights at 9 p.m. for 9 minutes on a chosen day and light lamps to go “from darkness to hope”. As is well known, the number 9 and lighting lamps are powerful positive symbols in India.

In Singapore, the government, perhaps taking a cue, supported an event, “Sing Together Singapore”. People at home were encouraged to sing as well and wave a torchlight as gratitude for frontline and migrant workers.

Going back to the main constructs of the HBM, to be effective, the social marketing message would present the benefits as applying direct to the individual, not just indirectly to society at large. And, messaging about barriers should not make the change appear too difficult to engage in or make the cost of adopting the behaviours appear too high. Supportive measures should facilitate the adoption of the desired behaviour.

Here is an example to illustrate this. In the 1970s, Bangladesh undertook an ambitious family planning campaign keeping in mind the country’s limited resources. Research showed that while the women were able to readily see the benefits, the men, who were the decision makers at home, could not.

The campaign became successful after social marketers decided to empower women by making female contraceptives available through women rural medical practitioners who made house calls. The marketers also designed a communications programme directed at men highlighting benefits such as better health for their wives, thereby enabling them to look after their husbands and children better.

Gauging receptivity

This writer conducted informal interviews (not scientific by any means) in Chennai to gauge receptivity to recommended behaviours during the pandemic. Here are the findings in relation to some of the recommended behavioural actions and possible messaging and support measures.

Many were not quite convinced of the threat posed by asymptomatic others merely because they were close by. The perceived direct benefits of social distancing were thus moderate at best. Further, one does not have the luxury of observing physical distancing in many situations (especially in densely populated areas). Telling someone to stand away is also difficult because it could be considered rude. Hygiene instructors often ask an audience to colour their hands and then show the imprints they leave everywhere to demonstrate how germs can spread. Would a social marketing campaign that paints a picture of the virus “jumping” onto you if you are close to an infected person work? This needs to be supported by physical barriers wherever possible to promote social distancing.

The recommendation to hand wash often or use an alcohol-based hand rub was unrealistic for too many people even though they saw the merit in it. The two options have been presented as equivalent, but from a behavioural change point of view they are not. Even those who had fairly easy access to soap and washing facilities found it rather inconvenient to interrupt whatever they were doing to frequently head to a hand wash station. If alcohol-based hand rubs were available within arm’s reach, people had no need to interrupt their work and drying their hands was not a problem since they would swiftly dry on their own. This suggests high payoffs from a decision by governments to focus on increasing the supply of hand rubs and absorbing or highly subsidising the costs of making hand rub bottles readily available to supplement hand washing with soap and water.

We know that shame is a powerful disincentive to undesirable behaviour. This writer has considerable experience in projects to make villages open defecation free through the use of Community-led Total Sanitation, a technique that liberally and successfully uses “naming and shaming” to achieve its goals. It is not hard to visualise messaging that shows bystanders strongly disapproving of those who do not comply with the COVID-19 recommendations.

A well-crafted social marketing campaign would help address the COVID-19 crisis and set foundations that will help ameliorate the adverse consequences of future pandemics. Let us build policy from science in the effort to save lives and to put the local and global economies back on track.

S.N. Srikanth is Chairman and Managing Director of the Hauer-Diana Group of Companies of India

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