What is physical distancing?
Physical distancing is a geographical distance that must be maintained between person to person to prevent the spread of infection. This means we should keep a distance of at least 1 metre from each other and avoid spending time in crowded places or in groups to reduce the number, closeness and length of time spent with contacts.
Furthermore, the below table presents other inter-related physical distancing terms.
Why might it be hard to encourage physical distancing behaviours in LMIC settings?
Before the COVID-19 pandemic, physical distancing behaviours were not familiar to any culture or country. Humans are social beings - used to being in direct contact with other people. Therefore, adopting physical distancing measures will be a significant challenge for all of us.
However, physical distancing behaviours may pose an even bigger challenge in low and middle income countries (LMICs). This is because:
People in LMICs may be more likely to live in environments that make physical distancing challenging. For example people in LMIC settings are more likely to have more people living in a household with them (making it harder to limit transmission if any one individual gets COVID-19) and are more likely to have intergenerational families (in some settings this may create more of a risk for vulnerable individuals - but not all). Larger proportions of the population may also live in informal settlements in urban areas or camps for displaced populations. These densely populated environments often also have lower rates of water, sanitation and hygiene access, more limited access to health care and face other chronic health challenges. Together, this means that populations living in these settings are more vulnerable to infection and may experience more severe outcomes due to reduced treatment access.
People in LMICs are more likely to be adversely affected by the secondary impacts of physical distancing measures. The closure of workplaces, schools and other services has had substantial effects on the global economy. People in LMIC settings are more likely to rely on informal sources of daily income and are therefore more likely to experience losses of income at this time. There may also be fewer formal systems to support people if there are disruptions to local markets and supply chains or disruptions to key health care services.
What practical actions can be used to promote physical distancing in low and middle income countries?
In this section we provide a summary of some general principles of behaviour change that can be used for promoting and communicating about physical distancing in low and middle income country (LMIC) settings . Many of the specific examples described in this section are the results of a working session run by The Curve about physical distancing in LMICs. Note that because physical distancing is a new behaviour, none of these ideas have yet been evaluated, but they are based on behavioural theory and community-level innovations. To select which of these actions may be relevant to the settings where you are working, we recommend assessing current behaviour among your target population to identify the main barriers and drivers of physical distancing, then review this list and see which actions may enable you to address some of these barriers.
General principles of behaviour change for promoting and communicating about physical distancing:
Communicate about transmission: This includes simplified information about how COVID-19 transmits from one person to the next and how physical distancing interrupts transmission by reducing in-person interactions. If people don’t understand transmission, physical distancing and the social compromises associated with it will not make sense for people. Visual communications, such as simple videos or images, can be impactful in communicating how the virus spreads. Try to tailor these to your context so that they depict people who look like your population. The video below from Development Media International is a nice example of how this was done in Burkina Faso.
The Mexican government’s social media campaign uses a cartoon superhero to explain and encourage physical distancing in a way that is easy for children to understand.
Be specific and clear about the actions you want people to take: Communications about physical distancing should include information about who should practice physical distancing (target population), when physical distancing should be practiced (setting), and how to keep physical distance (defined behaviour). This resource can help guide how to select a target behaviour, population, and setting. Some examples of specific and clear messages to help physical distancing are to avoid all mass gatherings, make essential trips only, and to keep a distance of at least 2 meters from others. These messages also need to be contextualised in a way that people can easily apply them. This website provides some creative examples of how countries in different parts of the world have encouraged people to remember how far 2m apart really is.
Source: Physical distancing messaging from WaterAid India.
Change the physical environment to cue the behaviour: Depending on the context, individuals might forget to apply the advice at relevant moments in their day to day life. Provide timely reminders that prompt them to follow guidelines in critical moments and locations. For example, you can make distancing intuitive by spacing seats apart at health clinics, encouraging people to place jerrycans in a water queue (rather than people queuing themselves) and putting markings on the floor to keep distance at the entrance or inside small shops.
Source: A hospital in India has adapted the waiting hall to enable physical distancing to be maintained.
Source: A bench in Singapore has been divided and marked to encourage physical distancing.
Source: A Water4 WaSH Champion trains community members on social distancing at water points. She uses simple visual indicators (in this case lines drawn in the dirt) to indicate where people should place their jerrycans and explains that then they can maintain a safe distance and not miss their turn in the queue.
Adapt messages to fit your context by focusing on situations where physical distancing is challenging: To make sure your messages about physical distancing are effective for your target population, they need to be specific to their local realities. When developing communication materials think about the specific circumstances in your context where it will be challenging for people to maintain physical distancing. For example, in Pakistan a TV commercial was used to encourage Pakistanis to stay home and practice physical distancing during Eid.
Similarly, in South Africa some church services are being held in fields to enable physical distancing.
Source: Congregants of the Inhlanhla Yokuphila Apostolic Church In Zion practice physical distancing as they attend a church service in an open field in South Africa.
In Lebanon, some students realised that it would be hard for many people to spend Mother's Day apart, so they arranged a service where roses were delivered to mothers by drones.
Source: Mothers in Lebanon receive roses delivered by a drone for Mother’s day.
In Egypt, when theatres started to reopen, they placed photos of famous Egyptian actors on the seats so that physical distancing would be more acceptable and fun.
Source: El Sawy Culture Wheel Theatre placed photos of famous Egyptians on many of their seats to enable physical distancing.
In other settings, large markets have been decentralized into smaller neighbourhood-based markets where people can access basic products closer to home and therefore avoid unnecessary travel and large crowds. Similarly in crisis-affected situations, where hygiene or food distributions are common, organisations have been making adjustments to make sure these processes are safer.
Inspire people to act for the sake of others, not just themselves: Many COVID-19 preventative actions, including physical distancing, require us to make major compromises to our daily lives. While these actions do reduce our own exposure to COVID-19, we often adhere to physical distancing guidelines in order to protect others, particularly those who are most clinically vulnerable. It can be really powerful to link physical distancing with this altruistic idea of doing something with the greater good in mind. For example, the poster below was designed to celebrate the mundane activities of people who stayed home in the UK to protect the lives of others.
Source: Poster designed by Bold White Space.
Distinguish between physical distancing and social confinement:
Many individuals think physical distancing means isolation and confinement. It’s important to communicate that this doesn’t have to be the case and facilitate opportunities to bring people together at this time. For example, in the Philippines, online church services have provided new ways for congregations to come together. Other countries have developed COVID-19 mental health support services via phone hotlines, Facebook groups, radio, and by training frontline staff on mental health first aid. As noted in this guidance from CDC Africa, it can also help to clearly communicate that physical distancing measures are short term and, where possible, notify the public about proposed dates for things returning to normal. In other settings, people still visit each other but remain outside the house and at a distance.
Celebrate ‘positive deviance’: ‘Positive deviants’ are individuals who manage to correctly adhere to public health advice despite the majority of other people around them not doing so. During an outbreak it can be useful to identify, learn from and celebrate these individuals so that others in their community can be inspired by these relatable role models. It can be useful to conduct video or audio interviews with ‘positive deviants’ where they share their tips for how to practice physical distancing in a feasible way. See this webinar for information about applying positive deviance to COVID-19 response. It can also be useful to highlight normal, everyday reactions to physical distancing behaviours. For example this video captures the frank experiences of people who are physical distancing in the UK, discussing what they are missing, how they are coping and why they are motivated to continue despite large personal sacrifices. Similarly, MTV Shuga has set up a ‘Alone Together’ channel where characters discuss their every-day experiences of COVID-19 and challenge misconceptions about the virus.
Utilise trusted community leaders and networks: Community leaders and other influential individuals can be key to encouraging new physical distancing behaviours and are likely to be able help in normalising these practices. Community networks can help response actors understand the local context, explain local innovations and coping mechanisms, disseminate information and provide guidance on acceptable project implementation. Start by mapping out existing community networks, identifying trusted individuals and understanding how they currently work and could be strengthened. In many countries Mutual Aid and savings groups have been set up at a local level to support vulnerable people who are self-isolating or shielding.
Make physical distancing part of the ‘new normal’: It is important that physical distancing behaviours are normalised. To do this it is useful to think both about the delivery channel you are working through and the content of the messages. Some delivery channels, like mass media can be used to show physical distancing behaviours in action and therefore help to position them as normative. It’s also possible to use these formats to show people doing the wrong behaviours, or facing barriers to adhering to prevention behaviours. In this series of short videos from Zambia, they do just that and then show incorrect behaviours being corrected by others in the community or overcome through community level action.
Provide a range of alternative actions: It is useful to think of physical distancing measures as a spectrum ranging from the ideal set of practices to less ideal but more feasible options. This is important to factor into national or regional planning since there will be a lot of variation in the individual experiences of the COVID-19 pandemic (e.g. in terms of clinical vulnerability, socio-economic impact and personal circumstances). For example, many governments are recommending that older people and those with pre-existing conditions self-isolate in their households. However, it is common that these individuals will live within larger households where others are not at high risk and where these individuals need to continue to go to work and undertake some necessary travel. Furthermore, vulnerable individuals may not always reside in houses which are large enough to allow them to be isolated in a dedicated space. In such circumstances it may be necessary to provide guidance on the ideal self-isolating procedure (e.g. where vulnerable individuals have their own house and where relatives drop off necessary food and goods to them to minimise their contact), but also provide guidance on demarcating ‘safe’ areas of the household, encouraging frequent cleaning, handwashing with soap, mask use and planning which external activities can be reduced.
Has physical distancing been effective?
Physical distancing has been effective in mitigating the spread of COVID-19, together with other strategic public health interventions such as isolation and quarantine of confirmed cases and close contacts, mask wearing, hand hygiene, testing, and personal protective equipped use among health workers and other essential workers.
What are some of the secondary effects of physical distancing?
A scoping review documented the negative impacts of physical distancing on older people, children, students, low-income populations, migrant workers, people with disabilities, sex workers, victims of domestic violence, refugees, ethnic minorities, and people from sexual minorities. The study found that the previously mentioned vulnerable groups suffered from prolonged loneliness, mental distress, unemployment, income loss, food insecurity, widened inequality and disruption of access to social support and health services.
Editor's Notes:
Last updated: 20.08.2023