Behaviour change approaches to addressing COVID-19 preventative behaviours

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The tables below identify several ‘risky’ or sub-optimal behaviours related to mask use, handwashing and physical distancing that could lead to increased transmission of COVID-19. They describe the factors that may influence these behaviours, potential ways of addressing these behaviours and additional resources. It is important that we do not blame populations if they are adopting these ‘risky’ behaviours. Rather it is important to take time to listen to their concerns and understand what is driving their behaviour. It is also important that this is not used in place of learning from communities on an ongoing basis throughout the pandemic. All ideas from these tables should be adopted in discussion with community members and adapted to the local context. You may need to also adapt the activities to cover different settings – for example the approaches used at a household level may need to be different to approaches in public settings (e.g. markets or transport hubs) or institutions (e.g. health centres, schools workplaces). If you need further advice on any of these topics please go to the Global WASH Cluster website or use the technical resources on the COVID-19 Hygiene Hub. For tailored support please email support@hygienehub.info.

See the following tables below for 1) Mask Use 2) Handwashing and 3) Physical Distancing.

1) Mask Use:

Risky behaviour: Incorrect wearing of masks

Factors that may influence the behaviour

Examples of activities to address the behaviour

Resources

Knowledge

Comfort

Norms

Social support

Images showing how to wear/not wear a mask
Staff in key areas (e.g. entrances to buildings) supporting people to use masks correctly
Promoting masks that are comfortable, adjustable and desirable
Conveying information about how incorrect mask use can still cause transmission.

Risky behaviour: Reusing or sharing masks

Factors that may influence the behaviour

Examples of activities to address the behaviour

Resources

Mask access

Convenience

Knowledge

Soap and water access

Waste disposal

Disgust

Make sure everyone has access to at least 3 fabric masks as this will allow masks to be washed after each use.
Provide people extra laundry detergent and potentially a clothes line to help with air drying.
Avoid the use of medical masks except for people with COVID-19 symptoms, their careers and clinically vulnerable individuals. Supply enough medical masks to these individuals for them to replace masks at least once a day, train people how to use them and provide safe disposal mechanisms.
Link mask cleaning to other familiar behaviours such as cleaning underwear.
Heighten disgust around masks that are not cleaned regularly by showing people that they become dirty quickly.

CDC advice on mask cleaning

Risky behaviour: Not wearing masks

Factors that may influence the behaviour

Examples of activities to address the behaviour

Resources

Mask access Regulation

Affiliation

Norms

Social support

Culture and fashion

Make sure everyone has access to at least 3 fabric masks as this will allow masks to be washed after each use.
Provide clear guidance about when masks must be worn and have community members or staff to remind people to use them in these locations. Complement this with clear visual reminders.
Remind people that they need to wear masks to protect others and position mask use as something that shows you care.
Use norm based messaging to convey that others in the community believe mask wearing is the right thing to do.
Make masks culturally appealing and fashionable.

Hygiene Hub resource on using behaviour change principles to promote mask use.
CDC guidance on mask use
WHO guidance on mask use.
Videos explaining and visualising how masks preventing transmission (Example 1, Example 2)

2) Handwashing

Risky behaviour: Hands are washed with water only

Factors that may influence the behaviour

Examples of activities to address the behaviour

Resources

Access to soap

Handwashing facilities

Belief that water is sufficient to clean hands.

Provide people more soap
Provide people products that are specifically for hand washing (e.g. liquid handwashing soap or sanitizer)
Make sure that soap is always present at the handwashing facility – e.g. by creating a soap dispenser, soap dish or attaching it with a rope.
Help people to realise that soap is the key ingredient to leaving hands truly clean. Example activities to do this might include glow germs or other low-cost versions of this (Example 1, Example 2, Example 3).

Risky behaviour: Hands are not washed at critical times

Factors that may influence the behaviour

Examples of activities to address the behaviour

Resources

Access to handwashing facilities with soap and water

Access to sanitiser

Physical environment

Knowledge

Make people aware of additional times for handwashing.
Create new handwashing facilities in the places where people need to wash their hands.
Adjust the physical environment to encourage handwashing. This could include adding nudges to cue handwashing.

Risky behaviour: Hands are not washed thoroughly

Factors that may influence the behaviour

Examples of activities to address the behaviour

Resources

Knowledge

Convenience

Water availability

Show why handwashing should be done for at least 20 seconds (example 1, example 2)
Build handwashing facilities as this will help minimise water use and make handwashing easier.
Increase disgust around unwashed hands.

3) Physical Distancing

Risky behaviour: Attending social gatherings

Factors that may influence the behaviour

Examples of activities to address the behaviour

Resources

Norms

Culture/religion

Physical environment

Regulation

Knowledge

Identify cultural or religious occasions when people normally come together and develop alternative plans with the community.
Promote alternative ways for people to stay connected.
Work with religious, cultural and community leaders to identify acceptable ways of maintaining physical distancing.
Adjust or change physical spaces where people often gather to enable physical distancing.
Use norms based messaging to show that people think physical distancing is the right thing to do.
Explain why physical distancing is necessary in ways that are easy to understand (Example 1, Example 2, Example 3)

Hygiene Hub resource on physical distancing.

Risky behaviour: Being in close proximity to others in common gathering places

Factors that may influence the behaviour

Examples of activities to address the behaviour

Resources

Physical environment

Norms

Convenience

Knowledge

Change the physical environment by using nudges such as markers on the ground or spacing seats.
Limit the number of people allowed into a space at any one time.
Adjust operational hours at health centres, distribution points and markets to enable fewer people to congregate.
Encourage people to prioritise essential travel (e.g. do shopping once a week rather than daily).
Provide context adapted ways of explaining how to maintain distance.

Risky behaviour: Physical greetings (handshakes, hugs, kisses)

Factors that may influence the behaviour

Examples of activities to address the behaviour

Resources

Norms

Culture/religion

Social support

Promote acceptable and fun alternatives to greetings
Remind people that this is a short term measure the enable togetherness in the long term (e.g. this video from Nepal).

Alternative greetings cartoon from the WHO

Risky behaviour: Not isolating when experiencing symptoms

Factors that may influence the behaviour

Examples of activities to address the behaviour

Resources

Fear

Convenience

Physical environment

Social support

Income and other personal responsibilities

Recognise and celebrate people who do the right thing.
Provide people who are isolating with a care pack.
Find ways to enable isolating individuals to remain connected with others.
Set up local support systems to enable communities to deliver food and medicine to those who are isolating.
Provide mental health support.

Editor's note

Written by: Global WASH Cluster
Reviewed by: Hygiene Hub
Version date: 06.03.21