As COVID-19 sweeps through the globe, public health officials are grappling with communicating the urgency of adhering to safety measures. Even with the vaccine, we aren’t in the clear with infections and the death toll is still climbing. It’s important everyone continues safety measures until the majority are vaccinated.
In this post, I will take a look at public health messaging in the last year and see what lessons we can draw from it. I’ll explore these findings with what behavioural research shows us about how people respond to public health messages.
I spoke with Dr Yoeli, a research scientist at MIT, on how to elicit COVID-19 prevention behaviours, such as mask wearing and socially distancing among people.
Back in April of 2020, he along with Dr Rand, an Associate Professor of MIT, published a checklist for effective public health messaging based on behavioural science.
According to Dr Yoeli and Dr Rand, in order to motivate people to adhere to public health guidelines the messaging must:
- Communicate the benefit to the community
- Make the ask unambiguous, categorical and concise
- Generate the impression that others expect compliance.
Let’s examine each of these points in detail, and see if they were followed in the year 2020.
Do it for your community
According to Yoeli and Rand, people are more likely to follow safety measures when they know that it will benefit their community.
Framing public health messages so that it emphasises the public good rather than the individual also implies that on some level people will be judged for choosing not to do the right thing.
We saw examples of this type of messaging early on in the pandemic with popular social media campaigns like #stayhomesavelives and #flattenthecurve.
In the U.K. when residents came out to applaud the NHS workers, there was a powerful message behind the appreciation: We stay home to keep you and others safe.
Dr Josh Greenberg, Professor of Communications and Media Studies at Carleton University in Canada, agrees.
“As awareness increased, action-based tags like #wearamask and #stopthespread were successful in focusing public attention on specific things individuals can do to support larger community-wide efforts. #Stopthespread in particular has been effective insofar as it was adopted by local, regional (provincial, state) and national public health departments to encourage pandemic safety. It works because it has broad currency.”
According to Dr Yoeli, some of the mistakes of public health messaging in the past year is a failure to emphasise the public good and a politicisation of prevention efforts such as masks from the leadership. In the US in particular, the debate around mask wearing has become centred on personal freedoms.
Keep your message clear and concise
Another benefit of the viral hashtags was that they clearly communicated what was expected of us. For example, most people knew that by staying home and socially distancing they could reduce the spread of the virus.
Dr Maya Goldenberg, Associate Professor of Philosophy at the University of Guelph, Canada, says: “The early pandemic ‘flatten the curve’ slogan was a really successful communication. It gave a clear message about what we needed to do, by use of an effective visual…People were convinced that flattening the curve was something we needed to do, and because of that the first weeks of lockdown (back in March 2020) were matched with high public approval of (Canadian) government response to the pandemic.”
The point of making your ask unambiguous and clear is that you take away any excuses people have to implement prevention behaviors.
Unclear or conflicting messaging can lead to people feeling like they don’t have to follow the rules. As Dr Yoeli points out, without leadership from the top you end up with an incohesive response and conflicting guidance.
In the US, we saw this in the form of the CDC offering guidance but state and local governments implementing their own set of rules.
Dr Yoeli states that when “you’re trying to fight a pandemic it helps to have a set of best practices that most people are following and that everyone can kind of get on board with…That’s because if you don’t have the baseline, it introduces tons of plausible deniability.”
After the success of the initial lockdown, there was also confusion that followed. Dr Goldenberg explains that after the public success of the flatten the curve campaign: “there was no equally amplified follow up ‘now what?’ message once the curve was flattened… The lesson for health writers is to consider the next step and have a plan in place for the scenario where the message is a big success and of course if the message doesn’t resonate. ‘What next?’”
Everyone else is doing it; you should too
Dr Yoeli points out that people are more likely to practice a certain behaviour if they think others are expecting it of them.
“You want to generate the impression that most people are complying.”
By reinforcing stories of people following the rules, you increase the belief that the majority of people are doing the right thing. This can encourage more people to continue practising public health safety measures.
Conversely, highlighting those who violate the rules, especially people in a position of leadership, could send the wrong message.
Dr Greenberg says: “As stories about pandemic fatigue, anti-mask rallies, and violations of public health guidelines by elected official and healthcare leaders become more visible in our news feeds, the more our shared narrative of the pandemic changes and the more difficult it becomes to sustain our attention and adherence to public health measures.”
In the US, we’ve had many scandals of leaders failing to follow public health guidance and thus undermining the idea that everyone is expected to comply. This was seen with the former President and Vice President of the United States and other government officials not wearing masks long after CDC recommended them. Or when the Governor of California attended an indoor dinner party after banning indoor eating. “So, they’re explicitly telling people you’re not actually required to take this cautionary action,” says Dr Yoeli.
To shame or not to shame?
As the pandemic rages on, it is becoming increasingly difficult for many to continue following guidelines. Whether due to financial troubles or the psychological stress from lockdown and economic instability, many people are struggling at the moment.
As Dr Greenberg states: “The longer any crisis continues, the harder it becomes to sustain public vigilance to actions that are hard, inconvenient and costly.”
So, what’s the right way to deal with people who aren’t following public health measures?
How effective is shaming in promoting the right behaviour?
Dr Yoeli says: “The thing with shame is that the places where it’s most powerful are where it needs to be used rarely, where violations are rare.”
He points out that to some extent shaming or rather the threat of shaming does motivate the correct behaviour. Someone who is already masking may feel ashamed if they’re accidentally caught outside without a mask.
Dr Greenberg explains that shaming “may positively reinforce the affective bonds among adherents by reminding them of the virtuousness of their decisions to follow the rules.”
So, in those who are adhering to guidelines, shaming can reinforce their belief that those who aren’t complying are in the wrong. Dr Goldenberg notes: “There is no question that people who comply with difficult public health measures may feel frustrated that their sacrifices (like not seeing family members over holidays) are not amounting to much since others are not doing their part.”
So, should health writers start writing hit pieces on anti-maskers and calling out ‘covidiots’?
Dr Greenberg highlights why this is a mistake. “The problem with this strategy is not only that it almost surely fails to change risky behaviour, but it also polarises the issue making it more difficult to find the common ground that’s necessary for encouraging people who may be sceptical to comply with public health guidance.”
Dr Goldenberg states that shaming is “often a popular tactic for public health guidelines that need wide compliance.” However, she notes that “…individual shaming does nothing to assist with re-establishing solidarity. Solidarity is exactly what we need right now, and calling people stupid or shaming will do nothing to bring people along.”
So, how do we address those who aren’t adhering to public health safety measures? Well as Dr Yoeli notes: “when violations are common, constantly trying to shame people ends up being kind of costly for those shaming.” He proposes instead “to start looking towards more positive rewards of compliance.”
Both Dr Goldenberg and Dr Greeberg state that finding out why people choose to ignore guidelines can help better understand people’s motivations. “Not everyone who refuses to wear a mask or practice social distancing or get a vaccine is selfish or anti-science — some are frightened or feel that their dignity has been violated by officials, either elected leaders or public health experts who either don’t listen or don’t understand their views or needs,” Dr Greenberg says.
Dr Goldenberg echoes that choosing to empathise with people is more effective in getting to the root of non-compliance or COVID-19 vaccine hesitancy.
“What may appear like selfishness may not be the case,” she says. “For example, some people cannot respect instructions to stay home because they don’t have work from home options or access to adequate resources to take care of their families. Such people need assistance, not shame.”
With the availability of vaccines, a new focus of public health messaging will be to combat vaccine hesitancy and encourage everyone to get the vaccine. We can learn from the mistakes that we were made last year to inform how we proceed.
Dr Yoeli thinks the checklist can be a useful tool for people who may be relying on others to take the vaccine but don’t necessarily see the need to one themselves.
“You would want to message about how getting the vaccine is not just about you, you’re helping us generally protect the population, you’re helping to prevent you from spreading COVID to others who are vulnerable.”
Next, make taking the vaccine a simple straightforward process. No confused messaging about who should take it when.
Dr Yoeli suggests finding a way to bring the vaccine to the people and taking the pressure off of them to go and look for the vaccine. Once again it’s about getting rid of excuses.
“You’d want to eliminate excuses as much as possible and that means making it so that the vaccine comes to you basically and you really have to opt out of the vaccine in such a hard way that you would really look like a jerk.”
This may be a top-down approach but health writers can help by creating messages reminding individuals to take the vaccine like their peers.
Finally, listening to people’s concerns and questions regarding the vaccine can help health writers better communicate effective public health messaging. Dr Greenberg reminds us that asking people to adhere to public health behaviours is an act of trust.
“The best way to build trust over time is to listen with empathy and to be persistent in keeping open lines of communication. It also requires that we communicate in nuanced ways that do not set up an either/or barrier to the desired behaviour.”
Health writers can draw on these lessons to more effectively communicate public health messages. If we want people to continue adhering to COVID-19 prevention guidelines, we will need to craft our messages to be concise and actionable.
Messages that ask people to give up a certain behaviour, such as attending or hosting parties, can focus on the communal benefits. By leading with empathy and understanding we may be able to reach more people and help them.