Public Health and Risk Communication During COVID-19 - Enhancing Psychological Needs to Promote Sustainable Behavior Change

"Health communication that starts by fostering well-being and basic human psychological needs has the potential to cut through the infodemic and promote effective and sustainable behavior change during such pandemics."

Arguably, the COVID-19 pandemic has been exacerbated in some settings by inconsistent, ambiguous, contradictory messages and the absence of clear, actionable, credible, and inclusive information from trusted authorities, leaving space for perhaps less-responsible actors to fill the void. What has resulted has been a social-media-fueled "infodemic" that made it difficult for people to find trustworthy and reliable guidance to make informed decisions about their behaviours. The present study applied self-determination theory (SDT) and concepts from psychology, philosophy, and human-computer interaction (HCI) to propose practical guidelines with the hope of enhancing public health communication recommendations.

SDT is an empirically validated approach to identify factors that promote sustained motivation, behaviour change, and well-being. It was also selected as a conceptual framework because, compared to other motivational and behaviour change theories and techniques, it is specifically focused on the processes through which one acquires the motivation to change his/her behaviour and sustain it over time. In short, SDT helps us understand that, by maximising one's experience of autonomy (meaning, volition, choice), competence (effectiveness and mastery), and relatedness (the feeling of beingcared for by others, trusted, and understood), the control of health-related behaviours is likely to be internalised, and behaviour change is likely to be maintained.

Based on a literature search, the researchers propose 5 practical guidelines for public health and risk communication that are designed to cut through the infodemic and support well-being and sustainable behaviour change:

1. Create an autonomy-supportive healthcare climate: Findings show that to enhance effective management and adherence to social norms during this pandemic, interventions will need to be tailored to fit differences in countries' unique circumstances, while respecting their values, cultures, and belief systems. As outlined here, governments, particularly in "loose" nations with weak social norms and high tolerance of deviant behaviour, should strive to foster an autonomy-supportive health care climate that motivates individuals to engage in health-related behaviours for their own reasons, promotes success in dealing with barriers and resistance to change, and enhances emotions of acceptance, trust, and respect. One way to foster this is through clear, consistent, and repetitive messages that include a meaningful rationale for change and that reflect personal values. Such messages have the potential to cut through the infodemic and increase adherence to preventative measures.
2. Provide choice within limitations: It is useful not only to tell people what not to do but to advise them to do things that are constructive and directly relate to the crisis they are facing. Being proactive during a crisis can help to redevelop a sense of control, overcome emotions of helplessness and hopelessness, and diminish fear. Resilience training could enhance health ownership and self-efficacy.
3. Apply a bottom-up (vs. top-down) approach to communication, using principles of co-production: The questions to be asked are: What decisions or inferences are important for a particular audience to make in order to stay safe and healthy, given their specific values and context? What information do they need to make those decisions/inferences successfully? The focus should be on translating the science, even if it is limited/uncertain, into meaningful messages that resonate with the realities of people's circumstances and that are actionable within those. The literature stresses the need to engage stakeholders along the way. By reinforcing the importance of listening to and celebrating the voices of communities, the process of community engagement, particularly when it includes vulnerable groups, encourages a more equal partnership and enables deeper understanding of the issues. Community engagement is understood to be important not just for formulating and communicating the messages but also in implementing these messages. For example, Taiwan used a human-centric approach to managing the virus, recognising the need to foster cooperation and trust from the public. Instead of forcing laws to ban religious mass gatherings, the government reached an understanding with local religious leaders, which resulted in the voluntary postponement of mass events.
4. Create solidarity: Trust is identified as a multidimensional concept including 3 types of trust beliefs: benevolence (how much the public perceives health and official authorities to act in their interests), competence (the degree to which trustees are capable of meeting trustors' needs), and integrity (the degree of trustees' reliability and honesty). For people to feel relatedness and trust in local governments and health authorities, they need to feel part of the society and community. For example, communicating the social norm that the vast majority of people are restricting themselves to protect others encourages others to do the same. However, nudges that inform what others within the community are doing need to maintain people's sense of autonomy or they may backfire and elicit psychological reaction.
5. Be transparent and acknowledge uncertainty: The literature review indicates that trust is a critical factor influencing the public's adherence to preventative measures during COVID-19. Philosophers of science have emphasised the importance of transparency for creating (ethically well-placed) trust in science-informed policy. They distinguish epistemic transparency (e.g., What is known? What is still uncertain?) from value transparency (e.g., What political value judgments are the decisions based on? What overall aim/strategy is being pursued?). The recommendation made here is to communicate with both epistemic and value transparency, while acknowledging uncertainty. "Trust is probably the most important criterion in fighting the infodemic."

At the end of the Findings section, the researchers illustrate how these guidelines could be applied for encouraging people to wear face-coverings in public during this pandemic (see also Table 1 in the paper).

In reflecting on the above, the researchers note that the requirements and expectations from the public for sustained behaviour during the long haul of COVID-19 are extreme (e.g., staying at home, social distancing) and have serious implications for people's privacy, freedom, and well-being. When the restrictions on the public are so limiting, health communication strategies that focus on enhancing basic psychological needs such as autonomy (represented by #1 and #2 above), competence (represented by #3 above), and relatedness (represented by #4 and #5 above) are critical for maintaining well-being and motivation to adhere to these requirements for a long period of time.

In conclusion: "The proposed guidelines are a starting point for developing a multidisciplinary comprehensive public health communication strategy that fosters well-being and sustainable behavior change at its core....The factors affecting the pandemic outcomes in different countries is complex, and their medium and long-term social, psychological, and economic costs are far from being understood. Thus, part of the preparedness for future health crises should include a robust analysis of the best strategies for public cooperation and communication..."