Content analysis of behaviour change techniques in government physical distancing communications for the reopening of schools during the COVID-19 pandemic in Ireland

Introduction

Effective government communications and leadership are central to the management of pandemics. In response to public health crises, such as that posed by the ongoing novel coronavirus disease 2019 (COVID-19) pandemic, the government’s role includes enlisting public trust and cooperation with infection mitigation strategies to reduce the spread of infection and protect healthcare systems from becoming overburdened (Jetten et al., 2020; Levy, 2020; Siegrist & Zingg, 2014). Effective communications strategies can facilitate public trust and confidence, which can in turn increase public adherence to behaviour-based infection mitigation strategies (Carter et al., 2011; Siegrist & Zingg, 2014).

The fields of applied risk communication, cognitive and social psychology, sociology, and public policy have all traditionally provided important insights to guide pandemic communications strategies. The role of health psychology and behavioural sciences more broadly in responding to public health emergencies has become increasingly clear across the course of the COVID-19 pandemic. Several key principles in harnessing behavioural science in the development of public health campaigns to maintain physical distancing in response to the COVID-19 pandemic have been identified (Bonell et al., 2020). Specifically, communications should provide clear and specific guidance; utilise pro-social messages promoting collective group identities and supportive social norms (e.g., “protect each other,” “stand together,”); avoid messages based on fear or disgust in relation to others; avoid authoritarianism; promote action planning; utilise rewards and incentives; be professionally designed, visually appealing and widely visible (e.g., using responsible mass and social media campaigns and trusted spokespeople to emphasise collective adherence); be transparent regarding theory of behaviour change and evidence used in their development; and involve relevant stakeholders and audience groups in their design (Bonell et al., 2020). Furthermore, messaging strategies must be consistently evaluated and re-evaluated to ensure evolving technical knowledge of the disease as well as relevant socio-cultural dynamics are reflected (Hyland-Wood et al., 2021).

The behaviour change technique (BCT) taxonomy (Michie et al., 2013) is an extensive catalogue of 93 distinct BCTs, which offers a method for specifying interventions. BCTs are the smallest observable, replicable component or active ingredient of an intervention designed to change behaviour. Since its publication, coding of BCTs within individual and group-level behavioural interventions using the BCT taxonomy has become commonplace (e.g., Bayly et al., 2018; Bentley et al., 2020; Goodwin et al., 2016; Presseau et al., 2015). However, this type of analysis has been much less frequently applied to government public health communications that aim to change the public’s behaviour on a mass scale. Furthermore, recent advances in our understanding of the mechanisms of action (MoA) through which individual BCTs have their effects (Carey et al., 2019) may provide important insight to support future intervention development and evaluation. The current article presents a content analysis to identify which BCTs and associated MoAs were present in a set of government poster communications issued in preparation for the reopening of schools during the COVID-19 pandemic in Ireland.

Methods

The current study forms part of a broader project focused on physical distancing in Ireland, which is registered with the Open Science Framework (Durand et al., 2021). A protocol for this research has previously been published (Durand et al., 2020). Ethical approval for the broader project was obtained from the Research Ethics Committee at NUI Galway (Ref no.: HRB20-Apr-18).

Results

A total of eight posters were included in the content analysis. According to Government of Ireland policy, all posters issued for public use have been published on the government website; therefore, this sample of posters is considered exhaustive for the setting and time period in question. All posters were published online on the 7^th of September 2020. These were either originally issued or re-issued with modifications specific to the school setting on this date. All but one poster addressed multiple COVID-19 mitigation behaviours in addition to physical distancing. A description of included posters is provided in Table 1.

The results of the content analysis and examples of behaviour-change content from the posters are presented in Table 2. Eight unique BCTs were identified in the posters, linking to 11 unique MoAs. Instruction on how to perform a behaviour, prompts/cues, and credible source were the most frequently coded BCTs, appearing in all eight posters. All other coded BCTs (n = 5) were utilised in 50% or fewer posters. Note that although the majority of posters targeted several COVID-19 mitigation behaviours (e.g., symptom awareness, wearing a face covering, hand washing), the following content analysis pertains only to aspects of the posters related to physical distancing behaviours.

Discussion

The current article presents results of a content analysis of government physical distancing posters issued ahead of school reopening during the COVID-19 pandemic in Ireland. Most posters targeted several COVID-19 mitigation behaviours in addition to physical distancing. Eight unique BCTs from six unique groups were identified in at least one poster. Instruction on how to perform a behaviour, prompts/cues, and credible source were the most commonly used BCTs, appearing in all included posters. The eight present BCTs were linked to 11 unique MoAs through which behaviour change is theorised to occur. These MoAs reflect a diversity of psychological and physical/environmental processes upon which the included BCTs may act to promote adherence to physical distancing in the school setting. Findings from this content analysis may be used to inform future refinement of poster communications strategies, specifically to guide selection of additional relevant BCTs to target key MoAs theorised to increase adherence behaviour.

The current analysis revealed some important gaps in the poster communications strategy for the school setting. Several theoretically important groups of BCTs were underutilised or not utilised at all. In particular, BCTs grouped under the Natural Consequences cluster heading within the BCT taxonomy did not appear in any of the posters. BCTs within the National Consequences grouping relate to a range of possible social, emotional, and health consequences of performing (or not performing) a behaviour. This omission is despite recent evidence indicating that emphasising natural consequences of physical distancing behaviours (e.g., slowing the spread of COVID-19 in the community, saving lives) was the most strongly endorsed approach to motivate adherence to physical distancing guidance in a nationally representative sample of Irish participants (Durand et al., 2021). Several of these Natural Consequences BCTs (e.g., 5.1 Information about health consequences) could be integrated into future poster communications. In addition, MoAs reflecting social processes (e.g., social influences, norms, subjective norms) were not targeted by any of the included BCTs, despite being highlighted as important targets for public health messages to promote physical distancing (Bonell et al., 2020). BCTs under Social Support and Comparison of Behaviour groups within the BCT Taxonomy Version 1 may be integrated into future poster communications to target these processes.

Though this analysis provides useful information to inform future poster design, it is important to consider that posters are just one form of communication utilised in public health communication strategies. Some of the limitations of the poster communications identified in this study are inherent to the poster medium itself. For example, feedback and monitoring are theoretically important strategies to promote adherence to physical distancing that do not lend themselves to the poster medium. Furthermore, the static nature of posters means their design for inclusion in public messaging campaigns is challenging. The posters included in this analysis are required to convey a lot of information to target several distinct behaviours, which may cause confusion. Recent evidence identified confusion about government guidelines as a barrier to adherence to physical distancing (Farrell et al., 2021). Poster communications must convey clear, specific, and consistent guidance in the context of rapidly changing situations and environments.

Data availability