An address to journalists: evidence-based behaviour change and well-informed media
Two lessons to be learned post-COVID-19 are the necessity of evidence-based behaviour change policies and well-informed media.
You can find useful resources here: @HealthPsychX
and here: The British Psychological Society: #CombatCovidTogether
A retweet was suggested to me via a push notification on my phone. Behavioural scientists expressed a critique (rightly so) of an article entitled: ‘The behavioural scientists do more harm than good’[1]. If the article intended to attract attention and generate hits, it succeeded. It at least won the attention of the infuriated behavioural scientists on twitter as well as mine. The article claimed that the prime minister is misguided by behavioural scientists, which resulted in the delayed lockdown motivated by a ‘theory’ that the general public is likely to be ‘behaviourally fatigued’ by a prolonged lockdown. The delay led to more deaths; the author proceeded to allege. The call to dismiss behavioural research findings was published in Times UK — a paper with around 712 000 readers a month [2]. The image of the potential hazard terrified me. The main message of the article in Times UK [1] is unfounded; the account is unbalanced; and has dangerous implications for public health. I urge the media to consider the impact of its message to the public.
Before I proceed, a disclaimer: the below in, a large part, states the obvious. But hey, it is 2020, and you never know what undeniable facts need to be reiterated. Hence, I will follow the example of Washington Post [3] and Guardian [4] who recently urged people not to inject themselves with bleach and will state the vital obvious (in two parts).
I. Rigorous behavioural science works. When applied with good intent, it works for public benefit.
The Times UK article states that I agree with the author of the Times UK article that unfortunately, a lot of behavioural science is being wasted on causes that can harm the public welfare. Examples include tobacco and alcohol marketing, political campaigns that put the nation at a disadvantage; you name it. Behavioural Science is a lot like white and black magic in a fantasy game, You may choose to be a healer or a dark knight, and the research methods and findings are at your disposal. The national-wide positive impact produced by the healers includes, to name a few:
- Saving lives by encouraging people to eat fruit — ‘Five a day’;
- Saving lives by promoting physical activity and healthy diets: Change4Life Campaign [5];
- Improving the quality of life and health of heart failure patients: REACH-HF — a national service supporting heart failure patients and their caregivers, a collaboration between behavioural scientists and cardiologists; [6];
- Common models of chronic disease self-management support [7];
- Stop smoking interventions and services that are recommended by the National Institute for Health and Care Excellence [8,9];
- Research on psychological stress and cardiovascular disease led to the recognition of the latter as an occupational hazard [10]. This provided the basis for occupational health guidelines.
- Behavioural Science and Disease Prevention Task Force at the British Psychological Society pin downs how to get people to self-isolate. You can follow-up on the latest research via @divhealthpsych @HealthPsychX on Twitter.
Behavioural scientists, at least the healers, will not stop here. We will collaborate with other scientists, self-reflect, improve and continue the efforts to benefit the public. Journalists are invited to become an impactful ally.
II. Journalists change behaviour and therefore, can improve or harm public welfare.
A stated untested hypothesis that lockdown may result in ‘behavioural fatigue’ [1] was not expressed univocally by behavioural scientists around the globe, unlike the Times UK articles claims. Following this, many behavioural scientists communicated on twitter that behavioural fatigue is not a formal term and certainly not a theory.
Instead, the advice from The British Psychological Society on how to change what we do in order to stop the spread of COVID-19 is: ‘to help people feel capable, ensure they are given opportunities, and support their motivation’ (BPS, 2020). This may include providing an opportunity to self-isolate by giving a paid sick leave, placing stickers to remind people to stand two meters apart, and motivating people to wear masks as political self-expression. The latter was successfully taken on by one half of the bipartisan US, where a mask is an antidote to the red cup with the uncanny slogan: ‘let’s make America great again’.
Back in March, behavioural scientists at King’s College London conducted a rapid review of evidence to help people adhere to quarantine with ease. They advised: ‘The public health officials should provide a timely, clear rationale for quarantine and information about protocols and emphasise social norms to encourage this altruistic behaviour.’ — Dr Rebecca Webster.
Since the start of the pandemic, health psychologists also put up @HealthPsychX page on Twitter helping address worries, concerns and share their knowledge on how we can combat the pandemic together.
The article in Times UK would also have benefited by including the research on COVID-19 by a myriad of behavioural scientists. Including the following:
The WHO in collaboration with behavioural scientists develops tool for rapid monitoring of public views, risk perceptions, and behaviours during the pandemic [11];
Understanding the spread of the virus via cruise ships yields the preventative measures [12];
Social distancing, individual awareness interventions, and gradual ease of lockdown can reduce the risk for the re-emergence of COVID-19 [13];
Behaviour change techniques that can promote self-isolation, social distancing, and reduce automatic engagement in touching one’s face [14];
Formation of new habits, such as frequent hand washing; social distancing; moral decision making, and cultural shift as a critical response to combat the pandemic [15].
Adding any of these could have contributed to a balanced account of evidence that may guide a decision-maker.
The author in Times UK brought up the reproducibility crisis. If Times UK would like to support the initiative to hold behavioural scientists accountable, promote transparent and well-intended scientific research on health, and overcome the reproducibility crisis, they are few ways to do that. You may choose to promote public awareness that research on public health should be pre-registered like it was elegantly done in Guardian [13]. This includes observational studies, clinical trials, reviews (https://www.crd.york.ac.uk/prospero/), and rapid research — in the case of COVID-19. Media can take on popularising the knowledge that research should be peer-reviewed, preferably in an open manner and checked for correctness. You can also raise the awareness that the public can contribute to defying the scope of research and participate in the design of research studies as part of Patient and public involvement policy [16]. The behavioural research on health, at least the best of it that informs national guidelines, is always pre-registered and peer-reviewed. The research design is often informed by public/patient participation.
I wholeheartedly support journalists in their duty to vocalise their opinion, which is valued today more than ever. However, I even more so appreciate public health, which is put at risk by misinformed and unfounded claims journalists may make. A well-written [17], emotive [18] message, and a newspaper coverage [19] are one of the best strategies to change human behaviour on a large scale. The talentedly written, poignant article published in Times UK hits all three. And it fires, intentionally or unintentionally, at the public’s engagement with behaviour change interventions. Tomorrow it could be an intervention, a policy, or a campaign promoting an effective and safe COVID-19 vaccine uptake, wearing a mask, shielding, tackling antibiotic misuse, improving symptom reporting and many other behaviours crucial to life and death during and after the pandemic. The substantial implications of a mass-distributed opinion need to be considered. The consideration might encourage referencing sources, providing a balanced account, and engagement with the research subject at hand. At the end of the day, a large number of article hits will never justify any number of deaths.
Bibliography
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2 Press Gazette. National newspaper ABCs: Mail titles see slower year-on-year circulation decline as bulk sales distortion ends — Press Gazette. 2019.https://www.pressgazette.co.uk/national-newspaper-abcs-mail-titles-see-year-on-year-circulation-lift-as-bulk-sales-distortion-ends/ (accessed 29 Jun2020).
3 — The Washington Post. https://www.washingtonpost.com/gdpr-consent/?next_url=https%3a%2f%2fwww.washingtonpost.com%2fopinions%2f2020%2f04%2f24%2famerica-please-dont-put-bleach-inside-yourself-like-president-says%2f (accessed 29 Jun2020).
4 ‘Please don’t inject bleach’: Trump’s wild coronavirus claims prompt disbelief | US news | The Guardian. https://www.theguardian.com/us-news/2020/apr/24/trump-disinfectant-bleach-coronavirus-claims-reaction (accessed 29 Jun2020).
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6 REACH-HF — Medical School — University of Exeter. https://medicine.exeter.ac.uk/research/healthresearch/primarycare/projects/reach-hf/ (accessed 29 Jun2020).
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12 Liu F, Li X, Zhu G. Using the contact network model and Metropolis-Hastings sampling to reconstruct the COVID-19 spread on the “Diamond Princess”. Sci Bull (Beijing) Published Online First: 5 May 2020. doi:10.1016/j.scib.2020.04.043
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16 Patient and public involvement policy | Public Involvement Programme | Public involvement | NICE and the public | NICE Communities | About | NICE. https://www.nice.org.uk/about/nice-communities/nice-and-the-public/public-involvement/public-involvement-programme/patient-public-involvement-policy (accessed 29 Jun2020).
17 Hornik, Robert. Public Health Communication: Evidence for Behavior Change (Routledge Communication Series). 1st ed. Routledge 2002.
18 Richardson S, Langley T, Szatkowski L, et al. How does the emotive content of televised anti-smoking mass media campaigns influence monthly calls to the NHS Stop Smoking helpline in England? Prev Med 2014;69:43–8. doi:10.1016/j.ypmed.2014.08.030
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