The year was 2014. Governments and public health officials in West Africa were struggling against the Ebola outbreak. The global community was entirely ill-prepared. Misinformation and stigma were rife. Behaviours involved in traditional funeral rituals such as washing the bodies of the deceased were catalysing the virus’s spread. The government was issuing health warnings to the public to promote changes in behaviour, continuously emphasising the seriousness of the disease. However, the messaging repeatedly backfired, and was often met with widespread community resistance and continued denial.
Looking back, it took a few months too many but there came a turning point in the Ebola response efforts. Instead of focusing on top-down actions, public health officials became more purposeful in understanding human behaviour and in building relationships. Ebola’s hurdles were ultimately not just about epidemiology or medicine, they were about people.
And like Ebola, the coronavirus pandemic is also underscored by human behaviour. Specific behaviours like personal hygiene and physical distancing are fundamental to halting the virus’s spread. Changing individual and group habits to promote these behaviours is now a global priority, especially so in India. With a steep rise in cases, an extended lockdown and little hope of a vaccine in the near future, India is looking directly in the eye of an epidemic about to go berserk, and needs to move decisively and boldly with diverse approaches, all ideally informed by different scientific disciplines.
The role of behavioural science
Behavioural science is a field of study that combines insights from social and cognitive psychology, neuroscience and behavioural economics to make sense of human behaviour. Using an evidence-based approach, behavioural scientists unpack what makes individuals tick: from motivations and aspirations, to cognitive biases and social influences. Gaining in popularity in both the public and private sector, behavioural design is a recent offshoot of behavioural science. It uses scientific insights to identify how to enable certain behaviour and discourage others.
In India, adopting a behavioural science approach to this virus could be hugely beneficial, from facilitating change around key behaviours to reducing stigma and misinformation. However, unlike in other countries, these opportunities in India are riddled with complexities. For example, misinformation in India is not just limited to 5G conspiracy theories or false miracle cures. Videos falsely accusing Muslims of spreading the virus exacerbate stigma and stoke existing tensions. The risk of igniting violence accompanies each rumour. In many Indian states, misinformation carries a potential human cost.
Instead, here are a few examples of how behavioural science can be called upon to serve us better during the coronavirus pandemic.
1. Designing for limited cognitive bandwidth
The ramifications of the lockdown on daily-wage workers, migrants and their families have been devastating. For millions, basic needs of food, shelter and income hang in the balance. In these conditions, psychological and physical stress on these individuals is very high. Any solution or intervention that attempts to introduce new behaviours, such as physical distancing, will only exert an additional burden. Indeed, we know from behavioural research by Anandi Mani at the University of Warwick and others that extreme stress and poverty drain individuals’ limited mental resources.
In field experiments, researchers found that sugarcane farmers performed worse on cognitive tasks before a harvest than after. As farmers face greater financial pressures (e.g. loans and debt) pre-harvest, these findings reflect the negative impact of stress and poverty on people’s mental capacity to process information and make rational decisions.
So any behaviourally informed intervention during the lockdown, even at the level of messaging and communication, has to be carefully designed with limited cognitive bandwidth in mind. Information is quickly overwhelming and even one new behaviour, such as physical distancing, can induce stress. This in part explains why the now-infamous coronavirus helmets for policemen in Karnataka were an inadvertently successful example of effective communication. The bold imagery of the virus reduced the cognitive burden on individuals by using a simple, visual cue to communicate complex new information. Storytelling and tapping into existing oral traditions, such as singing and folklore, are other ways of reducing cognitive stress.
2. Adapting behavioural insights and methods
Behavioural science solutions are based on evidence of what has worked before. However, due to the scale of this pandemic, behavioural scientists have found themselves without a reliable evidence base to work with. Research groups around the world are now conducting real-time research, rolling out surveys to gauge public sentiments and testing the effectiveness of different messaging strategies in countries such as the UK, Italy and Germany.
In one recent study of Italian participants, for example, researchers randomly allocated individuals to receive one of eight messages that emphasised physical distancing. Of these interventions, some messages applied theories such as the influence of expert power and authority on behaviour (‘people are more likely to act in accordance with authority’); others used social norms (‘people are more likely to act when they think others are doing the same’); and some were pro-social (‘people are more likely to act in service of others’). These interventions were compared to a control condition of “stay home”. Participants then answered a series of questions about how might behave in different situations.
In the Indian context, however, it is virtually impossible to conduct a rapid-response study without circumventing constraints, including access to populations with low literacy and digital literacy, infeasibility of physical distancing due to high population density, limited resources (including soap or water), and the numerous influences on behaviour at the level of language, region, community, religion and the social environment.
So behavioural solutions in India need thoughtful adaptation, such that behavioural scientists can’t simply copy/paste successful interventions elsewhere into an Indian context or roll-out representative surveys. However, behavioural science can offer useful rules of thumb and levers of behaviour change that, combined with intuition and on-the-ground knowledge, can lead to effective solutions.
3. Engaging the community
A critical lesson in the Ebola outbreak was the importance of involving local communities at all levels of the crisis response. For example, when the initial response to the outbreak envisioned large-scale medical facilities, patients viewed these centres with suspicion and refused to report to them. Community care centres (CCC), on the other hand, were much more successful and leveraged the community mindset to relieve anxious individuals through messaging, like: “CCC is where you and your loved ones who are sick with Ebola symptoms can receive safe care closer to your home and community.”
Similarly, when health officials changed tack and focused on community activation, they invested considerable effort in training and empowering community influencers, health workers and religious leaders to instil trust and confidence, spread information about the virus and encourage collective action. It was only once individuals felt part of a community response that they were likely to change their behaviours and encourage others to follow suit.
Although this exercise of trust-building and subsequent behaviour change came late in the Ebola response, it has been widely adopted in many other settings since. In South Africa, bringing in community health workers to assume specific responsibilities helped to impede the HIV crisis by spreading information and engendering a trust that hospitals were unable to achieve.
In India, we have already seen some positive examples of boosting community involvement. According to state government officials, in Andhra Pradesh, nearly 250,000 village and ward volunteers along with ASHA workers and nurses, helped survey households in the state. These village volunteers went door to door asking questions and checking symptoms. The Kerala government has similarly created a network of volunteers to train others and assume responsibility for delivering essential items and services.
Although these are all steps in the right direction, India needs a more structured and systematic approach to use the community more efficiently. Volunteers, ASHA workers, panchayat heads, anganwadi workers, heads of self-help groups and community and religious leaders need to be involved, trained and equipped with protective gear. It isn’t only about checking symptoms or conducting surveys: these people hold an invisible power based on understanding ground realities, and can correct misinformation and support individuals more effectively.
There is no doubt that the road ahead is long and arduous. Like other experts, behavioural scientists have found themselves unprepared and ill-equipped for our present crisis. There is no set manual or solution to tackle this pandemic except to learn from past crises and to expeditiously integrate new approaches and solutions.
Sanna Balsari-Palsule is a behavioural scientist. She advises both the public and private sector on how behavioural science can be leveraged as a tool for policy, service provision and product design. She has a doctorate in social psychology from the University of Cambridge, and lectures on organisational behaviour. Her research has been featured in the BBC, Vice, New York Magazine and Psychology Today.