Towards an understanding of resilience: responding to health systems shocks

Journal article

This paper summarises useful evidence from behavioural science for fighting the COVID-19 outbreak. It is based on an extensive literature search of relevant behavioural interventions and studies of crises. The findings aim to be useful not only to government and public authorities, but to organisations, workplaces and households. Seven issues are covered: (1) Evidence on handwashing shows that education and information are not enough. Placing hand sanitisers and colourful signage in central locations (e.g. directly beyond doors, canteen entrances, the middle of entrance halls and lift lobbies) increases use substantially. All organisations and public buildings could adopt this cheap and effective practice. (2) By contrast, we lack direct evidence on reducing face touching. Articulating new norms of acceptable behaviour (as for sneezing and coughing) and keeping tissues within arm’s reach could help. (3) Isolation is likely to cause some distress and mental health problems, requiring additional services. Preparedness, through activating social networks, making concrete isolation plans, and becoming familiar with the process, helps. These supports are important, as some people may try to avoid necessary isolation. (4) Public-spirited behaviour is most likely when there is clear and frequent communication, strong group identity, and social disapproval for those who don’t comply. This has implications for language, leadership and day-to-day social interaction. (5) Authorities often overestimate the risk of panic, but undesirable behaviours to watch out for are panic buying of key supplies and xenophobic responses. Communicating the social unacceptability of both could be part of a collective strategy. (6) Evidence links crisis communication to behaviour change. As well as speed, honesty and credibility, effective communication involves empathy and promoting useful individual actions and decisions. Using multiple platforms and tailoring message to subgroups are beneficial too. (7) Risk perceptions are easily biased. Highlighting single cases or using emotive language will increase bias. Risk is probably best communicated through numbers, with ranges to describe uncertainty, emphasising that numbers in the middle are more likely. Stating a maximum, e.g. “up to X thousand”, will bias public perception. A final section discusses possibilities for combining these insights, the need for simplicity, the role of the media, and possibilities for rapid pretesting

Authors: Hanefeld, J; Mayhew, S; Legido-Quigley, H; Martineau, F; Karanikolos, M

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Oxford University Press
• Journal: Health Policy and Planning
• Volume: 33
• Issue: 3
• Pages: 355-367
• Publication date: 2017-12-20
• DOI: 10.1093/heapol/czx183
• EISSN: 1460-2237
• ISSN: 0268-1080
• Language: English
• Keywords: Finance; Community resilience; Workforce; Psychological resilience; Computer science; Business; Corporate governance; Development economics; Public relations; Political science; Economic growth; Shock (circulatory); Resilience (materials science); Social psychology; Economics; Psychology; Medicine