Universitat de Girona
Over the last few days, it has become apparent that Spain and the UK are on a very steep curve with regard to both COVID-19 cases and deaths. As this graph from John Burn-Murdoch at the Financial Times shows, it appears the Spanish and UK trajectories are even worse than Italy’s, which as of Saturday 21st March has suffered almost 5000 deaths.
NEW: Saturday 21 March update of our coronavirus mortality trajectories tracker
• Today we add annotations showing when each country locked down
• UK & US already have more deaths than when China, Spain, France & others locked down
— John Burn-Murdoch (@jburnmurdoch) March 21, 2020
In Spain, the advice has been relatively clear for well over a week and while the UK has been flip flopping around, in the last few days the instructions have become more explicit: stay at home unless you absolutely have to go out. As such, it seems hard to comprehend the numbers of people in both countries that continue to flaunt the warnings. In Spain, we’ve seen long queues of cars rushing out the most affected cities to second residences, and the number of fines imposed by the police is rising rapidly. In the UK, which appears to be about a week behind Spain, the situation is even more alarming; packed pubs with happy hours for one last send off, and unnecessary, selfish supermarket rushes. Anecdotally, I have heard many family members and acquaintances deride the Spanish or UK government’s lack of action, yet the same people regularly leave their houses for unneeded trips or social gatherings. The aim of this post is not to analyse the insufficient response of the respective public administrations (and it is clearly insufficient), but rather to outline a theoretical framework to understand:
- the incapacity of government warnings to change behaviour regarding social distancing; and
- the cognitive dissonance within individuals who accept the advice as valid but do not follow it.
Protection Motivation Theory
The Protection Motivation Theory (Maddux & Rogers, 1983; Rogers, 1975) has been extensively applied in a plethora of areas of potential risks such as nutrition, disease, road safety or cybersecurity. In accordance with this framework, an individual’s motivation to protect themselves depends on their assessment of the threat –“threat appraisal”– and their evaluation of strategies to deal with the threat –“coping appraisal”. As shown in Figure 1, these two branches of the framework are divided into different subcategories.
Figure 1. Conceptual Model of Protection Motivation Theory. Adapted from (Briggs et al., 2017; Martens et al., 2019)
The threat appraisal is comprised of two elements: on the one hand, the perceived severity of the threat; and, on the other hand, the degree to which the individual considers themselves vulnerable to that threat.
The coping appraisal involves three factors. Firstly, the perceived ability of the individual to respond to the threat. Secondly, the anticipated efficacy of this response with regard to the threat. Finally, the individual will consider the costs of the response.
So, how can the threat appraisal be applied to COVID-19?
Firstly, it seems that large parts of both the UK and Spanish public still do not consider coronavirus to pose a significant threat. Given the huge well-publicized number of fatalities in other large neighbouring European countries and the fast-increasing death count in Spain and UK, it’s hard to understand why this could be the case, but two hypotheses jump out.
On the one hand, it seems likely that there is widespread distrust in the emitters of the information, i.e. press, government officials and, worryingly, scientists. On the other hand, the non-stop barrage of news coverage may have led to information overload and desensitizing of the citizens to updates and reports.
Secondly, for many individuals, especially younger generations, there appears to be a sense of invulnerability: “The virus only affects old people” or “it’s just like a bad flu”. The World Health Organisation and national health institutions in both countries have debunked these myths, yet they still appear to be strongly pervasive.
And what about coping appraisal?
It’s hard to imagine that all the people we’ve seen travelling around Spain or in pubs in the UK believe they are incapable of staying in their house; however, it certainly seems plausible that they doubt the efficacy of such a strategy. Studies have already shown that many infected persons are asymptomatic, or that symptoms may not appear until 5 days after contagion. But, if you don’t think you’re infected or you think any potential infection will only have a mild effect on you, then the perceived efficacy of staying at home is reduced. It may also be that the science behind the strong infectivity of the virus and the need for social distancing is confusing for some members of the public. There are many hypotheses flying around about how the virus can move between people and, moreover, much government advice on social distancing has initially been contradictory. For example, the lethargic reaction in Madrid when it was undoubtedly identified as a virus hotspot or the incoherent pronouncements by Boris Johnson regarding life as normal versus social distancing. Faced with these inconsistencies, it’s not difficult to understand why a significant part of the public may doubt the efficacy of staying at home.
Finally, the costs of full confinement are impossible for many to bear. For example, many jobs cannot be easily moved online and, therefore, citizens need to physically go out to work to be able to pay the rent. Although the Spanish and UK governments have thrown big numbers around regarding how they plan to stem the economic fallout, the practicalities of how this money will get to individuals is still extremely unclear. In other cases, the costs of confinement are much lower –boredom, lack of exercise, etc.– but the perceived lack of benefits can still lead to decisions that could have grave consequences.
So, what can be done?
In accordance with Protection Motivation Theory, government officials, scientists and anyone else with an interest in ensuring social distancing must find a way to improve the communication of their message:
- The threat must be considered real and relevant for everyone.
- Individual action such as social distancing must be framed as essential and effective. In addition, individual action must be facilitated. This means posting clear coherent rules that are easy to follow and providing comprehensible and practical information on how the costs of confinement will be mitigated.
Behavioural economics research provides many insights that can help improve public health warnings regarding COVID-19. These will be dealt with in a future post.
Briggs, P., Jeske, D., & Coventry, L. (2017). Chapter 6—Behavior Change Interventions for Cybersecurity. In L. Little, E. Sillence, & A. Joinson (Eds.), Behavior Change Research and Theory (pp. 115–136). Academic Press. https://doi.org/10.1016/B978-0-12-802690-8.00004-9
Maddux, J. E., & Rogers, R. W. (1983). Protection motivation and self-efficacy: A revised theory of fear appeals and attitude change. Journal of Experimental Social Psychology, 19(5), 469–479. https://doi.org/10.1016/0022-1031(83)90023-9
Martens, M., De Wolf, R., & De Marez, L. (2019). Investigating and comparing the predictors of the intention towards taking security measures against malware, scams and cybercrime in general. Computers in Human Behavior, 92, 139–150. https://doi.org/10.1016/j.chb.2018.11.002
Rogers, R. W. (1975). A Protection Motivation Theory of Fear Appeals and Attitude Change1. The Journal of Psychology, 91(1), 93–114. https://doi.org/10.1080/00223980.1975.9915803