Psychological and psychosocial determinants of COVID related distancing behaviours: A systematic review

Background

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has resulted in illness, deaths and societal disruption on a global scale. Societies have implemented various control measures to reduce transmission of the virus and mitigate its impact. Individual behavioural changes are crucial to the successful implementation of these measures. One commonly recommended measure to limit risk of infection is distancing. It is important to identify those factors that can predict the uptake and maintenance of distancing.

Objectives

We aimed to identify and synthesise the evidence on malleable psychological and psychosocial factors that determine uptake and adherence to distancing aimed at reducing the risk of infection or transmission of COVID-19.

Search Methods

We searched various literature sources including electronic databases (Medline ALL, Child Development & Adolescent Studies, ERIC, PsycInfo, CINAHL & Web of Science), web searches, conference proceedings, government reports, other repositories of literature and grey literature. The search strategy was built around three concepts of interest including (1) context (terms relating to COVID-19), (2) behaviour of interest and (3) terms related to psychological and psychosocial determinants of COVID-19 Health-Related Behaviours and adherence or compliance with distancing, to capture malleable determines. Searches capture studies up until October 2021.

Selection Criteria

Eligibility criteria included observational studies (both retrospective and prospective) and experimental studies that measure and report malleable psychological and psychosocial determinants and distancing (social and/or physical) at an individual level, amongst the general public. We defined physical distancing as, maintaining the recommended distance from others when physically present. And social distancing being defined as, minimising social contact with those outside of your own household. Screening was supported by the Cochrane Crowd. Studies' titles and abstracts were screened against the eligibility criteria by three independent screeners. Following this, all potentially relevant studies were screened at full-text level by the research team. All conflicts between screeners were resolved by discussion between the core research team.

Data Collection and Analysis

All data extraction was managed in EPPI-Reviewer software. All eligible studies, identified through full-text screening were extracted by one author. We extracted data on study information, population, determinant, behaviour and effects. A second author checked data extraction on 20% of all included papers. All conflicts were discussed by the two authors until consensus was reached. We assessed methodological quality of all included studies using an adapted version of the Joanna Briggs Institute Quality appraisal tool.

Main Results

A total of 91 studies were suitable for inclusion in the review, representing 199,604 participants. The vast majority of studies had samples from the general public, with 15 of the studies focusing on specific samples. The majority of studies included participants over 18 years old, with 5 reporting on specific ages (adolescents and adults over 65). The quality of 29 of the studies was rated as unclear, 48 were rated as low, and 14 rated high risk of bias, predominately due to lack of reporting of recruitment, sample characteristics and methodology. Overall the majority of these relationships were weak. Stronger relationships were observed between attitudes, social norms, perceived behavioural control and both social and physical distancing. And between worry, response effectiveness, self-efficacy and social distancing. However, there is a high level of heterogeneity in the findings. This heterogeneity might be, partly, due to the differences in measurement of the determinants and distancing across studies.

Authors' Conclusions

The findings from this review indicate that social distancing behaviours are more likely to be undertaken by people who are worried about COVID-19 and who believe that social distancing is an effective way of avoiding COVID-19. Physical distancing behaviours are more likely to be undertaken by those who believe that they can control physical distancing from others, who believe that physical distancing is the social norm and who have a positive attitude to engaging in this behaviour. It is important to understand how to strengthen these behavioural determinants to develop effective interventions to promote distancing behaviours in any potential future waves of COVID-19, and other respiratory infections.