In countries like South Africa that face severe resource shortages, the burden of fighting COVID-19 falls heavily on citizens to change their behaviour and follow preventative measures. These include avoiding mass gatherings, physical distancing and wearing masks.
But a crucial determinant of whether people will change their behaviour includes having access to credible health information that’s trusted and that people can adopt. Inadequate sources of information carry a number of risks. One of the biggest is that people who don’t have credible information will be more exposed to the virus because they are less likely to abide by these behaviour changes. The second risk is that people don’t fully perceive the danger of COVID-19 or its negative outcomes.
This is often the case with preventative health interventions: they require individuals to make an investment in their health prior to being sick. For example, a person has to wear masks even though they are healthy.
Unfortunately, high-impact behaviour change is not happening fast enough in South Africa. Our research found that most people – 91% of those surveyed – reported that they had changed their behaviour since the start of the pandemic. But most of these efforts were on lower-impact strategies, such as washing their hands and cleaning surfaces.
Of those who changed their behaviour, the focus was less on high-impact strategies like wearing masks (53%), avoiding people by either staying at home or not attending large gatherings or avoiding big groups (58%), and physical distancing (25%).
The ‘why’ question answered
The survey was based on the nationally representative National Income Dynamics Study (NIDS) – Coronavirus Rapid Mobile Survey. In this survey, 7000 South Africans are telephoned every month and asked a range of questions about their income and employment, their household welfare, receipt of grants, and about their knowledge and behaviour related to COVID-19. Because the same people are contacted every month, researchers can track how their personal and household circumstances change over time.
The first survey showed that there is inadequate knowledge of COVID-19 symptoms among South Africans. For instance, only 11% of those surveyed were able to list tiredness as a symptom, and only 6% could list all three of the most common COVID-19 symptoms – coughing, fever and tiredness.
And 8% of people surveyed were not able to list any symptoms at all.
This is worrying. The country’s current public health approach relies on society to monitor their symptoms in order to know when to isolate or seek additional care.
The infectious nature of COVID-19 means that behaviour changes are required to change the trajectory of the disease. For instance, universal masking of at least 80% is required to flatten the infection curve. The paucity of COVID-19 symptom knowledge implies that South Africans may be unable to self-screen and self-isolate should they become infected. The joint failure on these two fronts may impede the containment of the virus.
The question of where people got their information was also revealing. Almost four in five of those involved in the survey said they relied on news media for their trusted source of COVID-19-related information. Only 14% said they relied on government sources and 11% on health workers.
The study found that those who relied on the government and health workers had more accurate knowledge of symptoms and were more likely to abide by high-impact preventative strategies.
There is a clear responsibility placed on South Africans to adopt and adhere to high-impact preventative behaviours, remain vigilant and make daily sacrifices. This commitment requires serious societal buy-in.
So, how should the government go about encouraging this, given that current messaging and law enforcement efforts aren’t getting people to change their behaviour sufficiently?
We recommend that positive behaviour change should be encouraged by using clear, concise and consistent communication. And high-impact preventative measures such as mask wearing and physical distancing should be prioritised relative to lower-impact interventions (like surface cleaning and hand washing) when communicating about preventative measures.
There’s also a problem with reach: messages from the government aren’t reaching the population. Given that people are predominantly using news media, government sources should use these avenues more effectively to distribute centralised messaging.
Finally, given the long term behaviour changes required from South Africans, it may be more effective to create an enabling rather than a punitive environment to encourage the adoption of high-impact preventative strategies. This could include the free provision of masks, restructuring the delivery of services to encourage physical distancing (for example, home delivery of medication and telehealth) and empowering community champions, organisations and leaders to encourage these behaviours.
Changing social norms in a short amount of time is difficult, and a one-size-fits all policy is unlikely to have the desired effect. These changes require messaging that is context specific and which resonates strongly with its targeted audience.