The UK is in the process of acclimatising to Prime Minister Boris Johnson’s “conditional plan” to ease lockdown measures. This includes allowing people in England to spend more time outdoors and replacing the message to “stay home, protect the NHS, save lives” with the instruction to “stay alert, control the virus, save lives”.
The shift in message has not been well received. A lack of clarity and actionable advice have been highlighted as particular problems. On the day of its release, a snap poll found only 30% of Britons felt the new message “makes it clear what I am supposed to do”.
The debate over this change of government messaging illustrates some well-established principles for effective risk and crisis communication. We know, for example, that when trying to encouraging behavioural change in response to unfamiliar health threats such as COVID-19, it is important to comprehend how the public understands that threat, in terms of how serious it is and how likely they are to become infected.
Increasing threat perceptions by appealing to people’s fear, such as with government adverts warning “If you go out, you can spread it. People will die”, can increase the chances of people taking action. Heightened threat perceptions do not necessarily predict compliance with public health guidance, though. Fear can, for example, lead people to evacuate an area when it would be safer to stay put.
And as risk assessments change, it can be challenging to persuade people to tolerate the uncertainty associated with the lifting of more restrictive measures. Using threat-based messages may therefore be counterproductive.
Research suggests that more emphasis should be given instead to the effectiveness of the recommended actions and people’s ability to carry them out. This research also demonstrates that it is important to understand the emotional costs associated with carrying out recommended behaviours, such as being separated from loved ones during lockdown.
However, there have been very high levels of adherence to official guidance designed to stop the spread of COVID-19. This shows that these costs will not prevent compliance when the threat is considered sufficiently high, the recommended behaviour is understood to be effective and people feel capable of carrying out the advice.
A matter of trust
Trust is also well established as a primary route to co-operation with public health advice.
Following a series of anthrax attacks in the US in 2001, people from occupational groups who may have been exposed were told to take a course of prophylactic antibiotics to protect themselves against illness. But only some of them followed the advice.
This differential uptake was attributed to a failure by public health officials to effectively communicate why some groups were given one treatment regime and others another. A further problem was a failure to address ongoing concerns about historic racial discrimination in vaccination programmes.
Initially, public trust in the “stay home, protect the NHS, save lives” message was high across the political spectrum. This is likely because the campaign emphasised shared values and priorities regarding the NHS and saving lives. It is also likely that trust was increased by the consistency of messaging across different organisations and by the government’s use of communicators in trusted positions, such as government chief medical adviser Chris Whitty, to establish that the guidance was “led by the science”.
The new “stay alert” message, by contrast, was met with criticism from the scientific community. The level of scientific input into the change in messaging has also been questioned. Furthermore, the governments of Scotland, Wales and Northern Ireland have all rejected the new message, meaning there is no longer consensus in the advice that is being provided.
It is inevitable during complex evolving health threats that there will be differences in expert opinions and that scientific understanding will change as new information becomes available. This is illustrated by the debate about the public use of facemasks to prevent the spread of COVID-19. The global nature of the COVID-19 outbreak also means that people will be exposed to differences in national guidance that will also reflect cultural, economic and environmental variation.
In the context of a major pandemic, it is therefore particularly important for governments to work with local partners and across multiple organisations to build consensus and trust. Transparency about the reasons behind differences in and changes to advice is also required for the maintenance of trust.
In situations of reduced trust, it becomes vitally important that spokespeople tasked with communicating with the public are able to provide a coherent and credible rationale for the guidance that is being provided.
Finally, it’s also important to remember that the level of compliance for a public safety campaign of this kind not only comes down to what people are willing to do but what they are able to do. They may understand the risk of close personal contact and be willing to follow current government guidance on staying safe outside the home, but if they cannot access transport and safe working conditions, they will be unable to comply.
When communicating the need to maintain social distancing as lockdown measures ease, the government must take capability and opportunity into consideration too. Effective communication campaigns must be based on recommendations that are equitable and actionable. This includes the provision of structural support to make public compliance possible in the first place.