Review

. 2022 Jun:303:114946.

doi: 10.1016/j.socscimed.2022.114946. Epub 2022 Mar 26.

Interventions to promote physical distancing behaviour during infectious disease pandemics or epidemics: A systematic review

Tracy Epton¹, Daniela Ghio², Lisa M Ballard³, Sarah F Allen⁴, Angelos P Kassianos⁵, Rachael Hewitt⁶, Katherine Swainston⁷, Wendy Irene Fynn⁸, Vickie Rowland⁹, Juliette Westbrook¹⁰, Elizabeth Jenkinson¹¹, Alison Morrow¹², Grant J McGeechan¹³, Sabina Stanescu¹⁴, Aysha A Yousuf¹⁵, Nisha Sharma¹⁶, Suhana Begum¹⁷, Eleni Karasouli¹⁸, Daniel Scanlan¹⁹, Gillian W Shorter²⁰, Madelynne A Arden²¹, Christopher J Armitage²², Daryl B O'Connor²³, Atiya Kamal²⁴, Emily McBride²⁵, Vivien Swanson²⁶, Jo Hart²⁷, Lucie Byrne-Davis²⁷, Angel Chater²⁸, John Drury²⁹

Affiliations

¹ Manchester Centre for Health Psychology, University of Manchester, UK. Electronic address: tracy.epton@manchester.ac.uk.
² Manchester Centre for Health Psychology, University of Manchester, UK.
³ Faculty of Medicine, University of Southampton, UK.
⁴ School of Social Sciences, Humanities and Law, Teesside University, UK.
⁵ Department of Applied Health Research, University College London, UK.
⁶ School of Healthcare Sciences, Cardiff University, UK.
⁷ Psychology, Centre for Applied Psychological Science, Teesside University, UK.
⁸ IEHC, University College London, UK.
⁹ Public Health, London Borough of Havering, UK.
¹⁰ Department of Psychology, University of Bath, Bath, UK.
¹¹ Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
¹² NHS Fife, UK.
¹³ Centre for Applied Psychological Science, Teesside University, UK.
¹⁴ School of Psychology, University of Southampton, Southampton, UK.
¹⁵ Lancashire and South Cumbria NHS Foundation, UK.
¹⁶ Department of Clinical Health Psychology, Royal National Orthopaedic Hospital, UK.
¹⁷ Department of Psychology, City University of London, UK; Surrey County Council, UK.
¹⁸ Warwick Clinical Trials Unit, University of Warwick, UK.
¹⁹ Research and Communication, Education Support, London, N5 1EW, UK.
²⁰ Centre for Improving Health Related Quality of Life, Queen's University Belfast, UK.
²¹ Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, UK.
²² Manchester Centre for Health Psychology, University of Manchester, UK; Manchester University NHS Foundation Trust, University of Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK.
²³ School of Psychology, University of Leeds, UK.
²⁴ Department of Psychology, Birmingham City University, UK.
²⁵ Department of Behavioural Science and Health, University College London, UK.
²⁶ University of Stirling, UK.
²⁷ Manchester Centre for Health Psychology, University of Manchester, UK; Division of Medical Education, University of Manchester, UK.
²⁸ University of Bedfordshire, UK.
²⁹ School of Psychology, University of Sussex, UK.

PMID: 35605431
PMCID: PMC8957361
DOI: 10.1016/j.socscimed.2022.114946

Review

Interventions to promote physical distancing behaviour during infectious disease pandemics or epidemics: A systematic review

Tracy Epton et al. Soc Sci Med. 2022 Jun.

. 2022 Jun:303:114946.

doi: 10.1016/j.socscimed.2022.114946. Epub 2022 Mar 26.

Authors

Affiliations

¹ Manchester Centre for Health Psychology, University of Manchester, UK. Electronic address: tracy.epton@manchester.ac.uk.
² Manchester Centre for Health Psychology, University of Manchester, UK.
³ Faculty of Medicine, University of Southampton, UK.
⁴ School of Social Sciences, Humanities and Law, Teesside University, UK.
⁵ Department of Applied Health Research, University College London, UK.
⁶ School of Healthcare Sciences, Cardiff University, UK.
⁷ Psychology, Centre for Applied Psychological Science, Teesside University, UK.
⁸ IEHC, University College London, UK.
⁹ Public Health, London Borough of Havering, UK.
¹⁰ Department of Psychology, University of Bath, Bath, UK.
¹¹ Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
¹² NHS Fife, UK.
¹³ Centre for Applied Psychological Science, Teesside University, UK.
¹⁴ School of Psychology, University of Southampton, Southampton, UK.
¹⁵ Lancashire and South Cumbria NHS Foundation, UK.
¹⁶ Department of Clinical Health Psychology, Royal National Orthopaedic Hospital, UK.
¹⁷ Department of Psychology, City University of London, UK; Surrey County Council, UK.
¹⁸ Warwick Clinical Trials Unit, University of Warwick, UK.
¹⁹ Research and Communication, Education Support, London, N5 1EW, UK.
²⁰ Centre for Improving Health Related Quality of Life, Queen's University Belfast, UK.
²¹ Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, UK.
²² Manchester Centre for Health Psychology, University of Manchester, UK; Manchester University NHS Foundation Trust, University of Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK.
²³ School of Psychology, University of Leeds, UK.
²⁴ Department of Psychology, Birmingham City University, UK.
²⁵ Department of Behavioural Science and Health, University College London, UK.
²⁶ University of Stirling, UK.
²⁷ Manchester Centre for Health Psychology, University of Manchester, UK; Division of Medical Education, University of Manchester, UK.
²⁸ University of Bedfordshire, UK.
²⁹ School of Psychology, University of Sussex, UK.

PMID: 35605431
PMCID: PMC8957361
DOI: 10.1016/j.socscimed.2022.114946

Abstract

Objectives: Physical distancing, defined as keeping 1-2m apart when co-located, can prevent cases of droplet or aerosol transmitted infectious diseases such as SARS-CoV2. During the COVID-19 pandemic, distancing was a recommendation or a requirement in many countries. This systematic review aimed to determine which interventions and behavior change techniques (BCTs) are effective in promoting adherence to distancing and through which potential mechanisms of action (MOAs).

Methods: Six databases were searched. The review included studies that were (a) conducted on humans, (b) reported physical distancing interventions, (c) included any comparator (e.g., pre-intervention versus post-intervention; randomized controlled trial), and (d) reported actual distancing or predictors of distancing behavior. Risk of bias was assessed using the Mixed Methods Appraisal Tool. BCTs and potential MoAs were identified in each intervention.

Results: Six articles (with seven studies and 19 comparisons) indicated that distancing interventions could successfully change MoAs and behavior. Successful BCTs (MoAs) included feedback on behavior (e.g., motivation); information about health consequences, salience of health consequences (e.g., beliefs about consequences), demonstration (e.g., beliefs about capabilities), and restructuring the physical environment (e.g., environmental context and resources). The most promising interventions were proximity buzzers, directional systems, and posters with loss-framed messages that demonstrated the behaviors.

Conclusions: The evidence indicates several BCTs and potential MoAs that should be targeted in interventions and highlights gaps that should be the focus of future research.

Keywords: COVID-19; Physical distancing; Social distancing; Systematic review.

PubMed Disclaimer

Conflict of interest statement

AK and JD participate in the UK's Scientific Advisory Group for Emergencies sub-groups SPI-B but are writing in a personal capacity.

Figures

**Fig. 1**
Flow diagram of papers included in the review.

See this image and copyright information in PMC

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Template for Rapid Iterative Consensus of Experts (TRICE).
Chater AM, Shorter GW, Swanson V, Kamal A, Epton T, Arden MA, Hart J, Byrne-Davis LMT, Drury J, Whittaker E, Lewis LJM, McBride E, Chadwick P, O'Connor DB, Armitage CJ. Chater AM, et al. Int J Environ Res Public Health. 2021 Sep 29;18(19):10255. doi: 10.3390/ijerph181910255. Int J Environ Res Public Health. 2021. PMID: 34639553 Free PMC article.

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Interventions to promote physical distancing behaviour during infectious disease pandemics or epidemics: A systematic review

Affiliations

Interventions to promote physical distancing behaviour during infectious disease pandemics or epidemics: A systematic review

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Conflict of interest statement

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