Key messages
- During a pandemic, governments and other authorities need to clearly communicate with the public about how people can keep themselves safe. This communication needs to be based on trust and well-planned. People and communities affected by the pandemic need to be involved in planning and delivering the communication. The communication should reach all people across the community, including those who have trouble reading and writing, people who speak languages other than the community's dominant language, and people who face other types of disadvantage. Clear communication can improve how well people are able to follow measures to keep themselves safe.
- This review identified six themes which can guide best-practice approaches to public health communication during a pandemic. These themes are:
1) Strengthening public trust and countering misinformation;
2) Two-way communication involving communities so that people have input into how communication can best happen;
3) Development of and preparation for public communication by considering who the audience is and how different people's needs within the community can be met;
4) Public communication features, including how and when messages are delivered to communities;
5) Supporting behaviour change at individual and population levels;
6) Fostering and sustaining receptiveness and responsiveness to public health communication over time.
- The review findings can help governments and other authorities make decisions about public health communication during a pandemic. The findings are relevant to COVID-19 and future public health emergencies. The findings can be applied across different countries and different emergency situations.
- Some gaps in the research were found through this review. These included: communication with people who are at higher risk of getting severely sick or dying from COVID-19; communication in lower- and middle-income countries; and communication in settings known for social inequalities. Further research in these areas may help increase knowledge and improve practices related to pandemic communication.
What are physical distancing measures?
The term 'physical distancing measures' describes ways to reduce the spread of diseases such as COVID-19 by reducing physical contact between people. Physical distancing measures include contact tracing, avoiding crowds, isolating, quarantine, and measures to reduce transmission in schools and workplaces.
What did we want to find out?
We wanted to find out which ways of communicating with the public are best to increase people's understanding and use of physical distancing measures to protect themselves and limit the spread of COVID-19 and other similar diseases. We also wanted to find out whether there were ways of communicating that worked better for certain groups in the community, including people who experience disadvantage.
What did we do?
This review is an update of a review conducted in 2020. The 2020 review included primary studies (qualitative and quantitative) and secondary sources (review studies and guidelines).
During the searches for this update, we looked for guidelines or review studies examining communication about physical distancing measures for preventing and/or controlling COVID-19 or selected other infectious diseases. We compared and summarised the results of included studies and guidelines, together with the findings from the 2020 review.
What did we find?
This review has 68 included studies (guidelines, reviews and primary studies [studies undertaken by researcher(s) which collect original data]). This update added 17 guidelines and 20 reviews (which are considered secondary research) to the original 2020 review.
We identified six main themes related to planning and implementing communication about physical distancing during a pandemic.
These themes can inform policy and decision-making around pandemic and public health emergency communication. These themes are: 1) Strengthening public trust and countering misinformation; 2) Two-way communication; 3) Development of and preparation for public communication; 4) Public communication features; 5) Supporting behaviour change at individual and population levels; 6) Fostering and sustaining receptiveness and responsiveness to public health communication.
What are the limitations of the evidence?
This update focused on reviews and guidelines. Typically, these represent the best available evidence but, in this update, were mainly rated as having low or moderate quality. Because of studies' different designs, the quality ratings are not meant to be used as a hierarchy (ranking) of evidence.
A strength of this review is that major themes and findings came from diverse sources, including primary studies, reviews and guidelines. Often, similar findings were reported across different study types, populations and settings. The findings from this updated review also build on those of the 2020 review, adding to the main findings and filling major gaps. Having similar findings across different study types, and adding new information through this update, increases our confidence in the findings even though most of the included studies are of low or moderate quality. However, since searches for new evidence last occurred in 2021, it is likely that further relevant evidence now exists.
How up-to-date is this evidence?
This evidence is up-to-date until August 2021.
Implications for practice
Evidence highlights the critical role of communication throughout a public health emergency. Like any intervention, communication can be done well or poorly, but the consequences of poor communication during a pandemic may mean the difference between life and death.
The approaches to effective communication identified in this review can be used by policymakers and decision-makers, working closely with communication teams, to plan, implement and adjust public communications over the course of a public health emergency like the COVID-19 pandemic.
Implications for research
Despite massive growth in research during the COVID-19 period, gaps in the evidence persist and require high-quality, meaningful research. This includes investigating the experiences of people at heightened COVID-19 risk, and identifying barriers to implementing public communication and protective health measures particular to lower- and middle-income countries, and how to overcome these.
This review is an update of a rapid review undertaken in 2020 to identify relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control. The rapid review was published when little was known about transmission, treatment or future vaccination, and when physical distancing measures (isolation, quarantine, contact tracing, crowd avoidance, work and school measures) were the cornerstone of public health responses globally.
This updated review includes more recent evidence to extend what we know about effective pandemic public health communication. This includes considerations of changes needed over time to maintain responsiveness to pandemic transmission waves, the (in)equities and variable needs of groups within communities due to the pandemic, and highlights again the critical role of effective communication as integral to the public health response.
To update the evidence on the question 'What are relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control?', our primary focus was communication approaches to promote and support acceptance, uptake and adherence to physical distancing.
Secondary objective: to explore and identify key elements of effective communication for physical distancing measures for different (diverse) populations and groups.
We searched MEDLINE, Embase and Cochrane Library databases from inception, with searches for this update including the period 1 January 2020 to 18 August 2021. Systematic review and study repositories and grey literature sources were searched in August 2021 and guidelines identified for the eCOVID19 Recommendations Map were screened (November 2021).
Guidelines or reviews focusing on communication (information, education, reminders, facilitating decision-making, skills acquisition, supporting behaviour change, support, involvement in decision-making) related to physical distancing measures for prevention and/or control of COVID-19 or selected other diseases (sudden acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza, Ebola virus disease (EVD) or tuberculosis (TB)) were included. New evidence was added to guidelines, reviews and primary studies included in the 2020 review.
Methods were based on the original rapid review, using methods developed by McMaster University and informed by Cochrane rapid review guidance.
Screening, data extraction, quality assessment and synthesis were conducted by one author and checked by a second author. Synthesis of results was conducted using modified framework analysis, with themes from the original review used as an initial framework.
This review update includes 68 studies, with 17 guidelines and 20 reviews added to the original 31 studies.
Synthesis identified six major themes, which can be used to inform policy and decision-making related to planning and implementing communication about a public health emergency and measures to protect the community.
Theme 1: Strengthening public trust and countering misinformation: essential foundations for effective public health communication
Recognising the key role of public trust is essential. Working to build and maintain trust over time underpins the success of public health communications and, therefore, the effectiveness of public health prevention measures.
Theme 2: Two-way communication: involving communities to improve the dissemination, accessibility and acceptability of information
Two-way communication (engagement) with the public is needed over the course of a public health emergency: at first, recognition of a health threat (despite uncertainties), and regularly as public health measures are introduced or adjusted. Engagement needs to be embedded at all stages of the response and inform tailoring of communications and implementation of public health measures over time.
Theme 3: Development of and preparation for public communication: target audience, equity and tailoring
Communication and information must be tailored to reach all groups within populations, and explicitly consider existing inequities and the needs of disadvantaged groups, including those who are underserved, vulnerable, from diverse cultural or language groups, or who have lower educational attainment. Awareness that implementing public health measures may magnify existing or emerging inequities is also needed in response planning, enactment and adjustment over time.
Theme 4: Public communication features: content, timing and duration, delivery
Public communication needs to be based on clear, consistent, actionable and timely (up-to-date) information about preventive measures, including the benefits (whether for individual, social groupings or wider society), harms (likewise) and rationale for use, and include information about supports available to help follow recommended measures. Communication needs to occur through multiple channels and/or formats to build public trust and reach more of the community.
Theme 5: Supporting behaviour change at individual and population levels
Supporting implementation of public health measures with practical supports and services (e.g. essential supplies, financial support) is critical. Information about available supports must be widely disseminated and well understood. Supports and communication related to them require flexibility and tailoring to explicitly consider community needs, including those of vulnerable groups. Proactively monitoring and countering stigma related to preventive measures (e.g. quarantine) is also necessary to support adherence.
Theme 6: Fostering and sustaining receptiveness and responsiveness to public health communication
Efforts to foster and sustain public receptiveness and responsiveness to public health communication are needed throughout a public health emergency. Trust, acceptance and behaviours change over time, and communication needs to be adaptive and responsive to these changing needs. Ongoing community engagement efforts should inform communication and public health response measures.