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Applying principles of behaviour change to reduce SARS-CoV-2 transmission
Open accessAbstract
Human behaviour is central to transmission of SARS-Cov-2, the virus that causes COVID-19, and changing behaviour is crucial to preventing transmission in the absence of pharmaceutical interventions. Isolation and social distancing measures, including edicts to stay at home, have been brought into place across the globe to reduce transmission of the virus, but at a huge cost to individuals and society. In addition to these measures, we urgently need effective interventions to increase adherence to behaviours that individuals in communities can enact to protect themselves and others: use of tissues to catch expelled droplets from coughs or sneezes, use of face masks as appropriate, hand-washing on all occasions when required, disinfecting objects and surfaces, physical distancing, and not touching one's eyes, nose or mouth. There is an urgent need for direct evidence to inform development of such interventions, but it is possible to make a start by applying behavioural science methods and models.
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“In line with the BCW intervention development tool, a first step in understanding which interventions are appropriate to generating behaviour change (in this context we refer to the change in or maintenance of social distancing behaviour) is to identify the COM factors that the intervention needs to target [10, 11].”
From Facilitators and barriers to social distancing for young people during the COVID-19 pandemic (2022) · cites this paper as [11]
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“The Behaviour Change Wheel (BCW) can be used as a guiding tool to support this [10, 11].”
From Facilitators and barriers to social distancing for young people during the COVID-19 pandemic (2022) · cites this paper as [11]
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“The survey items were guided by the COM-B model [10], to provide a theoretical framework a priori, and were deemed relevant given the applications of the model in relevant contexts [11].”
From Facilitators and barriers to social distancing for young people during the COVID-19 pandemic (2022) · cites this paper as [11]
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Kuo, C.-T., Yu, R.-R., & Kan, K.-H. (2025) · Personality and Individual Differences · doi:10.1016/j.paid.2025.113381 · Cited by 1
A simple message and two framings to enhance protective behaviours adoption in a pandemic
Braut, B., & Migheli, M. (2024) · International Review of Economics · doi:10.1007/s12232-024-00482-7 · Cited by 1
“Crucially, research in the field may also help to develop new patterns of behaviour in preparation for future pandemics (West et al. 2020; Van Bavel et al. 2020; Habersaat et al. 2020).”
InfluentialSong, Y., Xu, L., Liu, D., Feng, M., Yang, C., Jiang, Y., & Wu, Y. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1439749 · Cited by 2
“Throughout the pandemic, behavioral change has been central to mitigating the spread of COVID-19, with the stringency of policies significantly influencing public protective behaviors across countries (6, 7).”
Hanratty, J., Leonard, R. A., O'Connor, S. R., Keenan, C., Yuan, C., Ferguson, J., Axiaq, A., Volz, A., Welsh, C., Campbell, K., et al. (2024) · Campbell Systematic Reviews · doi:10.1002/cl2.1442 · Cited by 2
“With physical distancing being defined as, maintaining the recommended distance from others when physically present (West et al., 2020).”
BackgroundMethodInfluentialA Microsimulation Model of Behaviour Change Calibrated to Reversal Learning Data
Reyes, R. D., Keenan, H. L., & Zachreson, C. (2024) · Journal of Artificial Societies and Social Simulation · doi:10.18564/jasss.5637 · Cited by 1
“Despite such theories being used in designing and implementing nationwide public health policies and disaster preparedness and response strategies [2, 21, 29], they are rarely incorporated into models that are also developed to support decision making in those scenarios [31].”
Lower Elementary School Student Non-Locomotor Movement Profile During COVID-19 Pandemic
Melinda, C., Gumilar, A., & Nuryadi, N. (2023) · TEGAR: Journal of Teaching Physical Education in Elementary School · doi:10.17509/tegar.v6i2.56842 · Cited by 1
“Because the physical activity that is carried out educates students to align their behavior with prevention and con-trol measures at home, school, and in the community (West et al., 2020).”
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Wibowo, R. A., Hartarto, R. B., Bhattacharjee, A., Wardani, D. T. K., Sambodo, N. P., Utomo, P. S., Annisa, L., Hakim, M. S., Sofyana, M., & Dewi, F. S. T. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.960500 · Cited by 1
“Given that there was no vaccine or effective pharmaceutical treatment at that time, behavioral interventions promoting hand washing, physical distancing, and wearing a face mask were recommended to reduce the SARS-CoV-2 transmission (7, 8).”
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“This need is based on the idea that the most effective steps to reduce infection and death rates during the pandemic have been based on changes in individual behavior [2].”
Kikutani, M., Matsui, M., & Takiguchi, Y. (2023) · Vaccines · doi:10.3390/vaccines11010192 · Cited by 1
“The occurrence of behavior change was especially drastic during the early stages of the pandemic, brought about by strict restrictions on movement and inter-individual physical contact [2] and the implementations of various other prevention measures [3].”
BackgroundAzh, N., Najafimoghadam, T., Motamed-Gorji, N., Koohpayehzadeh, J., Asadi‐Lari, M., Tavakoli, N., Zahraei, S. M., Goshtae, M., Eshrati, B., Moghtadaei, M., et al. (2022) · Medical Journal of the Islamic Republic of Iran · doi:10.47176/mjiri.36.143 · Cited by 1
“Therefore, behavior change plays a major role in controlling the pandemic (10, 11).”
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Manzoor, S. A., & Alomari, A. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.904838 · Cited by 1
“Evidence suggests that behavioral science is pivotal to understanding the factors that encourage stakeholders to adopt behaviors that shape the progression of the outbreak (35).”
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“In this instance, anxiety is likely to prompt adherence to behavioural advice such washing hands and social distancing (West et al., 2020).”
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Gootjes, F. C., de Wit, J. B. F., de Ridder, D. T. D., Stok, F. M., Kroese, F. M., & de Bruin, M. (2025) · SSM - Population Health · doi:10.1016/j.ssmph.2025.101847
“The potential success of behavioral intervention can be harnessed by drawing on systematic approaches, such as the behavior change wheel (see Michie & West, 2021; West et al., 2020).”
InfluentialPeters, G.-J., Kwasnicka, D., ten Hoor, G. T., Crutzen, R., Varol, T., Warner, L., Algargoosh, M., Ali, E. E., Anwar, M., Asih, S., et al. (2025) · Behavior Research Methods · doi:10.3758/s13428-025-02743-x
“Given the crucial role of human behaviour in the spread of the virus (Perofsky et al., 2024; West et al., 2020), most countries introduced preventive measures that require behaviour change, including social distancing, wearing masks, and increasing the frequency of hand washing (Ingram et al.,…”
Alobaydullah, A., LaJoie, A. S., Thomas, S. D., Fumey, R., & Alsaleem, A. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1588931
“Without adequate medical technologies, health authorities resorted to controlling the pandemic through social and behavior change (6).”
InfluentialWesemael, T. V., Rocha, L. E. C., Alleman, T. W., & Baetens, J. M. (2026) · Journal of Medical Internet Research · doi:10.2196/87723
“Therefore, understanding public sentiment toward these measures is crucial for health informatics, as it can inform epidemiological models, guide public health communication strategies, and support evidence-based policymaking [6,7].”
Analysis of preventive behaviours related to covid-19 among colombian people
Salamanca-Camargo, Y., Aguirre-Dávila, E., Moreno-Vásquez, M., & López-Castillo, S. (2025) · Diversitas · doi:10.15332/22563067.10707
“Additionally, this implies the creation of scenarios for social support through norms and social rules in which protective behaviours are positively valued and become habitual (West et al., 2020).”
Meredith, L. S., Tobin, J., Cassells, A., Howell, K., Hernandez, H. G., Gidengil, C., Williamson, S., Dong, L., Timmins, G., Alvarado, G., et al. (2025) · Contemporary Clinical Trials · doi:10.1016/j.cct.2025.107848
Bacon, S., Lavoie, K., Buckeridge, D. L., Dietz, W. H., Freedland, K. E., Grimshaw, J., Jaworski, B. K., Laur, C. V., Marques, M. M., Michie, S., et al. (2024) · Annals of Behavioral Medicine · doi:10.1093/abm/kaae087
Self-citationBignardi, G., Ahmed, S. P., Bennett, M., Dunning, D. L., Griffiths, K., Leung, J. T., Sakhardande, A., Pi‐Sunyer, B. P., Kuyken, W., Dalgleish, T., et al. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e41403 · Cited by 1
“Many effective public health policies rely on voluntary adherence from the public [65].”
ten Hoor, G. A., Ruiter, R. A. C., & Kok, G. (2024) · Discover Social Science and Health · doi:10.1007/s44155-024-00111-2 · Cited by 2
“Reviews on behavior change methods or techniques to promote healthy behaviors in general, or specifically those in relation to COVID-19 prevention [37, 38] do not provide specific suggestions to reduce risk compensation.”
You Want to Foster Creative Behavior? Try Behavioral Sciences Models
Bonetto, É., Naczaj, D., & Arciszewski, T. (2024) · Creativity Theories – Research – Applications · doi:10.2478/ctra-2024-0006
Collette, T., Stevens, L., Robinson-Dooley, V., & Sterling, E. (2024) · Social Work in Public Health · doi:10.1080/19371918.2024.2381621
“According to the CDC, as of March 2024, almost 7 million (6,880,585) people have been hospitalized due to COVID-19, and 1, 184, 376 people have Before developing a vaccine, behavioral interventions were the recommended strategy to prevent transmission (West et al., 2020).”
Bandara, S., Dapat, C., Oishi, W., Tsinda, E. K., Saito, M., & Sano, D. (2024) · Science of the Total Environment · doi:10.1016/j.scitotenv.2024.175055
Verot, E., Chaux, R., Gagnaire, J., Bonjean, P., Gagneux-Brunon, A., Berthelot, P., Pelissier, C., Boulamail, B., Chauvin, F., Pozzetto, B., et al. (2024) · JMIR Public Health and Surveillance · doi:10.2196/47170
“As West et al [14] pointed out in May 2020, effective interventions are urgently needed to increase adherence of the general population to the proper implementation of health measures for protecting people individually and collectively.”
BackgroundPathology of life in the Coronavirus-stricken world: a re-analysis of Sadraean practical theology
Ganjvar, M., Sarmadi, N. A., & Jome, S. M. E. (2024) · Contemporary Islam · doi:10.1007/s11562-024-00557-w
Pre-service science teachers’ reflections on COVID-19 control and prevention measures
Matorevhu, A., & Madzamba, H. (2024) · Aquademia · doi:10.29333/aquademia/14330 · Cited by 1
“Thus it is important to understand human behavior and its role in controlling and preventing pandemic outbreak (West et al., 2020).”
Medidas sanitarias y evolución de las tendencias de casos confirmados de COVID-19, Ñuble, Chile
Sobarzo, A., Morales-Ojeda, I., Gutiérrez, E., Alarcón, M., & Gelabert, R. (2023) · Revista Chilena de Salud Pública · doi:10.5354/0719-5281.2023.72825
The Impact of Controlling Health Behavior on Awareness Levels to Limit the Spread of COVID-19
Alturif, G. A., & Al-Sanad, H. (2023) · Information Sciences Letters · doi:10.18576/isl/120648
“The study [34] found that isolation and social distancing can reduce virus transmission, but there is an urgent need for effective interventions to increase compliance with behaviors that protect individuals.”
BackgroundIndonesian Community Risk Perception of COVID-19 in 2022
Tejamaya, M., Putri, A., Nugroho, S. B., & Safhira, I. (2023) · The Indonesian Journal of Occupational Safety and Health · doi:10.20473/ijosh.v12i1si.2023.25-34
“Behavior change in the community plays a crucial role in reducing the transmission of the SARS-CoV-2 virus and preventing future pandemics (Betsch, Wieler and Habersaat, 2020; Seale et al ., 2020; West et al ., 2020).”
BackgroundFahmi, A. (2023) · Jurnal Psikologi Sosial · doi:10.7454/jps.2023.07
Supriyati, S., Putri, N. D., Darmawan, K., Suaidah, R., Yudhistira, P., Ismandhani, A. K., & Permatasari, E. (2023) · Jurnal Pengabdian dan Pengembangan Masyarakat · doi:10.22146/jp2m.68232
Amoroso, A., Pavão, C., Luke, R. E., McCoy, J., Richey, S., & Evans, S. (2022) · Journal of the Georgia Public Health Association · doi:10.20429/jgpha.2022.080206
“Although evidence-based, the recommendations did not meet APEASE criteria for a successful intervention (Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects and safety, Equity) (see Appendix A for a discussion of deficits) (West et al., 2020).”
BackgroundGonzález‐Olmo, M. J., de Diego, R. G., Delgado-Ramos, B., Romero‐Maroto, M., & Carrillo‐Diaz, M. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.864783
“As well as preventive hygienicmeasures, the implementation of lockdown in homes and the over-information of the mass media had an impact on physical health and in matters of a psycho-social nature and upon the economy (6, 10).”
BackgroundThe development of compliance behavioral imperatives in public for management of covid-19
Agarwal, M., Parsad, C., & Sharma, S. (2022) · Psychology, Health & Medicine · doi:10.1080/13548506.2022.2125164
“…and appropriate psychological and behavioural perspectives, government interventions can be successful; therefore, it’s essential to understand how people behave towards the required compliance measures to build coping strategies for handling such emergencies (Lau et al., 2010; West et al., 2020).”
BackgroundNguyen, H., & Tang, C.-W. (2022) · International Review of Research in Open and Distance Learning · doi:10.19173/irrodl.v23i3.6178
“Scholars have suggested benefits of applying the aforementioned behavioral change principles to motivate people toward desirable behavior to help control the COVID-19 pandemic (West et al., 2020).”
Hantira, N. Y., Abdelaziz, M. M., Demerdash, D. A. E., & Ahmed, H. A. E. (2022) · International Journal of Health Sciences · doi:10.53730/ijhs.v6ns5.11082
Fear during the Covid-19 Pandemic
Pascaru, M. (2022) · Bulletin of the Transilvania University of Braşov: Series VII: Social Sciences, Law · doi:10.31926/but.ssl.2022.15.64.1.2
“As West and colleagues once remarked, human behaviour „is central to transmission of SARS-Cov-2, the virus that causes COVID-19, and changing behaviour is crucial to preventing transmission in the absence of pharmaceutical interventions” (West et al., 2020, p. 451).”
BackgroundCorker, E., Altieri, E., Michie, S., & Adsett, E. (2022) · Qeios · doi:10.32388/sed5iq.3
Self-citationHewitt, R., Pattinson, R., Daniel, R., Carrier, J., Sanders, O., & Bundy, C. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-051575
Pérez-Bautista, Y. Y., Fernández-Vega, M., Gálvez, A. L. B., Erazo, L. R., Alfonso Urzúa, M., & Lugo-González, I. V. (2021) · Psicología Iberoamericana · doi:10.48102/pi.v29i3.334 · Cited by 1
Christofoletti, A. E. M., Fukushima, R. L. M., Fernandes, M., Nunes, H. F. P., Metzner, A., & Drigo, A. J. (2021) · Revista Brasileira de Atividade Física & Saúde · doi:10.12820/rbafs.26e0229
Embedding Covid-safe behaviours into everyday life through an enhanced risk management approachPreprint
Michie, S., & West, R. (2021) · Qeios · doi:10.32388/spl9qe
“Key individual behaviours that reduce Covid-19 transmission have been clearly identified.[8] Table 1 lists these behaviours.”
BackgroundSelf-citationRumahorbo, H., Priyanto, P., & Karjatin, A. (2021) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2021.6907
“Several studies have shown that wearing faces masks, washing hands, and physical distancing can prevent COVID-19 virus transmission [5], [7], [8] and are the main adaptive behaviors recommended to prevent the spread of infections [9], [10].”
BackgroundYang, G.-Y., Gerong, X., Wang, X., Zhang, J., Huang, X., & Liu, L.-Q. (2021) · doi:10.21203/rs.3.rs-355999/v1
Modelling infectious disease transmission potential as a function of human behaviourPreprint
Walters, C. E., Dunbar, M. B., Weston, D., & Hall, I. (2021) · medRxiv · doi:10.1101/2021.07.16.21260521
“Behaviour of individuals is a key driver of epidemic disease dynamics (Ferguson, 2007; Durham et al., 2012; Weston et al., 2018; Atchison et al., 2021; West et al., 2020), however behavioural theories are rarely mentioned within epidemiological model descriptions (Weston et al., 2018).”
BackgroundBerry, E., Jenkins, C., & Allen, S. (2021) · doi:10.31234/osf.io/yf6hk
“The survey 110 items were guided by the COM-B model [10], to provide a theoretical framework a priori, and were 111 deemed relevant given the applications of the model in relevant contexts [11].”
MethodZaccarelli-Marino, M. A., Balderi, T., Crepaldi, F., Alessi, R., & Martins, M. (2021) · Fortune Journal of Health Sciences · doi:10.21203/rs.3.rs-471704/v1
Corker, E., Altieri, E., & Michie, S. (2021) · Qeios · doi:10.32388/sed5iq
“Large scale behaviour change is required to reduce transmission (Schwarz & Stensaker, 2020; West et al., 2020).”
BackgroundSelf-citationArikan, I., & Demir, B. (2021) · Galician Medical Journal · doi:10.21802/gmj.2021.2.2
Senerat, A. M., Pope, Z., Rydell, S., Mullan, A. F., Roger, V., & Pereira, M. A. (2021) · medRxiv · doi:10.1101/2021.05.11.21256774
“, physical distancing, mask wear, hand/surface disinfection).(5-7) While these mitigation strategies may help reduce COVID-19 infection rates, unintended negative consequences on employees may arise (e.”
BackgroundInfluentialApplying Behavioral Science in Combating COVID-19 at the Workplace: A Narrative ReviewPreprint
Ahadzi, D. F., Owusu, H.-M., Otoo, J. E., & Akumah, E. E. (2021) · Preprints.org · doi:10.20944/preprints202104.0136.v1 · Cited by 1
“Not touching your T-zone at all is a behavior change that could prevent infection (Sawyer & White, 2015; West et al., 2020).”
BackgroundA Review on Prevention, Transmission and Symptoms of the Covid-19
Mohammadi, H., Ehteshaminia, Y., & Mahdavi, S. (2021) · doi:10.18502/tbsrj.v2i4.5468
“Importantly, this behavior should be put into serious consideration due to the lack of need for special equipment, (27).”
BackgroundSARS-COV-2 pandemic: the food insecurity and social inequalities in Brazil
Caetano, C. C. D. S., Oliveira, L., Nogueira, A., Pena, L. J., & della Lucia, C. D. (2020) · The Journal of the Food and Culture of the Americas · doi:10.35953/raca.v2i2.79
COVID-19 Related Behavioral Modification and Anxiety among Egyptian Adults: An Online Survey
Yacout, D. A. E. S. A., Sherbini, H. H. E., & Lassy, R. B. M. E. (2020) · Egyptian Journal of Health Care · doi:10.21608/ejhc.2020.145664
“It was guided and based on the COM-B Self-Evaluation Questionnaire, the COM-B Behavioral DiagnosisMichie et al., (2011), West et al. (2020) and recent and evident knowledge retrieved until time of constructing the form, from (CDC, WHO 2020) and available researches (Barker et al., 2016), (Mayne…”
MethodInfluential
Metadata
- Authors
- West, R., Michie, S., Rubin, G. J., & Amlôt, R.
- Affiliations
- University College London (GB)
- King's College London (GB)
- Public Health England (GB)
- Corresponding author
- West, Robert
- Venue
- Nature Human Behaviour
- Published
- 2020-05-06
- Volume
- 4
- Issue
- 5
- Pages
- 451-459
- ISSN
- 2397-3374 (ISSN-L)
- OpenAlex
- W3021447918
- Cited by
- 658
- References
- 0
- Citations by year
- 2026: 26 · 2025: 37 · 2024: 50 · 2023: 96 · 2022: 133 · 2021: 206 · 2020: 109
- FWCI
- 21.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Nature Human Behaviour (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health Research Health Protection Research Unit
- National Institute for Health and Care Research
- Department of Health and Social Care
- University of East Anglia
- King's College London
- Public Health England
- Topics
- Social Sciences › Sociology and Political Science › COVID-19 Prevention and Impact
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Keywords
- SARS-CoV-2 transmission, COVID-19 pandemic, behaviour change interventions, face masks, hand washing, social distancing, behavioral science, droplet transmission
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Communicable Disease Control, Disease Outbreaks, Hand Disinfection, Humans, Pneumonia, Viral, Quarantine, Health Behavior, Coronavirus, Coronavirus Infections, Disease Transmission, Infectious, Severe Acute Respiratory Syndrome, Pandemics, Hand Hygiene
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