Evidence-based Intervention Design for Behaviour Change during a Health Emergency

A toolkit based upon the COM-B model and Behaviour Change Wheel


As vaccine availability has increased in much of the world, challenges remain related to acceptance and uptake of COVID-19 vaccines, further compounded by global inequities in vaccine access and the emergence of new variants. As such, non-pharmaceutical interventions (NPIs) continue to be an important tool in slowing and preventing the spread of SARS-CoV-2. 
This series of rapid evidence assessments (REA), using the COM-B model as a theoretical framework, sought to understand the existing evidence about who delays or refuses COVID-19 vaccination and who does not adhere to NPI measures, why and in what contexts. The objective is to inform tailored policies and interventions that support vaccination acceptance and adoption of recommended NPI measures, drawing in the COM-B Behaviour Change Wheel. 

Demographics did not consistently predict non-adherence to protective behaviours during the COVID-19 pandemic. In terms of psychological capability, people with less COVID-19 knowledge are more likely to delay or refuse vaccination and not adhere to social distancing. In terms of social opportunities, people who perceive less social normative pressure to engage in protective behaviours are more likely to not adhere to social distancing and mask wearing recommendations. In terms of reflective motivations, people who perceive the protective behaviour to be less effective are more likely to delay or refuse vaccination and avoid mask wearing; people who perceive themselves to have less control over protective behaviours are less likely to adopt social distancing and mask wearing behaviours; and people who perceive themselves to be less susceptible to catching COVID-19 are more likely to avoid or refuse vaccination and to not adhere to mask wearing recommendations.
The series of REAs was used to develop an evidence-informed practical toolkit for policy makers and practitioners to inform decision making around future efforts to promote uptake and maintenance of some or all recommended NPIs to mitigate the spread of outbreaks of transmissible respiratory diseases, including potential new and emerging pandemic threats.   

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UNICEF Innocenti
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