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Persuading the public to take protective measures in the pandemic

Stanford Medicine's Recover, Restore and Re-open website offers guidance from physicians and scientists on living and working during a pandemic.

Soon after the COVID-19 pandemic struck, experts at Stanford Medicine realized that organizations and communities -- along with individuals -- would need scientifically based guidance to help them navigate the health crisis and eventually return to normal.

They created a framework, known as Recover, Restore and Re-open, or R3, to provide information and insights for government agencies, health care organizations and other institutions. The collection of resources represents a culmination of lessons learned while delivering patient care, conducting research and forming policy recommendations over the course of the pandemic.

"Our experts' immediate and steadfast response to the pandemic has built a valuable resource that we feel is imperative to share with the broader community," Priya Singh, chief strategy officer and senior associate dean for strategy and communications at Stanford Medicine, said in a Stanford Medicine article about the effort. "We see the R3 framework as a collection of resources that community members -- whether you're from academia, industry or government, or you're an individual -- can use to inform and guide how they adapt to the uncertainties wrought by COVID-19."

One facet of R3 covers how to convince millions of people to drastically change their behavior, a challenging, though essential, aspect of limiting the virus's spread.

Douglas Owens, MD, professor of medicine and director of the Center for Health Policy, and Jason Wang, MD, PhD, associate professor of pediatrics and of medicine, discussed strategies in a Q&A.

This is a condensed version of their conversation.

What has to be accomplished to see broad adherence to public safety measures?

Wang: We have to build slowly, based on cultural context, some sort of a social solidarity -- the idea that we have to fight this virus together. We have to support people. If you ask essential workers to stay home and they need to make a living, you need to support them. Or if they go to work, they must have somebody to take care of their kids.

What makes a difference to people as they decide what protective actions to take, according to research?

Wang: Adherence really depends on the social circumstances of that person. If people are essential workers -- if they need to go out and work, go to the grocery store, things like that -- they are less likely to completely observe social distance measures.

Owens: It was probably easier to achieve adherence early on, but maintenance of these behaviors can be very hard. Things that people consider nonessential for a month might not be nonessential for six months. One of the big challenges is figuring out how to maintain these behaviors over long periods of time.

How important is it that messaging be consistent?

Owens: The United States has had many challenges with public health messaging during this pandemic. Different parts of the government haven't been on the same page, so people haven't been getting a single message.

In one county, you might be able to have hair salons open, but then in a neighboring county, you can't. It makes people wonder what to think about the virus.

There are also many different cultural contexts to consider. In Santa Clara County, for example, you have people with very different health beliefs and very different understandings. You also have a complex problem of trying to reach people in five or 10 different languages.

What can officials do when new evidence makes it necessary to change their public health messaging?

Wang: If you must change recommendations, you give the rationale and you help regular citizens understand why you changed course. There's a lot that we don't know about the virus, and we have to be humble and be ready to change practice when new evidence emerges.

How can public health strategies convince people to comply?

Wang: We need to be persistent in the messaging and to be creative in the way we do it. For example, a study from Temple University asked people to rate how attractive somebody is wearing a mask and not wearing a mask; they found that people tend to rate wearing the mask as more attractive. You could say, "Most people believe you're more attractive when you wear a mask."

Self-efficacy is also important -- making sure that people feel like they're not powerless. That makes them more likely to take action.

Have other countries used stricter measures than the United States?

Wang: In many Asian countries, they monitor you. For example, I was in Taiwan, and during the 14-day quarantine period, they monitored me with my cellular signals.

When you have something like that, people can feel restricted. They counteracted that strategy by offering to bring people food and bring them masks. They also pay you during the quarantine -- $33 a day. Maybe I think it's not worth my time, but my teenage daughters loved it.

Photo by THPStock

Recover, Restore and Reopen -- or R3 -- is a framework developed by experts at Stanford Medicine to provide scientifically based guidance for communities and organizations as they navigate the COVID-19 pandemic.

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