Examining the application of behaviour change theories in the context of infectious disease outbreaks and emergency response: a review of reviews

BACKGROUND: Behavioural science can play a critical role in combatting the effects of an infectious disease outbreak or public health emergency, such as the COVID-19 pandemic. The current paper presents a synthesis of review literature discussing the application of behaviour change theories within an infectious disease and emergency response context, with a view to informing infectious disease modelling, research and public health practice. METHODS: A scoping review procedure was adopted for the searches. Searches were run on PubMed, PsychInfo and Medline with search terms covering four major categories: behaviour, emergency response (e.g., infectious disease, preparedness, mass emergency), theoretical models, and reviews. Three further top-up reviews was also conducted using Google Scholar. Papers were included if they presented a review of theoretical models as applied to understanding preventative health behaviours in the context of emergency preparedness and response, and/or infectious disease outbreaks. RESULTS: Thirteen papers were included in the final synthesis. Across the reviews, several theories of behaviour change were identified as more commonly cited within this context, specifically, Health Belief Model, Theory of Planned Behaviour, and Protection Motivation Theory, with support (although not universal) for their effectiveness in this context. Furthermore, the application of these theories in previous primary research within this context was found to be patchy, and so further work is required to systematically incorporate and test behaviour change models within public health emergency research and interventions. CONCLUSION: Overall, this review identifies a range of more commonly applied theories with broad support for their use within an infectious disease and emergency response context. The Discussion section details several key recommendations to help researchers, practitioners, and infectious disease modellers to incorporate these theories into their work. Specifically, researchers and practitioners should base future research and practice on a systematic application of theories, beginning with those reported herein. Furthermore, infectious disease modellers should consult the theories reported herein to ensure that the full range of relevant constructs (cognitive, emotional and social) are incorporated into their models. In all cases, consultation with behavioural scientists throughout these processes is strongly recommended to ensure the appropriate application of theory.