Table 1 Models of behaviour focusing on different motivational processes

From: Applying principles of behaviour change to reduce SARS-CoV-2 transmission

ModelBrief summaryExamples of insights relevant to behaviours to limit transmission of SARS-CoV-2
PRIME theory33Behaviour at any one moment results from the strongest of potentially competing impulses and inhibitions operating at that moment. These are driven by habit and instinct processes as well as by feelings of want or need. Wants and needs in turn are driven by emotions and drive processes as well as by evaluations. Evaluations are driven by judgement processes, wants and needs and plans. Plans are created by judgement processes and enacted when they are recalled and when they generate sufficiently strong wants and needs, and then generate impulses or inhibitions to overcome others that are being generated by the immediate situation. Identity and modelling play an important role in the whole motivational system.Messaging to the public should aim to create a strongly felt ‘need’ to engage in protective behaviours rather than just a belief that one ‘should’ do them. People should be supported to develop plans that are specific and strongly linked to identity through development of personal rules (for example, always washing hands when entering one’s home). Interventions should recognise the balance of impulses and inhibitions at key moments, and promote development of habits that come into play when needed. Educational materials should include modelling of desired behaviours.
Prospect theory of judgement and decision-making; judgement heuristics38Focuses on evaluations: We make decisions based on comparison of the positive and negative consequences of options under consideration, weighted by the subjective likelihood of those consequences occurring. Our evaluations and subjective likelihoods are subject to important biases, including (i) overweighting negative outcomes compared with positive ones, (ii) overweighting certainty compared with near certainty, (iii) underweighting numerical differences in value against a background of large numbers compared with small numbers and (iv) judging outcomes to be more likely if they are more readily imagined.Interventions need to ensure that perceived benefits of protective actions outweigh the costs, and support should be provided to mitigate the costs. Benefits should be framed in terms of certainties and avoidance of negative outcomes, and they should be made readily imaginable.
Conflict theory of decision making49Focuses on evaluations and plans: Our decision-making processes are radically altered by the conditions under which the decision takes place, and particularly the degree of stress involved. ‘Vigilant decision-making’, the optimal mode, gives way to suboptimal modes of decision-making under defined conditions: (i) unconflicted inertia when the risks of inaction are not judged to be serious, (ii) unconflicted change when risks of action are seen as minimal, (iii) defensive avoidance when there seems little hope of avoiding negative outcomes, and (iv) hypervigilance when there is strong time pressure and some hope of finding a solution. Following the decision, suboptimal modes of decision-making lead to defective strategies for coping with negative outcomes, whether or not these were avoidable.Messaging and support should create ‘concern’ that motivates action rather than anxiety that could lead to defensive avoidance. This involves providing a clear indication of practical and realistic steps that can be taken to address the risk with a strong sense that these will work.
Cognitive dissonance theory50Focuses on evaluations: We experience negative emotions when we notice that we have beliefs that conflict with each other, and we feel a need to reduce these by changing our beliefs, suppressing them or adding new beliefs.Messaging to the public should aim to heighten dissonance linked to nonadherence, and it should aim to prevent people engaging in ‘exceptionalism’, where they add beliefs about their situation being a special case that means they do not have to adhere.
Temporal discounting51Focuses on evaluations: When making decisions, we undervalue outcomes to a greater extent the further they are expected to occur in the future. People differ with regard to the shape of the temporal discounting curve, with people who are susceptible to impulse control problems tending to have steeper discounting functions.Communications promoting protective behaviours should aim to bring the benefits into people’s immediate time horizon, and any use of incentives and or punishments should focus on creating immediate contingencies.
Social norm theory40Focuses on evaluations and wants and needs: People adopt values, motives and behaviours that they perceive as normative within groups with which they identify.Interventions, including communications, should maximise the visibility and approval of desired behaviours and should minimise the visibility of undesired ones by groups with which the target groups identify.
Operant learning theory39Focuses on wants and needs and impulses: Through a process of associative learning, we learn to want to enact, and experience impulses to engage in, behaviours that are contingently followed by positive emotional experiences or relief from unpleasant ones or from drive states, even when we are not consciously aware of the associations.Social rewards, for example, through praise, should be liberally used to maintain desired behaviours, and people should be encouraged to support each other in this way. Where sanctions are used, it is important for these to be consistently applied.
Habit theory44Focuses on impulses: Repetition of behaviours in a given context results in those behaviours becoming increasingly automatized, occurring without conscious thought.Resources supporting protective behaviours should help people to identify and train the required habits, including habits that conflict with behaviours one is attempting to prevent.
Five-factor theory of personality52Covers all motivational processes: People range along five broad continua in terms of emotional reactions, wants and needs, and ways of thinking: (i) extraversion–introversion, with extraverts tending to find social stimuli more rewarding, (ii) stability–neuroticism, with more stable people tending to feel less anxious and threatened by events, (iii) openness versus closed-mindedness, with open-minded people tending to be curious and independent thinkers, (iv) conscientiousness–carelessness, with conscientious people being more thorough and careful and less impulsive, and (v) agreeableness–disagreeableness, with more agreeable people tending to be helpful, trusting and empathetic.Messaging, regulatory and enabling interventions should recognise individual differences in factors influencing protective behaviours; for example, some people will require more stringent measures than others, and level of concern will need to be raised for some people while anxiety will need to be reduced for others.