Table 2 Behaviours required to limit SARS-CoV-2 transmission and what is required for these to be enacted

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

BehaviourCapabilityOpportunityMotivation
Only cough or sneeze into tissues and safely dispose of theseAbility to hold a cough or sneeze until a tissue has been brought out or to stifle it altogether. Knowledge of how to handle tissues and dispose of them safely and quickly. Could prove extremely difficult to contain droplets within the tissue without leakage and involvement of the hand.There must be tissues readily available when needed. This will require preparatory actions, including remembering to carry tissues at all times. There also needs to be facilities for disposing of tissues safely. Stronger norms and organisational rules could be important to support the behaviour.People must feel a need to do it, and self-train the behaviour so that it becomes habitual.
Wear face masks as appropriateUnderstanding what kinds of masks to use, when to use them, how to use them and how to safely dispose of them or disinfect them. Developing techniques for taking them off without causing contamination.Availability of suitable masks or facilities for making them; ready availability of facilities for safe disposal or decontamination of masks.Countering motivation to use masks in ways that are counterproductive, including touching them and slipping them down to speak to people or scratch an itch. Establishing strong routines around safe removal and disposal of masks. Preventing feelings of false reassurance leading to neglect of other personal protective behaviours.
Maintain physical distanceUnderstanding the importance of this and developing ways of achieving it in challenging situations, for example, in the home where isolation is required.Spatial layouts in areas such as shops where contact is likely. Rules and procedures that allow physical distance to be maintained (for example, maximum number of people in a shop). Stronger norms could be important to support the behaviour including social rules about contactless greeting.People must feel a need to do it at all times, even when it comes into conflict with other motives such as wanting to socialise or not wanting to appear rude.
Wash or disinfect hands under defined conditionsKnowledge of effective hand-washing or disinfectant techniques and the specific conditions when this should occur. Knowledge of what is an effective hand sanitiser. Understanding the importance of using moisturiser to protect hands.Availability of soap and washing facilities or effective hand sanitiser at all times when required. Availability of moisturiser to protect hands from increased exposure to soap. Stronger norms could be important to support the behaviour.People must feel a need to do it in all the situations where it is required and must prioritise it at the time required. For certain situations, for example, entering the home, the behaviour needs to be self-trained so that it becomes habitual.
Disinfect surfaces and objectsUnderstanding the importance of this, what kinds of disinfectant are effective and how to do it effectively in a way that minimises risk of recontamination. Knowledge of specific situations when this must be done.Ready access to effective disinfectant and appropriate cloths. Enough time to be able to do it whenever required. Ready availability of gloves to protect hands from increased exposure to cleaning liquid.People must feel a need to do it whenever required, even when it gets in the way of other activities.
Do not touch the T-zone unless one has just thoroughly washed one’s handsUnderstanding the importance of this and developing methods for stopping oneself doing it (for example, focusing on keeping hands below shoulder level).Nothing is required, but access to aids such as mobile apps and devices to create physical barriers may be helpful. It could important to develop norms around not face-touching in public.People must feel a very strong need to prevent themselves touching their T-zone to overcome the powerful habitual and sensory factors driving it. They need to retrain habits to block or divert the act and to find ways to bring the action to conscious awareness at all times. They need to find ways of resisting the urge to touch the face in response to itches (for example, using distraction).
Social distancing (staying at home except under specifically defined circumstances)Understanding the importance of this and ways of mitigating the adverse consequences, both physical and psychological. Understanding the precise circumstances in which people can leave their home and where they can go.Availability of services and resources to maintain livelihood and physical and mental health. Access to safe facilities for shopping and exercise on the occasions when these are permitted. Access to home-based leisure facilities and ways of carrying on working that do not require going out. Organisational rules that permit working at home or time off.People must feel a very strong need to stay at home and obey social distancing rules, and this must be stronger at all times than the want or need to socialise, earn money or pursue usual activities.
Isolation of people who have symptoms or who are highly vulnerableUnderstanding the importance of this and ways of achieving it tailored to the specific household and family circumstances. Understanding ways of mitigating the adverse psychological effects.Access to space and physical domestic arrangements that make this possible. Access to services and resources to maintain physical and mental health. Access to home-based leisure facilities and ways of carrying on working that can be undertaken in isolation.People must feel a need to maintain isolation in the face of practical and emotional barriers, develop new habits to sustain the behaviour and be motivated to find ways to overcome specific challenges that occur from time to time.