The programme, called Keeping Wales Safe: Covid Behaviours, involved the partnership helping three teams based in Welsh Local Authorities to pilot interventions in their area. At the outset of this work in the summer of 2021, Y Lab conducted an evidence review. It was designed to be used as a tool to help contextualise the challenge for the teams, and inform the overall approach of the programme
What we did
Purpose - to underpin programme design, provide teams with insights into Covid behaviours and to inform the design of interventions to minimise risk.
Reviewed - existing research, published and unpublished, on the themes of self-isolation and avoiding risky behaviour around Covid-19.
Research - at the time research focused on top-level government interventions, pharmaceutical and non pharmaceutical, with little on the place-based, tailored intervention envisaged in this programme which are designed to support higher risk groups.
Many themes noted in the review were echoed as teams tested their interventions with target groups on the ground in real time, and again in the Predictiv national trial.
Many of the themes uncovered by the evidence review underpin the key learning that’s emerged from the programme.
What we found
Thinking about risk - Different groups develop different mental maps of risk, formed by both psychological and structural influences and life experiences. Structural as well as behavioural aspects of risk create their own barriers to risk reduction. We wanted teams to think about transmission risk as cumulative, so that disaggregating the various barriers into specific behaviours would help them design interventions that could effectively target key behaviours.
Existing research - Evidence from existing research suggested how simple interventions can have an impact. Developing an understanding of people’s engagement with eliminating Covid-19 and the specific measures to do that can yield useful insights into how to communicate with them to change their behaviour.
The review revealed a real gap in understanding the impact of more bespoke approaches, particularly around communications with those higher risk groups, for example younger men, people working in precarious or low-paid employment.
Research has used varied methods and wasn’t necessarily comparable. Mathematical models of macro-level interventions and self-report surveys were much more common than empirical work on interventions at the scale envisaged by the programme.
Importance of evaluation - Interventions should be designed carefully and robust evaluation built in as part of the design.
Shift to guidelines - The programme would play out in a different context to the research we found. As responsibility passes to the public, the stake in having an input into behavioural change is set to increase.
Teams used the evidence review to evaluate local context and build their own insights into Covid behaviours using BI tools and techniques and PPR approaches.
How it informed the programme
What increases risk - Groups emerge from the statistical data as being at high risk for transmission and/or for low adherence (to vaccination, self-isolation, social distancing, etc.), by engaging in risky behaviours, often in risky places, while doing risky occupations, or combinations of these.
We found that these groups are typically younger (especially men); people working in precarious and/or low-paid employment; living in more crowded conditions; and some ethnic minority communities. However, we also acknowledge that there are other groups that do not engage with public health practices for other reasons (cultural and social).
A diagram developed by Y Lab to help the teams identify categories of risk and priorities of engagement with it.
The explanations for non-adherence in the literature fall into two camps; ‘structural’ e.g. financial reasons and ‘psychological’, i.e. to do with the way they see themselves and society.