What will it take for face coverings to achieve wide acceptance?
Masks must be grounded in social and cultural realities of affected communities
A Dublin shopper wearing a face covering. Photograph: Tom Honan
The novel coronavirus is with us six months. It feels longer, such is the uncertainty around Covid-19. And with its recent resurgence, any sense of summer optimism has evaporated.
Less than firm political leadership hasn’t helped. Mixed messages, inconsistently transmitted by politicians, frustrate healthcare professionals. Senior politicians who blatantly ignore stringent guidelines, as well as creating an “us and them” divide, make it a lot easier for others to jump from the collective train of prevention.
The reality of Covid-19, in the absence of a vaccine, is less about the cutting edge of medicine and more about doggedly following public health advice: physical distancing, practising hand hygiene and the use of face coverings are monotonous, unsexy and repetitive. But they work. What we need most of all at this juncture is a community-wide recommitment to public health guidelines.
As the risk of fracture lines – young versus old, rural versus urban – becoming permanent increases, we need to acknowledge what has happened and put strategies in place to deal with the new reality.
Rule-breaking is not a new phenomenon. According to Reuters Health, behavioural scientists say it is being exacerbated in the coronavirus pandemic by cultural, demographic and psychological factors.
A key factor is individualism versus collectivism. Individualism is about expressing your sense of identity and who you are. People in individualist cultures tend to reject rules and ignore attempts by public health authorities to “nudge” behaviour change with risk messages or appeals for altruism. In response to the message that wearing a mask will help protect others, individualists simply shrug their shoulders. Whereas in cultures dominated by collectivism, people are more likely to do what’s best for the group.
Trust, fear and other instincts are significant influences on human behaviour. In societies with more political division, people are less likely to trust advice from one side or the other. The balance between optimism and fear is crucial: a little of both can be positive, but too much of either can be damaging.
We need public information campaigns that reframe all elements of coronavirus public health advice
Social distancing is possibly the most difficult advice to adhere to. As social animals our bodies and brains are designed for connection. This is one of the reasons why local outbreaks are often linked to pubs and house parties. And faced with a collective problem such as coronavirus, if we all break the rules just a bit, the effect is similar to most of the population not following the guidelines at all.
Writing in the British Medical Journal, Helene-Mari van der Westhuizen and colleagues at the University of Oxford say that in order to be widely accepted, face coverings need to be grounded in the social and cultural realities of affected communities. If we encourage the public to see face masks as a social practice, which they can use to express their cultural background or their personality rather than a medical necessity, this will encourage use and diminish resistance, the authors say. The view of face masks as a medical intervention has persisted in public health messaging about the use of face coverings. This includes emphasising medial narratives about “donning and doffing” (putting on a face covering in a certain way), “decontamination” (how to clean it) and “risk” (not touching certain parts of it).
“Wearing face coverings is being rapidly introduced as a public health intervention in countries with no cultural tradition of doing so,” they write. “For successful uptake, such interventions need to be grounded in the social and cultural practices and realities of affected communities, and campaigns should not only inform, but also work to shape new sociocultural norms.”
And therein lies the key to our current impasse. We need public information campaigns that reframe all elements of coronavirus public health advice. Preferably campaigns that are innovative, work across different media platforms, and it has to be said, are as “politician lite” as possible.