Interventions to increase personal protective behaviours to limit the spread of respiratory viruses: A rapid evidence review and meta-analysis

Abstract

Purpose: Increasing personal protective behaviours is critical for stopping the spread of respiratory viruses, including SARS-CoV-2: We need evidence to inform how to achieve this. We aimed to synthesize evidence on interventions to increase six personal protective behaviours (e.g., hand hygiene, face mask use, maintaining physical distancing) to limit the spread of respiratory viruses.

Methods: We used best practice for rapid evidence reviews. We searched Ovid MEDLINE and Scopus. Studies conducted in adults or children with active or passive comparators were included. We extracted data on study design, intervention content, mode of delivery, population, setting, mechanism(s) of action, acceptability, practicability, effectiveness, affordability, spill-over effects, and equity impact. Study quality was assessed with Cochrane's risk-of-bias tool. A narrative synthesis and random-effects meta-analyses were conducted.

Results: We identified 39 studies conducted across 15 countries. Interventions targeted hand hygiene (n = 30) and/or face mask use (n = 12) and used two- or three-arm study designs with passive comparators. Interventions were typically delivered face-to-face and included a median of three behaviour change techniques. The quality of included studies was low. Interventions to increase hand hygiene (k = 6) had a medium, positive effect (d = .62, 95% CI = 0.43-0.80, p < .001, I² = 81.2%). Interventions targeting face mask use (k = 4) had mixed results, with an imprecise pooled estimate (OR = 4.14, 95% CI = 1.24-13.79, p < .001, I² = 89.67%). Between-study heterogeneity was high.

Conclusions: We found low-quality evidence for positive effects of interventions targeting hand hygiene, with unclear results for interventions targeting face mask use. There was a lack of evidence for most behaviours of interest within this review.

Keywords: COVID-19; SARS-CoV-2; behaviour change; intervention; personal protective behaviours; rapid review.

Figure 1

Map of personal protective behaviours relevant for blocking transmission of respiratory viruses, including SARS‐CoV‐2: hand washing and use of hand sanitizers; avoiding touching the ‘T‐Zone’; catching droplets in tissues and discarding these; face mask use; disinfecting surfaces; and maintaining physical distancing. Reproduced with permission from the authors (West & Michie, 2020).

Figure 2

PRISMA flow chart of included studies.

Figure 3

Frequencies of behaviour change techniques (BCTs) coded in published intervention descriptions.

Figure 4

Proportions of reported effects (i.e., positive, negative, no difference, or indeterminate) of interventions targeting hand hygiene behaviours and face mask use.

Figure 5

Forest plot for the standardized mean difference (d) in the frequency of hand hygiene behaviour in intervention and control or pre‐ and post‐study comparisons. The comparison in Chan (Chan et al., 2007) pertains to a pre‐ and post‐study comparison; the remaining studies were two‐ or three‐arm RCTs.

Figure 6

Forest plot for the odds of compliance with face mask use in intervention compared with control arms. The comparison in MacIntyre (MacIntyre et al., 2009) pertains to the surgical mask (intervention) vs. the P2 mask arm (control) at the longest point of follow‐up.