Social Influence in a Pandemic

As social distancing and preventative measures are eased in the U.S., the CDC finds that 1 in 4 adults feel comfortable lifting these safeguards. While the majority of Americans remain more diligent in their adherence to coronavirus precautions, the behavior of the remaining 25% of the population will pose an increasing threat to healthcare resources. This dichotomy in behavior poses a familiar challenge to healthcare providers and leaders – non-compliance.

Healthcare providers have long struggled with issues related to compliance with medication usage, dietary and physical fitness goals, and early detection and treatment. The presence of a significant portion of the population that is non-compliant in their pandemic precautions is not a surprising development. 

As we understand and address the 1 in 4 adults who have chosen to minimize their reliance on preventive measures in the midst of a pandemic, guidance can be drawn from the science of persuasion that has been effectively deployed in changing attitudes toward smoking, exercise, nutrition, and preventive care.

Principles of Social Influence

By applying the principles of social influence, I find evidence and application of the below six principles related to social distancing, mask use, and other preventative measures recommended to curb the spread of the coronavirus.

1.    Scarcity: In the face of scarcity, people tend to overvalue the scarce item. When lock-down orders and quarantines are in place over many months, we see an over-valuation of the ability to shop, dine, and socialize. This overvalue tends to lessen the perceived risk level of these activities in exchange for the freedom of mobility.

2.    Authority: Opinions and convictions are more firmly held by an individual when the belief is shared by a person they perceive to be in authority. Whether or not an individual adheres to social distancing or wears a mask is a reflection of the authority they deem to medical experts, politicians, celebrities or other influential leaders who share their position.

3.    Social Proof: People tend to replicate the behavior of those they identify as having similar beliefs or circumstances. As neighbors begin to socialize, as families reunite, as the workplace reopens, individuals will likely adopt the social distancing practices of those around them.

4.    Liking: People tend to say “yes” more easily and adopt the practices of those people for which they have a natural fondness. Some individuals will find it difficult to say “no” to invitations to socialize with friends.

5.    Reciprocity: People generally feel obligated to repay in kind. If a person is wearing a mask and engages in conversation with someone not wearing a mask, the mask-wearer may feel obligated to remove their mask as a sign of trust.

6.    Consistency: Individuals feel compelled to maintain a strong conviction expressed publically. If a person has been adamant that the pandemic is a hyper-inflated fear created by media reports, government officials, or medical experts, they will tend to maintain that stance, even in the face of information to the contrary.

Application by Healthcare Leaders and Providers

By understanding these six principles of social influence, healthcare leaders and providers may lessen the non-compliance related to pandemic counter-measures. To achieve optimal levels of compliance, individuals must have the ability and motivation to adopt preventive measures.

The ability to adopt safeguards is certainly constrained when individuals suffer from socio-economic factors that restrict the availability of clean water, soap, face masks, adequate housing, workplace space, or other influences that restrict the ability of a person to adopt preventative measures. These factors are outside the scope of this article but are important to the overall preventative strategy that must be considered by healthcare leaders.

The call-to-action for healthcare decision-makers and providers is to consider the six principles of social influence when creating a pandemic response for their local communities. The following applications are suggested:

1.    Scarcity: The overvalue of mobility and personal interaction has caused individuals to minimize the risk. Communication and education that identify the variability of risk between venues (i.e. attending a concert versus a neighbor’s backyard BBQ) can be helpful to offset the overvaluing of mobility and interaction. Additionally, education related to the treatment of the coronavirus (i.e. what is involved in the use of a ventilator in the treatment protocol) may balance the risk decisions.

2.    Authority: When developing communication, marketing, and education strategies, use medical experts, recovering patients, and community influencers in the delivery of the message. Highlight the credentials of experts, the story of patient struggles, and the identity of influencers to establish the authority of the messenger. Provide time and training for caretakers and providers, who are often seen in positions of authority, to reinforce compliance among patients.

3.    Social Proof: Use identifiable role models to deliver positive messages of compliance to secure social comparability. Highlight positive examples of average people who were once skeptics and have now adopted compliant practices.

4.    Liking: Train providers to leverage positive relationships to influence social compliance among their patients and the patient's circle of influence. Well-liked providers have the ability to ask patients and community members to adhere to safety guidelines and to encourage others to do so as well.

5.    Reciprocity: Give recognition and affirmation to examples of compliance. Equip compliant individuals to have meaningful discussions in their community that explains why they wear a mask when others do not or why they remain on a stay-at-home status.

6.    Consistency: Remind individuals they have the right to change their position from non-compliant to compliant behavior. Ask the non-compliant to become an opinion leader among others who are non-compliant to change their position. Provide compliant supporters with accessible and understandable information to advocate for safety in their community.

Healthcare leaders and providers must address not only the clinical challenges of a pandemic but also share the burden of advocating for compliance. As participants in the delivery of healthcare, we have a special responsibility regarding the safety of our community. As part of the overall effort to flatten the coronavirus curve, it is imperative that we employ creativity, expertise, and resiliency in the pursuit of safe behaviors. By understanding the principles of social influence, we are able to understand the mindset from which compliance and non-compliance emerge and seek to influence beliefs and behaviors.

Rod Brace, Ph.D. is a founding partner at Relia Healthcare Advisors.