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Lookup NU author(s): Dr Nick Meader
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© The Author(s) 2025. Background: Clear communication is essential for the effective uptake of public health interventions promoting protective behaviours for respiratory infection control. The emergence of novel infectious diseases, particularly the COVID-19 pandemic, has highlighted the need for rapid adaptation of established and new behavioural practices. However, there remains limited knowledge concerning effective strategies for disseminating risk-reduction information and predicting population responses. Methods: This systematic review and meta-analysis (PROSPERO: CRD42020198874) assessed the effectiveness of these interventions using behavioural science frameworks, including MINDSPACE contextual influencers and behaviour change techniques (BCTs), to identify key components and mechanisms of action (MoAs). Twenty-four full-text articles, comprising 36 randomised controlled trials (RCTs) across 11 countries, were included via electronic databases (MEDLINE, EMBASE, PsycINFO, Scopus) and other sources (grey literature, Google Scholar, and reference lists) searched to March 2022. Results: Here, we show that interventions mainly target social distancing, mask wearing, hand washing, and various behavioural intentions and actual behaviours, using a median of three-arm study designs with passive comparators. Interventions include a median of two contextual influencers and four BCTs. Behaviour intention is the most frequently applied mechanism of action. Study quality is moderate. Narrative synthesis of 16 full-texts (26 RCTs) shows significant effects, while network meta-analysis of 16 full-texts (21 RCTs) indicates that prosocial messages, particularly those referencing loved ones, are effective in reducing the risk of respiratory infections (d = 0.09; 95% CrI=0.06–0.14; CINeMA: Low). Conclusions: Although further research is needed, the review provides insight into designing public health messages that effectively improve protective behaviours for respiratory infection control.
Author(s): Grimani A, Antonopoulou V, Meader N, Bonell C, Michie S, Kelly MP, Vlaev I
Publication type: Article
Publication status: Published
Journal: Communications Medicine
Year: 2026
Volume: 6
Print publication date: 20/01/2026
Online publication date: 24/12/2025
Acceptance date: 01/12/2025
Date deposited: 02/02/2026
ISSN (electronic): 2730-664X
Publisher: Springer Nature
URL: https://doi.org/10.1038/s43856-025-01296-6
DOI: 10.1038/s43856-025-01296-6
Data Access Statement: This systematic review and meta-analysis is based on data extracted from publicly available studies. The authors declare that the data supporting the findings of this study are available within the paper, its supplementary information file and supplementary data files. The characteristics of all included studies are provided in Supplementary Data 2 and 3. The source data for Fig. 1 (PRISMA flow chart) can be found in the Supplementary Information. The source data for Figs. 2 and 3 (ERs of MINDSPACE contextual influencers and behaviour change techniques, respectively) can be found in Supplementary Data 5. The source data for Fig. 4 (risk of bias) can be found in Supplementary Data 4. The source data for Table 1 (network meta-analysis) can be found in Supplementary Data 6. The source data for Tables 2 and 3 (CNMA of MINDSPACE contextual influencers and behaviour change techniques, respectively) can be found in Supplementary Data 6.
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