COHERE phase 2: Living systematic reviews and evidence and gap map on determinants of COVID-19 Health Related Behaviour

Lead Research Organisation: Queen's University Belfast
Department Name: Sch of Behavioural Sciences


Health-protective behaviours, like washing your hands, wearing a facemask and social distancing, can help to protect people from contracting or transmitting COVID and other similar serious respiratory infections. This project aims to help us understand more about the factors that influence these behaviours in the general public. This project represents the second phase of our research.
In phase one we conducted a rapid review of published studies that looked at the things that influenced uptake of these protective behaviours during COVID or during previous outbreaks of similar serious respiratory infections, for example SARS, MERS and H1N1 (swine flu). We quickly put the results of these studies together to understand what influences people's health protective behaviours. By putting the data from different studies together in a new analysis, a meta-analysis, we were also able to find out how strong these relationships are. Finally we assessed the quality of the studies we found so that we know how confident we can be that the evidence we have is good enough to support our conclusions.
We completed the first phase quickly to provide answers to urgent questions about COVID. Working quickly meant that we only had time to look for published, peer-reviewed studies and not all the studies conducted that hadn't yet been published in scientific journals. As well as that, there has been a very large increase in the number of potentially relevant studies conducted in the context of COVID-19 over the last nine months, since we last searched for studies. In phase two, we are going to repeat this process of finding and putting evidence together but this time we have more time and resources to search more thoroughly.
To begin with, we will publish an open access 'evidence and gap map' that will contain information on all of the studies we have already found (in phase 1). This will be open to anyone to use and allow other researchers, policy makers and those who fund research to see what evidence we already know about and where the gaps in our knowledge are. The next step will be to do a thorough search for any new studies and any unpublished work that we didn't find in phase 1. We will then check every study we find to see if it can tell us something about why people do, or do not, adopt the behaviours that help protect against getting or passing on COVID-19. When we find new relevant studies we will add them to our map. Once we have gathered up all of the relevant studies we will extract information about each study, such as who took part, how the behaviours of interest were measured, what factors related to relevant behaviours and any information on how strongly related each factor is to each behaviour. We will also assess the quality of each study we include. Finally, we will put all of the relevant information from the studies we find together in a new analysis and then publish a separate systematic review of the evidence on each behaviour of interest (washing hands, wearing masks, social distancing, physical distancing, self-isolation or quarantine, disinfecting surfaces). We will follow all of the established guidelines and best practices for conducting research of this kind, such as Cochrane and Campbell guidance.
The last part of our project will be to update our searches to capture any new evidence as it emerges and integrate that into the reviews. This is called a 'living review' and the reviews will remain living for at least the life of the project (18 months). We will work on using technology to find ways to make this process as efficient as possible so that our reviews stays up to date and available to use.
The main aim of our project is to understand what determines people's positive health protective behaviours. This in turn will help others to develop better ways to support people to protect themselves and others from contracting or passing on COVID and other similar serious respiratory viral infections.
Description We searched for research which would help us understand the determinants of the behaviours that were suggested to minimise the spread of COVID-19. Our initial search found 23,587 results, of which 1034 studies were considered relevant to the study objectives. All of these studies were included in an evidence and gap map (EGM) which can be found at:
The EGM includes 487 studies measuring social distancing, 382 about masks and face coverings, 308 on handwashing, 177 on physical distancing, 157 on isolation/quarantine, 75 on respiratory hygiene/ etiquette, 59 on cleaning surfaces, and 48 on avoiding touching the T-zone. There were 333 studies which used a composite measure of two or more behaviours.
We have also identified a subset of these studies which examine malleable determinants of the target behaviours and have synthesised their findings. The 3 most studied behaviours are handwashing, mask use and distancing (social and physical).
For handwashing, 55 studies were synthesised. Findings indicated that self-efficacy, knowledge of COVID-19, COVID-related anxiety and worry and perceived social norms were among the malleable determinants most associated with handwashing.
For mask wearing, 23 studies were synthesised. Findings indicated that knowledge of COVID-19 was the malleable determinant most associated with mask wearing. Perceived susceptibility of COVID-19 and COVID related worry and anxiety had little to no effect on mask wearing behaviour.
For distancing behaviour, worry about COVID has the strongest association.
Exploitation Route The Evidence and Gap Map is open access and allows researchers and policymakers to identify the research that already exists and the gaps that might need to be addressed.
The results of the systematic reviews will help to inform the design of interventions that might be needed in the case of future similar epidemics and also help to identify the research that has already been completed, to avoid unnecessary replication and better directing of research funds.
Sectors Healthcare

Description Presentation for 4 Nations Public Health Group 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact I presented our preliminary findings, including the first version of our Evidence and Gap Map to public health practitioners across the UK. They were provided with a link to the evidence and gap map so that they could check for updates on an ongoing basis. The audience will now have this tool at their disposal to inform their decision making around public health messaging and policies concerning COVID-19 preventive behaviours and will also be able to apply this information to any future similar epidemics.
Year(s) Of Engagement Activity 2022
Description Project website 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact We have created a project website, with text and videos, to explain the project in lay terms and provide interested parties with links to our findings.
Year(s) Of Engagement Activity 2021