Rapid co-design, implementation and evaluation of a digital behaviour change intervention to improve hand hygiene and limit spread of the COVID-19 outbreak

The public can play a crucial role in infection outbreaks by adopting simple behaviours such as handwashing to curb the spread of infection. This can save lives by preventing everyone becoming ill at once, which would mean the healthcare system could not cope and a vaccine could not be developed in time. Evidence shows that despite public health advice most people need to increase behaviours such as handwashing that can help prevent infection. We developed an online intervention (‘Germ-Defence’) that was tested in the swine flu pandemic and seasonal flu years. Germ-Defence increased handwashing and reduced infections and healthcare use. This new project will quickly work with stakeholders and users to adapt and translate Germ-Defence to be suitable for preventing infection from coronavirus (and other flu-like infections) in the UK and China. We will roll it out rapidly and widely in both countries, and collect online information about how it is used, how it affects people’s attitudes and behaviour, and users’ views of it. We will use our findings to immediately update and improve Germ-Defence and to make recommendations and provide tools for adapting Germ-Defence and other public health advice for use in more countries and in future outbreaks.

This COVID-19 Rapid Response award is jointly funded (50:50) between the Medical Research Council and the National Institute for Health Research. The figure displayed is the total award amount of the two funders combined, with each partner contributing equally towards the project.

This project will evaluate how an existing digital public health intervention can be very rapidly adapted and optimised for the changing needs of an infection outbreak, using novel participatory-co-design methods, and building on partnerships with PHE and leading Chinese researchers. We will translate and immediately widely disseminate in both UK and China our NICE-endorsed ‘Germ-Defence’ digital infection control intervention for the general public. We will then engage with stakeholder (n=15) and PPI (n=20-30) online panels in each country to co-design, update and optimise the intervention as required for re-release in later and second phases of the outbreak. At every stage of dissemination we will document reach and impact using unobtrusive measures of usage and handwashing intentions and behaviour. We will triangulate these data with findings from online interviews with a purposive user sample (n=20-30) in each country to understand contextual effects on engagement. We will also carry out a rapid online trial in China (n = 1318) comparing the effects of the initial and adapted versions of the intervention on infection control beliefs, attitudes and behaviour, to evaluate the value of the adaptation process. This work is intended to contribute directly to the management of the outbreak by preventing infection transmission and slowing the spread of infection, so that the healthcare system will have more capacity to cope with demand. This work will also contribute to a better understanding of how to rapidly optimise public health interventions for future emergencies, and the factors influencing behaviour relevant to infection transmission.