What works to make people keep their distance during infectious disease outbreaks: systematic review

What is it about?

This systematic review searched six databases to identify studies testing interventions designed to increase physical distancing (maintaining a distance of 1 to 2 metres from others) during infectious disease pandemics or epidemics. Eligible studies required a comparator condition, such as a pre-post design or a randomised controlled trial, and had to measure actual distancing behaviour or its direct predictors. Six studies of moderate or high quality met the inclusion criteria. The review identified the specific behaviour change techniques (BCTs) used in each intervention, including feedback, information about consequences, and environmental restructuring, and mapped them to potential mechanisms of action. Key delivery modes identified across effective interventions included posters and proximity buzzers. Risk of bias was assessed using the Mixed Methods Appraisal Tool.

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Why is it important?

Physical distancing is one of the primary non-pharmaceutical tools for controlling airborne and droplet-transmitted infections, yet the evidence base for what actually changes distancing behaviour in practice was remarkably thin at the time of the COVID-19 pandemic. This review provides the first systematic map of effective BCTs and delivery mechanisms for distancing interventions, giving public health practitioners and policymakers an evidence-grounded starting point for designing future pandemic responses. The finding that only six high-quality studies existed at the time of a global pandemic also signals a critical gap in preparedness research, making the case for investing in intervention development and evaluation ahead of the next outbreak.