Interventions to promote physical distancing behaviour during infectious disease pandemics or epidemics: A systematic review

Tracy Epton*, Daniela Ghio, Lisa M Ballard, Sarah F Allen, Angelos P Kassianos, Rachael Hewitt, Katherine Swainston, Wendy Irene Fynn, Vickie Rowland, Juliette Westbrook, Elizabeth Jenkinson, Alison Morrow, Grant J McGeechan, Sabina Stanescu, Aysha A Yousuf, Nisha Sharma, Suhana Begum, Eleni Karasouli, Daniel Scanlan, Gillian W ShorterMadelynne A Arden, Christopher J Armitage, Daryl B O'Connor, Atiya Kamal, Emily McBride, Vivien Swanson, Jo Hart, Lucie Byrne-Davis, Angel Chater, John Drury

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

4 Citations (Scopus)
9 Downloads (Pure)


OBJECTIVES: Physical distancing, defined as keeping 1-2m apart when co-located, can prevent cases of droplet or aerosol transmitted infectious diseases such as SARS-CoV2. During the COVID-19 pandemic, distancing was a recommendation or a requirement in many countries. This systematic review aimed to determine which interventions and behavior change techniques (BCTs) are effective in promoting adherence to distancing and through which potential mechanisms of action (MOAs).

METHODS: Six databases were searched. The review included studies that were (a) conducted on humans, (b) reported physical distancing interventions, (c) included any comparator (e.g., pre-intervention versus post-intervention; randomized controlled trial), and (d) reported actual distancing or predictors of distancing behavior. Risk of bias was assessed using the Mixed Methods Appraisal Tool. BCTs and potential MoAs were identified in each intervention.

RESULTS: Six articles (with seven studies and 19 comparisons) indicated that distancing interventions could successfully change MoAs and behavior. Successful BCTs (MoAs) included feedback on behavior (e.g., motivation); information about health consequences, salience of health consequences (e.g., beliefs about consequences), demonstration (e.g., beliefs about capabilities), and restructuring the physical environment (e.g., environmental context and resources). The most promising interventions were proximity buzzers, directional systems, and posters with loss-framed messages that demonstrated the behaviors.

CONCLUSIONS: The evidence indicates several BCTs and potential MoAs that should be targeted in interventions and highlights gaps that should be the focus of future research.

Original languageEnglish
Article number114946
Number of pages16
JournalSocial Science and Medicine
Early online date26 Mar 2022
Publication statusPublished - 1 Jun 2022
Externally publishedYes


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