Understanding behaviour during crises

Over the past decade, King’s researchers have navigated the delicate but essential line between providing timely yet rigorous evidence in times of crises. King’s expertise has informed the UK Government, Local Authorities and Executive Agencies in developing policy and contingency plans that prepare the country to handle major national incidents and emergencies, including flooding, terrorism, attempted assassinations and disease outbreaks.

When disasters occur, people’s behaviour plays a major role in determining the overall health and social impact of the event in question. The Health Protection Research Unit (HPRU) in Emergency Preparedness and Response at King’s College London was set up to increase our understanding of how people react in a crisis. The Unit is a partnership between King’s, UK Health Security Agency and the University of East Anglia and is supported by a £9 million National Institute for Health and Care Research (NIHR) grant. Through its work, the Unit has informed national contingency planning, effective public communication and incorporation of mental health impacts into emergency response plans.

King’s researchers continue to help the UK Government prepare for potential emergencies and major incidents. They have become ‘go to’ advisers when such events occur, and are called upon to support the national emergency response in real time.

Developing better survey tools to enable rapid response

During the 2009-10 ‘swine flu’ pandemic, King’s researchers worked with the UK Department of Health (now the Department of Health and Social Care (DHSC)) to analyse data from 39 nationally representative surveys assessing how the UK public were reacting. Through these analyses, the researchers identified that the design of DHSC surveys could be improved to more accurately capture public perceptions and behaviour. In 2012-13, King’s researchers were granted NIHR funding to develop better survey tools, grounded in psychological theory, that could be rapidly deployed during a future pandemic. Using stakeholder workshops, qualitative interviews and two baseline national surveys, they designed, tested and refined a survey in collaboration with the DHSC and Public Health England (PHE) that provided a more accurate assessment of whether the public were understanding and following official advice.

Public health communication: giving information not reassurance

The way that information is communicated in an emergency can influence how people behave and, if done effectively, can reduce the risk of harm to the public. King’s findings revealed that reassurance during crises is counterproductive to reducing public concern. During the 2006 polonium-210 incident in London – following the poisoning of Alexander Litvinenko – King’s researchers conducted a rapid survey of a large representative sample of Londoners to identify how they were responding to the incident. They revealed that while only 12% thought their own health might be at risk, concern was higher among people directly caught up in the incident who felt authorities attempted to “reassure”, rather than inform, them. These findings on the importance of giving information rather than reassurance influenced future public health communication, including during the COVID-19 pandemic.

Professor Sir Simon Wessely joined experts to discuss how people respond to crises and what COVID-19 can tell us about human behaviour:

Public resilience in the face of disaster

In the immediate aftermath of a disaster, King’s research found that most people are resilient to crises and that mental health resilience can be supported within the community. After the 7 July 2005 bombings, King’s researchers found that most people are resilient to a terrorist attack in their community, do not need psychiatric support and can turn to their informal support networks for help.

However, specific groups need more support: King’s, in collaboration with the London School of Hygiene and Tropical Medicine (LSHTM) and PHE, showed that severe flooding can have long term impacts on mental health. Following the 2013-14 floods, 36% of those flooded reported symptoms of post-traumatic stress disorder (PTSD) .The mental health impact extended to people whose lives were disrupted by flooding even if no water entered their homes.

Research highlighting the importance of community support in developing mental health resilience amongst the public was utilised following the 2017 London Bridge terrorist attack. King’s findings informed and guided Southwark Council’s plans for managing the psychological consequences of the attack. Drawing on King’s research, Southwark Council’s Humanitarian Assistance Steering Group coordinated support for those affected, with a subgroup focused on the multi-agency response for psychosocial and psychological interventions including public facing communications.

King’s research has highlighted that, not only are people resilient to disaster, but they are likely to demonstrate altruism in the face of disaster. In 2018, the Cabinet Office commissioned King’s to review evidence on how the public are likely to respond in a crisis to help inform official planning. King’s researchers demonstrated that altruism, rather than panic or mass criminality, can be expected and promoted.

Informing the UK response to COVID-19

For the first year of the COVID-19 pandemic, with no innate immunity, no vaccine and no treatment, prevention of the predicted worst-case scenarios required people to adhere to a challenging set of behaviours and endure substantial social, economic and psychological costs. King’s research contributed in real time to the UK’s public health response.

Throughout the pandemic, King’s researchers were members of the Government’s Scientific Advisory Group for Emergencies (SAGE) and New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) for COVID-19, which considered the scientific evidence supporting the Government’s pandemic response. Several members of the HPRU for Emergency Preparedness and Response at King’s participated in and co-chaired the Independent Scientific Pandemic Insights Group on Behaviours (SPI-B), a COVID-19 SAGE subcommittee providing behavioural science advice to improve adherence to recommended interventions.

In February 2020, the DHSC asked King’s to support the national COVID-19 response by activating the pandemic research response plan and providing advice and analysis using the DHSC’s weekly polling data. This became the COVID-19 Rapid Survey of Adherence to Interventions and Responses (CORSAIR) study. King’s work was cited in at least 50 SAGE papers on adherence to self-isolation, hand hygiene, levels of distress and stigma in the community, the importance of ventilation and barriers to NHS Covid App uptake, in turn informing urgent policy decisions.

As part of the CORSAIR study, King’s research identified that most people who reported symptoms of COVID-19 were not fully adherent to self-isolation guidance. This research was crucial in identifying the factors associated with non-adherence, including poor knowledge of guidance, lower socio-economic status, financial hardship and having to work. Consequently, SPI-B was commissioned to produce a report on how to improve rates of adherence to self-isolation which drew on King’s findings.

Professor James Rubin was a witness for the The House of Commons Science and Technology Committee in April 2020 as it explored the effectiveness and longevity of social distancing measures in the UK and the wider implications of these measures for the population:

King’s systematic review of evidence from past infectious disease outbreaks identified that the negative impact of self-isolation can be reduced by good financial, practical and emotional support, as well as by helping people to understand the rules and reasons surrounding quarantine. This review informed online resources to support self-isolation as well as public messages of thanks from the Chief Medical Officer.

King’s rapid and responsive research continues to contribute in real time to the UK’s response to emergencies and major incidents, including the ongoing COVID-19 pandemic. Through working to understand how the public behave in a crisis, King’s researchers have been a leading authority in guiding public health policy, communication, emergency response and contingency plans.