Masks Can Stop Coronavirus, So How Do Governors Get People to Wear Them?

Last updated: 07-07-2020

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Masks Can Stop Coronavirus, So How Do Governors Get People to Wear Them?

In the last few weeks, governors and other public officials have increasingly tried to send a simple message to the public: If you’re going to go out, wear a mask. said “Our message to Arizonans today is clear: They are safer at home,” said Arizona Gov Doug Ducey, a Republican, as he welcomed Vice President Mike Pence to the state on Wednesday. “If [Arizonans] do go out, we want them to mask up. We want them to physically distance. We want them to wash their hands.” Wearing masks, Arkansas Secretary of Health Nate Smith, told reporters this week, “is going to be a life-saving survival skill.” But the message doesn’t seem to be getting through. The number of new covid-19 cases has been setting daily records over the last couple of weeks, and Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told a panel of U.S. senators this week that fears the number of daily cases could double to more than 100,000. Governors in Sun Belt states who once enthusiastically led the move to reopen businesses are now closing bars, gyms and movie theaters because of surges in new covid-19 cases. The magnitude of new cases is so disturbing that the U.S. Chamber of Commerce is leading a broad effort by business and industry groups to urge governors, local officials and even President Donald Trump to agree to a national mask standard. “The medical evidence is clear: the wearing of masks or face coverings in public settings, especially when it is not possible to consistently maintain social distancing, is a critical element to preventing the spread of covid-19,” the Chamber wrote in a letter to be released Thursday. “Regrettably, in recent weeks we have seen evidence that in some areas where there is growing community spread, issuing voluntary guidance on masks is insufficient to protect public health. Absent stronger measures to prevent transmission, communities across America risk another round of shutdowns, broad restrictions on non-essential activities and irreparable economic harm,” it continued. The business groups said that conflicting local regulations “led to public confusion and lower levels of consumer confidence.” It asked the White House Coronavirus Task Force and the National Governors Association to clarify when mask requirements should be imposed in public spaces, to develop easy-to-enforce policies and to shield businesses and non-profits from liability if they turn away people who aren’t wearing masks. Such cross-country coordination may not be easy. But there may be effective steps governors and other officials can take in the meantime to get people to change their behavior. Namely, they can better hone their messages to the public. The message now, says Joseph Cappella, a communications professor at the University of Pennsylvania who specializes in public health communication, must be stronger than it has been in recent months. “The stronger message has to be now: You need to be masking unless you have a very, very good reason not to be masking, like you’re eating dinner or you’re in the water or there’s nobody else around in an outdoor environment,” he says. “I don’t think this is the time to be weak or uncertain or complex about masking and social distancing.” “We don’t have much in our toolbox to deal with this disease right now,” Cappella adds. Besides testing and contact tracing, the country’s success in fighting covid-19 will depend on individual behavior. “These are the things we have, and these are the things we need to push over and over and over again.” Mississippi State University communications professor Holli Seitz, another expert in public health communications, said public officials should be as specific and concrete as they can when talking to the public. Instead of telling people to “maintain social distancing,” Seitz says, officials should use phrases like “stay six feet away” or “stay two arm lengths as way.” Instead of telling listeners to wash their hands, public officials should tell them to wash their hands with hot water and soap for at least 20 seconds. Rather than telling residents to “stay safe,” she adds, officials need to draw the conclusions for them and specify an exact behavior like, “stay home except to pick up food or go to your job.” But officials need to be aware of potential “boomerang effects” – also known as “psychological reactance” – in their messaging, Seitz cautioned. The idea is that people who put a high value on personal freedom may re-exert that freedom if they feel it is being threatened. So, for example, a person who thinks masking requirements limit their individual choices may refuse to wear a mask just to prove a point. The best way to counter that, Seitz says, is to emphasize the choices that people do have to comply with the rule. If they complain that a cloth mask is too constraining, offer to let them wear a face shield, Seitz says. If they don’t like how the masks look, offer them different kinds of masks to choose from. Officials can use language like, “it’s up to you,” or, “the final choice is yours, but…” in order to help those people feel in control. “self-efficacy,” Another important goal of public officials should be to help people build their “self-efficacy,” or their belief that they can control their environment with the choices they make. “Covid -19 is scary for some people, but others don’t feel at risk. You want to make sure people feel susceptible to the health threat and know it’s serious. But you can’t stop there,” Seitz says. Once people believe the health risk is real, you have to persuade them that the behavior you want them to engage in – whether it’s wearing a mask, social distancing or getting tested – will effectively address the problem. The final step, Seitz says, is to build an individual’s belief that they can do what’s being asked of them. Officials can stress how quick or cheap or easy the behavior is, and show that there aren’t a lot of barriers. They can model the desirable behavior. In previous public health campaigns, that often meant prominent figures getting a vaccine or an HIV test at a press conference. These days, it means wearing a mask even when officials are outside and even when they’re talking. At press conferences, public officials should show the behavior they want others to follow – that means talking with masks on and keeping at least six feet from each other – Seitz says. For more complex behaviors, like getting a covid-19 test, officials can help people mentally rehearse the steps to build their confidence. They can tell people exactly where to go, when the testing sites are open, what they need to take with them and what the procedure will be.   Cappella, the University of Pennsylvania professor, said leaders in the United States are “struggling” with messaging over the need for masks. To understand why, it’s helpful to look at some simple principles Cappella says are necessary for effective public communication: Leaders need to be clear in what they want people to do Their message needs to be credible. Not only does that mean it comes from a credible source, but that the message is scientifically valid The message has to be presented in an apolitical way, without being confounded with the political leanings of the spokesperson In the case of the coronavirus in the United States, though, almost none of those have been true. Early in the outbreak, the country’s surgeon general discouraged people from wearing masks, because he was concerned that the general public would hoard medical-grade masks needed by health workers. Federal officials changed their advice, though, once it became clear that even cloth masks, if widely used, could slow the transmission of the virus. But the message has not just been inconsistent over time; it’s been inconsistent over geography. Often, officials in one state or city will be at odds with officials in a neighboring state or city about whether and when masks should be used. Notably, though, states in the Northeast have tried to coordinate their messaging on that question, Cappella says. “They were making very clear statements about the population centers and very clear statements – but different statements – about the lower-population density areas” in the Northeastern states, he says. That said, the more complex the message is, the more likely its meaning will be lost, Cappella warns. “One can try to explain away why it is that in rural Montana, the need for masking and social distancing is less pronounced than it is for Center City in Philadelphia or in Boise, Idaho,” he says. “But clarity can suffer as you try to make those subtle distinctions.” Traffic safety experts have worked for decades to change motorists’ behavior, whether that means convincing people to wear seat belts, persuading them to install car seats for small children, urging them not to speed or asking them to find a different way home rather than driving while drunk. Some of the lessons they learned could be applicable to changing behavior around the coronavirus, too. Pam Fischer, a senior director at the Governors Highway Safety Association, says one key to getting widespread adoption of new behaviors was to tailor the message for key demographics. In previous campaigns, for example, researchers found that messages from mothers and grandmothers were especially effective among Black men. For Hispanic audiences, appeals about the safety of close family members resonated especially well, Fischer says. In one campaign to urge wider adoption of child safety seats, she says, focus groups found that Hispanic motorists believed the safest way to transport children was in the arms of their parents. Advocates overcame some of the reluctance to use safety seats by having priests bless the seats before installing them in family vehicles. One of the biggest challenges in stopping the spread of covid-19 now, though, is convincing young people to wear masks and stay away from crowds of people, Fischer says. But it’s not simply a matter of young people thinking they’re invincible, she adds. Auto safety researchers have found that teens and young adults are concerned about their appearances and their ability to hang out with friends – that’s the reason many of them have returned to bars and restaurants after months of sheltering in place at home – so messages that address those concerns could be more effective. “Maybe it’s an issue where we talk about how, if you get coronavirus, you’re cut off from your friends. You could suffer from [long-term] breathing problems that will prevent you from doing the things that you love to do with your friends. Maybe that’s the end of sports for you,” Fischer says. “Kids don’t want to hear that stuff, because they think it’s the end of the world for them.” But another way that traffic safety advocates have gotten through with the public is to highlight the impact of unsafe behaviors on individual people and families. That was a central strategy for Mothers Against Drunk Driving in making it socially unacceptable to drive while intoxicated. The same could be done with the coronavirus, Fischer says. “It’s not just that 120,000 people died, but it’s that the 120,000 people are your neighbor’s brother, your coworker’s sister. You have to make these people real,” she says, “It’s not just statistics.” When an acquaintance told Fischer he was struggling with the masking requirements, Fischer told him her aunt – who had previously been fine – caught covid-19, ended up on a ventilator and died. That drove home the point. “The best defense in a crash is to wear a seatbelt,” she adds. “The best defense against contracting the disease right now is to wear a mask.”


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