Very small effects of an imagery-based randomised trial to promote adherence to wearing face coverings during the COVID-19 pandemic and identification of future intervention targets

Abstract

Objective: Mental imagery interventions are a cost-effective way of promoting health behaviour change. We tested a mental imagery intervention designed to promote adherence to wearing face coverings during the COVID-19 pandemic.Design: A four-arm randomised controlled trial to explore potential mechanisms of action. Main outcome measures: Measures of behaviour (frequency of self-reported face covering adherence), theory of planned behaviour constructs (i.e. intention, attitudes, subjective norms, and perceived behavioural control), personality traits, imagery ability and barrier self-efficacy were measured at baseline (T1). Behaviour was also assessed at four-week follow-up (T2).Results: Of 297 participants, a majority always wore face coverings (N = 216, 73% overall sample). Logistic regression analyses revealed no intervention effects on changes in adherence to wearing face coverings, though T1 wearing of face coverings and being male predicted T2 behaviour. Subgroup analysis of participants self-reporting ‘suboptimal T1 adherence, revealed that T2 non-adherence was predicted by being a non-student and by subjective norms and lower T1 intention to wear face coverings.Conclusion: Imagery-based interventions to increase face covering wearing adherence may exert significant public health effects but only when conducted on a very large scale. Our findings suggest that interventions should target men and disrupt habitual past behaviour.

Keywords:

• Mental imagery intervention
• behaviour change
• COVID-19
• face coverings
• habitual past behaviour

Disclosure statement

There are no conflicts of interest or competing interests to declare for this study.

Data availability statement

The data that support the findings of this study are openly available on figshare at http://doi.org/10.6084/m9.figshare.14535294. The authors affirm that participants provided informed consent for publication of their anonymized/de-identified responses in a dataset on a secure, publicly available online repository.

Notes

1 In the context of the coronavirus (COVID-19) outbreak, a face covering is something which safely covers the nose and mouth. You can buy reusable or single-use face coverings. You may also use a scarf, bandana, religious garment or hand-made cloth covering but these must securely fit round the side of the face. [material adapted from UK Government Cabinet Office (2020)]

2 To maximise the analytic possibilities held by available data, we conducted an intention-to-treat analysis (n = 465). In this analysis, we imputed estimated relevant T2 study variables based on T1 study variable values for missing values where participants had not provided a complete T2 response. Logistic regressions were then re-run. Intention-to-treat findings were very similar to the complete case analysis with gender and T1 behaviour highly significant predictors of T2 behaviour and a new statistically significant (p < .05 level) predictive effect of T1 attitudes on T2 behaviour (b = 0.84, SE = 0.38, O.R. = 2.32, 95% C.I. 1.096, 4.919).

3 Analysis re-run including covariates revealed no apparent effects for allocation to either outcome imagery (b = .178, p = .635), process imagery (b = -.083, p = .816) or outcome and process imagery (b = -.054, p = .920).

Additional information

Funding

This research was not funded. Armitage is supported by the NIHR Manchester Biomedical Research Centre and the NIHR Greater Manchester Patient Safety Translational Research Centre.