By early 2022, we had all experienced two years of an ongoing global pandemic. We’d endured changing regulations, repeated lockdowns, and waves of new variants.
At that time, Malaysia – with over 97% of the adult population having received at least two doses of a vaccine and a steady decline in daily cases – was beginning to reopen and transition to a new strategy of ‘living with the virus’. For the strategy to succeed, Malaysians needed to continue performing certain preventive behaviours:
- Get a ‘booster’ vaccination when eligible
- Self-test for coronavirus, and self-isolate if positive
- Continue to practise “new normal” behaviours like cleaning their hands, seeking fresh air, and physical distancing
To support the Ministry of Health (MOH), the World Health Organization (WHO) and BIT collaborated to develop communications materials (posters) that promoted these three target behaviours.
BIT undertook a data review and global literature review to identify principles to effectively encourage the adoption of preventive behaviours. After a comprehensive design process led by WHO, nine posters were developed. Malaysia’s Institute for Health Behavioural Research conducted interviews and focus groups with people in Malaysia to strengthen the content, format and presentation of these posters.
BIT then ran an online experiment with 4,000 Malaysian adults to test the effectiveness of the nine posters. Participants were randomly assigned to one of four groups: either a control group who did not see any materials, or one of three groups who saw one poster for each target behaviour.
Posters that used clear language, relevant images and simple instructions performed best
The posters were assessed across a battery of quantitative and qualitative measures, with the following results.
‘Booster shot’ posters
Although all three posters increased intentions to get a booster shot, compared to the control, we found that the “Safety” and “Protect Our Elders” posters were the joint best performers overall.
All three posters were effective in encouraging intention to self-test. The “Loss framing” poster performed best on recall, but some participants reported that they felt guilty or judged after viewing the poster. Overall, the “Rule of Thumb” poster was best received by participants.
‘New Normal’ posters
Among these posters, people best recalled the content of the ‘Self-efficacy” theme. Generally, however, these posters bumped up against a ceiling effect – intent to perform these behaviours was already so high (90%+) among the Malaysian population that the posters struggled to encourage further adherence.
Key lessons to optimise COVID-19 communications materials
Based on these findings, we gathered the following key insights that can inform the design of future public health communications materials:
- Test communications materials with the public before releasing. Although the posters tested in this experiment were generally well-received by participants, some did perform better than others and, in some cases, certain posters (such as the “Credible Source” poster) did worse than no poster at all on some metrics. This highlights the importance of conducting rigorous testing on new public health communications before they are rolled out en-masse.
- Identify and target key behavioural barriers when developing communications materials. Identify specific behaviours to target so that there is a clear call to action. Draw on previous research or conduct rapid research to determine the key influences on those target behaviours. The communications materials should aim to utilise or address these key influences.
- Communications materials should contain images consistent with their calls to action. We found that some participants were confused by the use of the remote control image on the “Self-efficacy” poster, and commented that “(t)he picture used should be more appropriate to the message you want to convey”. The use of a consistent image reinforces the intended message, and bolsters recall of the poster content.
We would like to thank WHO for engaging BIT for this joint project to support the MOH.