When did you last touch your face? What part? Are you touching your face right now?
The odds are that it was less than five minutes ago. And, right now, that may be a problem.
As COVID-19 cases spread across the globe, people are starting to get some consistent advice on what they can do to avoid the virus. In addition to washing their hands and coughing or sneezing into a tissue (or your elbow), people are being told to not touch their faces.
The problem is that they are not getting much advice on how to avoid touching their faces. Below I explain why that’s worrying, and how behavioral science could help us find effective ways to reduce face touching and impede disease spread.
The problem of face touching
The first issue is that people tend to touch their faces a lot. One study found that adults touched their eyes, nose or lips 15 times an hour on average while performing office-type tasks. Although only 10 people were observed, touching rates varied from 1 to 34 times an hour! Studies of medical students have found them touching their eyes, nose or mouth between 10 times and 45 times an hour. Even in a trauma intensive care unit, healthcare professionals were touching their faces around five times an hour. These are the only studies available, but they all conclude that this face touching provides a major risk to infection control.
The issue is that much of this face touching is likely to be outside our conscious control. People change how much they touch their face when they become aware it is being recorded. People touch their faces more, without realizing, when they watch a video of someone they identify with touching their face. Face touching appears to be one of the many activities that have become non-conscious in order to free our conscious minds to perform other tasks effectively.
A final problem is that people will not have any mental models for stopping face touching. Hand washing is a visible action that people will have been familiar with throughout their lives (although it is still difficult to do). Sneezing into an elbow is an action that can be easily imagined and observed. But the idea of stopping face touching is neither of these things – we need to give people specific things they should be doing instead.
Tackling face touching: substitutes, social reinforcements & physical barriers
If face touching happens a lot, without us realizing, then simply telling people not to touch their faces in the abstract will not have much effect. So, what should we be doing instead? Since there is very little hard evidence on what works, we need to turn to basic principles of behavior. Let’s start by proposing that there are two main kinds of face touching: prompted and unprompted.
“Prompted” touches are when someone feels an itch or ache in their eyes, nose or mouth, and they respond by rubbing or scratching. These are likely to be swift, non-conscious reactions. It is unrealistic to expect that they can be stopped.
In these situations, encouraging substitute behaviors may be a more effective route than simply telling people “do not touch your face”. A good one might be to use a tissue for prompted touches, but this may be unrealistic: people may not have one to hand, or may feel that the need is too urgent. Instead, perhaps we could help people associate rubbing their eyes or nose with the back of their wrist or arm, areas that may have been less exposed to infection than fingers. This is an easier change and therefore may be more achievable. While not ideal, there is a strong argument that this approach is likely to create less harm.
“Unprompted” touches are where someone is mentally engaged in a separate activity, and ends up touching their face as a behavioral byproduct of this engagement.
Here, we can focus more on prevention. If the need to stop touching is not immediate, then it would be helpful to first identify if there are any observable triggers for this kind of touching. But, as you may have guessed, it is hard for us to make these observations, given that the touching is non-conscious. Therefore, one option could be to ask friends, family or coworkers to say “face” or similar every time you touch or attempt to touch your face – and then attempt to determine what thoughts or actions preceded the touch attempt.
This kind of social reinforcement may act as an intervention in itself. But it is unlikely to be sustainable. A more promising approach is to help people consciously start doing something that makes later face touching less likely. These things could include keeping hands in pockets, holding hands together, or folding arms in a “locked” way (i.e. grasping the opposing bicep to make it less likely that hands are released).
The common theme for these actions would be to create even minor physical barriers to face touching. For that reason, wearing sunglasses or glasses rather than contact lenses may also be helpful. Some people have also suggested that a facemask could create a barrier for face touching. But, putting aside concerns about creating shortages for health professionals, facemasks would still need to be removed sometimes (and still leave the eyes exposed).
Since there is little to no evidence available on specific tactics, more work is needed to work out the most effective options and how they vary between groups (since we know face touching varies across cultures). However, there is strong evidence that the best way of ensuring that these tactics happen is by using “if-then” plans. These take the form of statements like “if I am looking at my phone, I will put my other hand in my pocket” or “if I sit down in a meeting, I will do ‘locked arms’”. Over time, these actions become habitual. The result is that people do not have to think about creating barriers to face touching: it just happens automatically.
An alternative possibility is that unprompted face touching occurs as a compulsive or habitual action, like nail biting. In those cases, the best option again is to create an alternative behavior that displaces the need away from face touching. Some options could be drumming fingers on legs or playing with a substitute object.
These may seem to be absurdly small and unimportant things to be discussed. In fact, they are crucial. Creating substitute behaviors and new barrier-forming habits are the most effective way of curbing face touching. We need to work out the most promising approaches and the best way of communicating them – fast.