‘Cough and sneeze into your elbow’: a field study testing the effects of persuasive messages on compliance with behavioral measures to prevent the spread of respiratory viruses

Background: Effective persuasive messages can contribute to enhancing pandemic preparedness and public health. An essential requirement for this is an excellent understanding of the effects of exposure to persuasive messages on compliance with behavioral measures against the spread of respiratory viruses. This field study tested the effects of persuasive messages on compliance with two behavioral measures to prevent the spread of viruses that cause respiratory infections such as COVID-19 and the flu: coughing/sneezing into the elbow and staying home when ill with respiratory infection symptoms. Materials and methods: A field study with an observational pre-post design was conducted at four educational institutions representing all common post-secondary school educational levels in the Netherlands. Data were collected among students and employees via online questionnaires before (n = 2096) and after (n = 1098) exposure to a set of persuasive messages with six different message framings. Two-way MANOVA, logistic regression analysis and repeated measures ANOVA were conducted. Results: Exposure frequency, behavioral measure type, demographic characteristics, trust in government, prosocial orientation, perceived health, educational institution, and student/employee status showed significant multivariate main effects and univariate main and/or interaction effects on the outcomes (intention to comply, attitude, social norms, moral norm, self-efficacy, response-efficacy, and risk perception; p <.05). The odds of compliance with staying home when ill were lower than the odds of compliance with coughing/sneezing into the elbow, regardless of exposure frequency (p <.001). Conclusion: In conclusion, messages positively influenced behavioral determinants–a critical prerequisite for behavior change and compliance. Findings also highlight that people are likely more willing to comply with measures that have less adverse personal and social impact. To enhance compliance more is needed, for instance explanations of the relevance and effectiveness of measures, and practical support to enact the measures. Practical and theoretical implications are discussed.