PONE-D-21-32828Practical behavioural solutions to COVID-19: Changing the role of behavioural science in crisesPLOS ONE

Dear Dr. Tanis,

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ACADEMIC EDITOR: I have now received sufficient review reports. Both reviewers recommended publication but also suggested revisions to your manuscript, especially on the methodology section where authors need to clarify certain issues highlighted by the reviewers.

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Gabriel Hoh Teck Ling, PhD

Academic Editor

PLOS ONE

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“We would like to thank André and Joyce van Reijen for opening up their supermarket to run this experiment, and PLUS for

printing all signage. We thank our team that helped collecting the data: Frederike Meijer, Sonja van Meerbeek, Zuzana Wilms,

Henk Nieweg, Nina Leach, and Lander Arteaga. The research project was supported by the Ministry of Economic Affairs and

Climate Policy. CT and TB were supported by an Innovation Exchange Amsterdam UvA Proof of Concept Fund”

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is an interesting experimental study examining the impact of rewards and cues, one component of behavioural interventions, on distancing behaviours inn a supermarket in the Netherlands during the initial wave of the COVID-19 pandemic. The study was well done and the analyses appear sound. I do not feel sufficiently expert to comment on the statistical approaches used; a statistical reviewer might be helpful.

While I do like this paper, I think that it overstates its purpose. A reader not familiar with behavioural science would conclude that this study is groundbreaking in introducing behavioural sciences to crises. This is simply not true and misleading on 2 counts. First, behavioural sciences have been quite active in the pandemic response. I did a quick PubMed search with the search terms "behavioural science" and "COVID" and got 106 papers from 2020 - 2022, including the following papers directly on behavioural science approaches:

Using social and behavioural science to support COVID-19 pandemic response

Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action

Research priorities for the COVID-19 pandemic and beyond: A call to action for psychological science

Psychological science and COVID-19: An agenda for social action

Infected by Bias: Behavioral Science and the Legal Response to COVID-19

Trust in Science, Perceived Media Exaggeration About COVID-19, and Social Distancing Behavior

The cognitive science of COVID-19: Acceptance, denial, and belief change

Intervening on Trust in Science to Reduce Belief in COVID-19 Misinformation and Increase COVID-19

Preventive Behavioral Intentions: Randomized Controlled Trial

Ending the Pandemic: How Behavioural Science Can Help Optimize Global COVID-19 Vaccine Uptake

Applying relationship science to evaluate how the COVID-19 pandemic may impact couples' relationships

Individual health behaviours to combat the COVID-19 pandemic: lessons from HIV socio-behavioural science

How behavioural science data helps mitigate the COVID-19 crisis

Lessons From the UK's Lockdown: Discourse on Behavioural Science in Times of COVID-19

Covid-19: What we have learnt from behavioural science during the pandemic so far that can help prepare us for the future

The Science of Persuasion Offers Lessons for COVID-19 Prevention

Can Behavioral Science Help Us Fight COVID-19

Fear of Covid-19: Insights from Evolutionary Behavioral Science

Process-based functional analysis can help behavioral science step up to novel challenges: COVID - 19 as an example

The Dynamics of Fear at the Time of Covid-19: A Contextual Behavioral Science Perspective

Effect of Targeted Behavioral Science Messages on COVID-19 Vaccination Registration Among Employees of a Large Health System: A Randomized Trial

Harnessing behavioural science in public health campaigns to maintain 'social distancing' in response to the COVID-19 pandemic: key principles

It falls to the authors to place their study into the context of the behavioural sciences. Second, the authors focus on one very specific aspect of the behavioural sciences; environmental context. They, in essence, draw on the sub-area of behaviour modification, primarily using cues and rewards to shape behaviour. There is nothing wrong with this, except behavioural science is broader, to include social influences, culture, biology, and the full range of cognitive processing characteristics. Again, nothing wrong with what the authors have done but they should inform the readers of the specific aspects of the behavioural science approach they are taking. For instance, great gains have been made by framing behavioural sciences within what is called the Theoretical Domains Framework, an integration of 33 behavioural change theories, that has identified 14 domains of behaviour change intervention and has been effectively summarized with the COM-B model; behaviour is the result of Capability, Opportunity, and Motivation. This paper falls within the Opportunity domain. For the author' information, this model has been developed from University College London UK, under the guidance of the behavioural scientist Dr. Susan Michie, who is a member of the UK COVID Response team at the highest level of government (the point being it is not accurate to say behavioural science has been left out of the response to COVID - other countries also have behavioural science teams offering advice).

The methodology of this study is very interesting and appears sound. I can see how this methodology can be useful for specific questions, I am a bit confused, however, by Table 1. We see 7 days of intervention but the analyses only involve comparing days 1, 3 (Shopping cart), 6 (signage) and 7 (rewards). What is the purpose of days 2, 4, 5? On that note the Table lists 'space' as an intervention but this is labelled shopping cart in the text.

In the discussion I wonder if the authors have any comment about this study being conducted at the beginning of lockdown experience, where most of the population was experiencing threat. Now that we are almost 2 years in, and many in the population are experiencing demoralization of outrage (the Netherlands has made international coverage of protests recently) do the authors think the study would yield the same results?

I look forward to the contribution of this work to the field, once the study is appropriately contextualized.

Reviewer #2: Summary

This was an interesting and timely naturalistic experimental study that examined the efficacy of three behavioural interventions for promoting physical distancing behaviour in grocery stores during the covid-19 pandemic: (i) rewarding customers for keeping distance; (i) providing signage to guide customers; and (iii) altering shopping cart regulations. They recruited 4323 participants and the main outcome was number of contacts less than 1.5 between customers measured using network analysis. Results showed that both rewards and signage increased physical distancing, but shopping cart regulations did not. Rewards also reduced the duration of contacts. The authors concluded that incorporating behavioural science approaches and interventions into pandemic management should be strengthened and emphasized to improve pandemic outcomes.

Comments

• The introduction of this paper was very compelling – the fact that in times of crisis we turn to crisis-specific experts (e.g., economists during financial crises), the authors did an outstanding job of asking why, given the importance of engaging in preventive behaviours (from distancing to vaccination) during the covid-19 pandemic crisis, did we not turn to behavioural science experts?

• The study was also generally well reasoned in terms of exploring the efficacy of different behavioural interventions to promote distancing behaviour. However, the choice of specific interventions was not described or articulated. Authors did not justify their underlying theoretical rationale (why would they be expected to change behaviour in this context and why these interventions over others?). Tying each intervention to an established behaviour change theory or model would strengthen the paper and highlight the importance of doing this in general. For example, the rationale for the shopping cart intervention is not obvious to me.

• Could the authors clarify what participants were told about the objective of the study – for example: did they know what each intervention was and what outcome was being measured? The authors described this as a naturalistic experiment, but if they knew what was being measured and why, this could have influenced their behaviour more than just being exposed to the intervention (without details).

• Could the authors also clarify if they delivered the interventions the same way they would have been delivered were they implemented in ‘real life’? For example, there were study personnel present to explain the study, hand out tags, and answer questions. Would these resources be available if we were deliver the interventions in real life? Would these roles be assumed by store personnel? The use of an implementation science approach to intervention design an delivery was not explicit.

• The use of objective measures of distancing (SafeTag) was judged to be a strength based on the non-intrusiveness and validity of the measures.

• The authors described how they treated shoppers who were shopping together (as they would likely have close contact throughout the intervention that needed to be accounted for). They described how they accounted for this (based on contact metrics), but the potential for misclassification seems high. For example, many people or families shopping together ‘split up’ in the interests of time – these shopping patterns may have been miscalculated for these groups. Why not just ‘tag’ people shopping together when they enter the store and receive their tags, so irrespective of their shopping patterns, they would not be counted in distancing measures (because we don’t expect those living together or family groups to distance). Could the authors clarify this?

• Given that national regulations at the time of the study limited the number of customers in the store (max one customer per 10m2), store access had to be monitored and controlled. The authors seemed to account for this by comparing conditions at times that were similar in terms of crowdedness, which is appropriate.

• For the signage intervention, the authors did not appear to assess how many people viewed the signs (eg, during exit interviews or surveys). It is difficult to attribute behavioural changes to this intervention in the absence of verifying the extent to which the intervention was ‘received’ by shoppers.

• The authors conducted experience assessments (though only 25-51% completed them), though these assessments did not appear to validate receipt of the interventions (e.g., viewing the signs) or the extent to which the decision to maintain distancing with automatic or reflexive (as per COM-B model)? This would have pointed to the mechanism of action of the interventions (which is how we think interventions are working), and so not assessing these things seems like a missed opportunity.

• The discussion could be strengthened by a discussion of the effect size of their findings and the extent to which results, some of which were statistically significant, were also clinically significant in terms of ability to translate into reduction of virus transmission. For example, on a population level, is reducing contacts from 8 to 6 clinically significant? Is reducing contact time by 1.7 seconds enough to prevent virus transmission? While I wholeheartedly agree that more behavioural interventions need to be designed, evaluated and implemented, we need to ensure we are demonstrating the value of these interventions for addressing the crisis at hand, which is going to strengthen the credibility of the argument to turn to behavioural science for solutions to the pandemic crisis.

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Reviewer #1: No

Reviewer #2: Yes: Kim L. Lavoie

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Practical behavioural solutions to COVID-19: Changing the role of behavioural science in crises

PONE-D-21-32828R1

Dear Dr. Tanis,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Gabriel Hoh Teck Ling, PhD

Academic Editor

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Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

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Reviewer #1: No

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