Capability, opportunity, and motivation to enact hygienic practices in the early stages of the
COVID-19 outbreak in the United Kingdom
COVID-19 Milestone Series
Extract from the originally published article in the British Journal of Health Psychology (2020), 25, 856–864. Authors: Jilly Gibson Miller et al.
Open Access. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
These few extracts from the published article indicate that all is not well with the COM-B model. The level of empirical support is weak, with only three of six factors showing the predicted positive association with hygienic practices. The most significant factor, ‘reflective motivation’, includes habits and intentions and is difficult to interpret. Many other studies indicate that the strongest predictor of health protective behaviours is the fear motive, notably missing from the COM-B model. Replacing Motivation with Fear Homeostasis, and removing Capability and Opportunity yields a more basic ‘Fear-Homeostasis- Behaviour’ (F-H-B) model, which already receives significant empirical support (e.g. Tannenbaum et al, 2015). As one would predict, in a recent Brazilian study, fear was significantly higher among those practicing protective measures against COVID-19 (facial mask, alcohol gel, and hand hygiene) and respecting social distancing (Giordani 2020).
Objectives. The COVID-19 pandemic is one of the greatest global health threats facing
humanity in recent memory. This study aimed to explore influences on hygienic practices,
a set of key transmission behaviours, in relation to the Capability, Opportunity,
Motivation-Behaviour (COM-B) model of behaviour change (Michie et al., 2011).
Design. Data from the first wave of a longitudinal survey study were used, launched in
the early stages of the UK COVID-19 pandemic.
Methods. Participants were 2025 adults aged 18 and older, representative of the UK
population, recruited by a survey company from a panel of research participants.
Participants self-reported motivation, capability, and opportunity to enact hygienic
practices during the COVID-19 outbreak.
Results. Using regression models, we found that all three COM-B components
significantly predicted good hygienic practices, with motivation having the greatest
influence on behaviour. Breaking this down further, the subscales psychological capability,
social opportunity, and reflective motivation positively influenced behaviour. Reflective
motivation was largely driving behaviour, with those highest in reflective motivation
scoring 51% more on the measure of hygienic practices compared with those with the
Conclusions. Our findings have clear implications for the design of behaviour change
interventions to promote hygienic practices. Interventions should focus on increasing and
maintaining motivation to act and include elements that promote and maintain social
support and knowledge of COVID-19 transmission. Groups in particular need of
targeting for interventions to increase hygienic practices are males and those living in
cities and suburbs.
What does this study add?Jilly Gibson Miller et al. (2020).
This study provides insight into the factors influencing UK citizens’ hygienic practices during the early stages of the COVID-19 pandemic.
We found that reflective processes were largely driving hygienic practices – these involve making plans to enact the behaviour and supporting the belief that the behaviour is a good thing to do.
Behaviour change interventions to improve and maintain hygienic practices throughout the lockdown and beyond should contain behaviour change techniques that focus on self-regulatory processes involving planning and goal setting.
Commentary by DFM
The article contains a series of red flags suggesting that all is not well with the COM-B model.
- Only three of the six COM-B variables were positively associated with hygienic practices. Two COM-B variables were negatively associated with hygienic behaviours (opportunity – physical and motivation – automatic) and one COM-B variable (capability -physical) was not associated with hygienic behaviours.
- It is notable that the measures were self-reported capabilities, opportunities and behaviours. (see Appendix 1).There is no objective evidence that any of the COM-B variables were associated with actual behaviour change.
- The majority of the studies are cross‐sectional in design so that inferences about causality are impossible.
- Measurement of the psychological constructs was heterogeneous. The measures need to be simplified and more cohesive.
- Measurement of motivation needs to include wants as well as needs and including feelings as well as cognitive judgment to improve the prediction of behaviour (Weinstein et al., 2007).
- The studies relied on self‐reports which are open to reporting bias from socially desirability.
- Self‐report measures of hand‐washing practices have poor validity (e.g., Curtis, Danquah, & Aunger, 2009; Curtis et al., 1993).
- The use of intention is limited by the ‘intention–behaviour gap’ such that reported intentions may not in fact translate into behaviour in the event of an actual pandemic (Orbell & Sheeran, 1998).
- The COM-B model accounted for only 17% of the variance in self-reported hygienic practices leaving 83% of the variance unexplained. This is typical of models in health psychology which rarely account for more than 20-25% of the variance in behaviour.
- The strongest association was between ‘reflective motivation’ and self-reported hygienic practices. However, the items used to define reflective motivation are diverse and include both intentions and habits, which themselves are problematic.
- According to the authors “reflective processes were driving hygienic practices” – making plans to enact the behaviour and supporting the belief that the behaviour is a good thing to do. However ‘reflective processes’ are cognitive not motivational processes and these have been mislabelled by the investigators as ‘motivational’.
- There is no evidence of a causal connection between self-reported reflective processes and hygienic practices, only a statistical association. Thus words such as ‘driving’ are inappropriate and misleading.
- A truly motivational process – fear – is omitted from the COM-B model yet multiple studies indicate functional fear to be of primary importance in motivating hygienic and other protective behaviours in attempts to minimise the risk of COVID-19 infection.
- Interventions must address the primary motive of COVID-19 behaviour change, which is fear.
- Indoor air quality and improved ventilation are key requirements in the fight to reduce SARS-CoV-2 infections, neglected factors in a neo-liberal policy of placing responsibility on citizens who are expected to conform to mandates and programmes of vaccination.
- Governmental policies for public health protection based on the COM-B model remain unsupported by empirical investigations.
Table A1. Descriptive data for survey items used to measure hygienic practices and COM-B
|Hygienic Practices (3-point scale)||Mean|
|B1||“Washed your hands with soap and water more often.”||2.72|
|B2||“Used hand sanitising gel if soap and water were not available.”||2.38|
|B3||“Used disinfectants to wash surfaces in your home more frequently.”||2.22|
|B4||“Covered your nose and mouth with a tissue or sleeve when coughing or sneezing.”||2.64|
|B5||Touching eyes and mouth (5-point scale)||3.62|
|COM-B items (5-point scale)|
|C1||“I knew about why it was important and had a clear idea about how the virus was transmitted.”||4.21|
|C2||“I knew about how and when to do it.”||4.21|
|C3||“I was able to overcome the physical and/or mental barriers that might have stopped me from doing it.”||3.92|
|O1||“I had the necessary time to do it.”||4.20|
|O2||“It was easy for me to do it.”||4.21|
|O3||“People were doing it around me.”||3.81|
|O4||“I had reminders that prompted me.”||3.46|
|O5||“I had support from others.”||3.55|
|O6||“I felt like doing it was normal and expected.”||4.15|
|M1||“I intended to do it.”||4.18|
|M2||“I felt that I wanted to do it.”||4.17|
|M3||“I believe that it was a good thing to do.”||4.31|
|M4||“I developed a specific plan for doing it.”||3.36|
|M5||“I developed a habit of it in my everyday routine.”||3.95|
|M6||“It made me feel anxious.” R||2.68|
|M7||“It made me feel disgusted.” R||2.14|
|M8||“I felt like I could control my emotional reactions so I could do it.”||3.42|
Notes: Higher scores relate to higher compliance/agreement with that measure. R indicates item is reverse-coded.
Tannenbaum M. B., Hepler J., Zimmerman R. S., Saul L., Jacobs S., Wilson K., et al. (2015). Appealing to fear: a meta-analysis of fear appeal effectiveness and theories. Psychol. Bull. 141 1178–1204. 10.1037/a0039729