Using behavioural science in communication to improve health in Malaysia

As countries move from an acute pandemic response towards a sustained management approach, many society-wide COVID-19 restrictions are being eased. Individuals must assess the risks for themselves and those around them and take actions that protect their loved ones and the community.

But just as the importance of personal responsibility grows, so has the public's weariness of COVID-19 information and calls to implement protective measures. To counter this, countries need to find new and more effective ways of communicating about the virus, and about how people can keep themselves and others safe, so that they feel motivated to assess their risk and do the right thing.

Malaysia has invested heavily in the establishment of dynamic listening and multi-source data collection to understand and respond to the public's questions and concerns around COVID-19. This has proven fundamental, not just in effectively engaging with the population, but also in designing behaviourally informed interventions to address COVID-19.

In late 2021, WHO worked together with Malaysia's Ministry of Health and the Institute for Health Behavioural Research (IHBR) to run a three-day workshop on the application of behavioural science for health communication.

WHO Representative to Malaysia, Brunei Darussalam and Singapore, Dr Rabindra Abeyasinghe, said, "The robust data and evidence available, in conjunction with newly developed skills obtained through the workshop, provided a foundation for designing a behavioural insights project that would support safe reopening of the country and ensure the population continued to perform key COVID-19 protective behaviours including vaccine uptake."

Building on this momentum, the Ministry of Health's Crisis Preparedness and Response Center, the Health Education Division and IHBR requested WHO's support to initiate a robust, evidence-driven process for developing new communications materials that would maximize the comprehension and intention among the Malaysian public to perform key COVID-19 protective behaviours.

"We engaged the public through focus group discussions to better understand the barriers and motivating factors influencing their behaviours, as well as their thoughts and feelings around current communication materials, so that new messagingcould be tailored to these findings. A review of global literature on what works for COVID-19 messaging gave us insights into the tactics that were effective in influencing behaviours in other settings and provided strategies for us to test in the Malaysian context," said Dr Manimaran Krishnan, Director of IHBR.

Based on this initial data and evidence generation, new materials were co-developed by the Ministry of Health and WHO. They went through iterative improvements after consultation with the audience via focus groups and interviews.

Elena Altieri, Head of the Behavioural Insights Unit at WHO Headquarters, said of this process, "Understanding what motivates specific behaviours is essential. A variety of different methods at different stages of this project allowed us to gather new insights and nuances with every iteration, achieving each time small but fundamental improvements."

The newly developed communication materials were then taken to an online randomized controlled trial where they were tested for effectiveness. Responses from 4000 Malaysians who were representative of the public revealed which materials performed best in terms of recall, intentions and sentiment. For example, a message that provides clear and practical advice on how and when to self-test for the virus was particularly effective for increasing people's intention to do so, and a message that communicates the benefit to the community increased people's intentions to get a booster shot. The results of the trial and earlier evidence gathering enabled the government to optimize communication materials in terms of language, design and process.

For WHO, Dr Rabindra Abeyasinghe said, "The recommendations are a launchpad to further adopt and mainstream the use of behavioural science across communication activities. We look forward to continuing this work with the Ministry and partners."

The growing use of behavioural insights

Since the onset of the COVID-19 pandemic, the use of behavioural science has been a key part of Malaysian authorities' efforts to control the virus, keep people healthy and minimize the burden to the health system. Evidence on what influences people's actions can improve the design of health communication, programmes and policies and better inform decision-making.

Malaysia's Minister of Health, YB Khairy Jamaluddin said, "Behavioural science is actually the first line of defence for public health. If you can get people to behave differently, to have health-seeking behaviour, to go for their vaccinations, then this will tremendously strengthen everything else in the healthcare system."

In WHO's Western Pacific Region, Behavioural insights is an element of the Communication for Health (C4H) programme, which uses participatory approaches and generates insights on how people behave to develop targeted, audience-centred communication that contributes to improved health outcomes. Under C4H and WHO's global Behavioural Science for Better Health Initiative, WHO is working with governments, including Malaysia, to build capabilities for behavioural and social sciences.

WHO's work supporting countries across the Western Pacific build capacities for C4H is made possible by the kind support of donors including Japan and the Republic of Korea.

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