Social distancing measures: barriers to their implementation and how they can be overcome – a systematic review

  1. Mahan Sadjadi
  2. Katharina S Mörschel
  3. Mark Petticrew

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Background

Despite their central role in the global response to the COVID-19 pandemic and previous infectious disease outbreaks, factors influencing the acceptability and implementation of social distancing measures are poorly understood. This systematic review aims to identify such factors drawing on qualitative literature.

Methods

A systematic search was carried out in eleven databases. Papers were included in the review if they reported on qualitative studies of factors influencing the implementation of social distancing measures in potentially epidemic infectious diseases. An adapted meta-ethnographical approach was used for synthesis. Review findings were assessed for strength and reliability using GRADE-CERQual.

Results

Twenty-nine papers were included from the systematic search that yielded 5620 results, and supplementary methods. The review identifies two broad categories of barriers to social distancing measures: individual- or community-level psychosocial phenomena, and shortcomings in governmental action or communication. Based on this, 25 themes are identified that can be addressed to improve the implementation of social distancing.

Conclusion

Among other findings, the review identifies the need for good communication as well as the need for authorities to provide comprehensive support as two key opportunities to increase acceptability and adherence. Further important enablers of adherence are adequate preparedness and appropriate legislation, the presence of community involvement, solidarity within communities and trust in governments and authorities.

Article activity feed

  1. Version published to 10.1093/eurpub/ckab103
  2. ScreenIT

    SciScore for 10.1101/2020.09.16.20195966: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    This final search was carried out between 17 and 19 March 2020 in MEDLINE, EMBASE, PsycINFO, Global Health, CINAHL, SCI-EXPANDED, SSCI, A&HCI, CPI-S, CPI-SSH, and ESCI.
    MEDLINE
    suggested: (MEDLINE, RRID:SCR_002185)
    EMBASE
    suggested: (EMBASE, RRID:SCR_001650)
    PsycINFO
    suggested: (PsycINFO, RRID:SCR_014799)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations of this review: This review has a number of limitations. Firstly, the literature search could have been complemented by searching specific journals and the grey literature. Most of the studies included in the review have some methodological limitations. The review attempted to account for this in the assessment of confidence for review findings. With regards to whether or not results are broadly representative, included studies were conducted in a limited number of contexts. Geographical areas of the world that are not represented are large parts of Europe and Asia as well as Central and South America. This introduces uncertainty since these measures might be highly settings-dependent. Importantly, the social distancing scenarios identified in this review are rather short-term. During the coronavirus pandemic, the implementation of social distancing measures has shown to be necessary over a longer period of time which might have a strong influence on adherence. Since no studies had been conducted on the COVID-19 pandemic at the time of the searches, the findings may not be completely representative of the present situation, but they provide an indication of ways to improve the pandemic response. A future review will have to assess new lessons learned and can benefit from the findings established in this work. Finally, while it is sensible to try and evaluate social distancing broadly, and, as this review has indicated, many findings apply to all aspects of social ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.09.16.20195966v2 on medRxiv
  4. Version published to 10.1101/2020.09.16.20195966v1 on medRxiv