Key factors for promoting protective behaviours in future pandemics: An umbrella review

Background: The COVID-19 pandemic highlighted the critical importance of protective behaviours—such as mask-wearing, hand hygiene, and physical distancing—in managing health crises. Understanding the factors that enable or hinder these behaviours is essential for improving preparedness and response in future health crises. This umbrella review aimed to synthesize evidence on determinants of protective behaviours during pandemics and provide recommendations for policy and practice. Methods: Following PRISMA 2020 guidelines, we conducted an umbrella review on peer reviewed literature reviews and meta-analyses published between 2020 and 2025. Searches in Epistemonikos, MEDLINE, and Scopus (last update June 2025) targeted reviews on “protective behaviours” and “COVID-19”. Eligibility criteria followed the Population–Concept–Context framework: general population, multifactorial determinants of protective behaviours, and pandemic contexts. Data extraction was performed in a table which included review characteristics, behavioural domains (general compliance, medical interventions, conversation promotion, information handling, hygiene, physical distancing, and other behaviours), and factor valence. Quality appraisal used the Joanna Briggs Institute checklist. Results: From 86 records identified, 11 met inclusion criteria, covering COVID-19 and other diseases. (e.g., H1N1, SARS, MERS, Ebola). Quality scores averaged 8.8/10. Protective behaviours were influenced by three categories of factors: (1) sociodemographic (age, gender, education, socio-economic status), (2) personal (perceptions, beliefs, trust in authorities and science, political orientation), and social and environmental factors (access to protective materials, social norms, community support, health education and communication, policies). Enabling factors included trust in credible sources, perceived effectiveness of measures, and multimodal communication. Barriers comprised misinformation, conspiracy beliefs, and resource inaccessibility. Some factors (e.g., age, gender, education) showed inconsistent effects across behaviours. Findings underscore the need for culturally sensitive messaging, transparent communication, and targeted interventions for vulnerable populations. Conclusions: This umbrella review synthesizes multi-level determinants enabling or hindering protective behaviours during pandemics. It provides evidence-based guidance for policymakers to design targeted interventions through trusted communication channels, culturally appropriate messaging, and addressing the specific needs of different demographic groups. The findings underscore the importance of consistent, positive messaging for pandemic preparedness and response. Registration: PROSPERO registration number: CRD42023467236. Funding: Brussels-Capital Region – Innoviris.