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Humankind’s main defence against the virus that cuases COVID-19 (SARS-CoV-2), besides vaccine development, was co-ordinated behaviour change. In many countries, co-ordination was assisted by tracking surveys designed to measure self-reported behaviour and attitudes. This paper describes an alternative, complementary approach, which was undertaken in close collaboration with officials in the Department of the Taoiseach (Irish Prime Minister). We adapted the Day Reconstruction Method (DRM) to develop the ‘Social Activity Measure’ (SAM). The study was conducted fortnightly for 18 months, with findings delivered directly to the Department. This paper describes the method and shows how SAM generated a detailed picture of where and why transmission risk occurred. By using the DRM, we built aggregate measures from narrative accounts of how individuals spent their previous day. SAM recorded the amount, location and type of social activity, including the incidence of close contact and mask-wearing, as well as compliance with public health restrictions by shops and businesses. The method also permitted a detailed analysis of how public perceptions and comprehension are related to behaviour. The results informed government communications and strategies for lifting public health restrictions. The method could be applied to other future situations that might require co-ordinated public behaviour over an extended period.

BACKGROUND: Intracranial pressure (ICP) monitoring is widely practiced, but the indications are incompletely developed, and guidelines are poorly followed. OBJECTIVE: To study the monitoring practices of an established expert panel (the clinical working group from the Seattle International Brain Injury Consensus Conference effort) to examine the match between monitoring guidelines and their clinical decision-making and offer guidance for clinicians considering monitor insertion. METHODS: We polled the 42 Seattle International Brain Injury Consensus Conference panel members' ICP monitoring decisions for virtual patients, using matrices of presenting signs (Glasgow Coma Scale [GCS] total or GCS motor, pupillary examination, and computed tomography diagnosis). Monitor insertion decisions were yes, no, or unsure (traffic light approach). We analyzed their responses for weighting of the presenting signs in decision-making using univariate regression. RESULTS: Heatmaps constructed from the choices of 41 panel members revealed wider ICP monitor use than predicted by guidelines. Clinical examination (GCS) was by far the most important characteristic and differed from guidelines in being nonlinear. The modified Marshall computed tomography classification was second and pupils third. We constructed a heatmap and listed the main clinical determinants representing 80% ICP monitor insertion consensus for our recommendations. CONCLUSION: Candidacy for ICP monitoring exceeds published indicators for monitor insertion, suggesting the clinical perception that the value of ICP data is greater than simply detecting and monitoring severe intracranial hypertension. Monitor insertion heatmaps are offered as potential guidance for ICP monitor insertion and to stimulate research into what actually drives monitor insertion in unconstrained, real-world conditions.

Best practice guidelines have advanced severe traumatic brain injury (TBI) care; however, there is little that currently informs goals of care decisions and processes despite their importance and frequency. Panelists from the Seattle International severe traumatic Brain Injury Consensus Conference (SIBICC) participated in a survey consisting of 24 questions. Questions queried use of prognostic calculators, variability in and responsibility for goals of care decisions, and acceptability of neurological outcomes, as well as putative means of improving decisions that might limit care. A total of 97.6% of the 42 SIBICC panelists completed the survey. Responses to most questions were highly variable. Overall, panelists reported infrequent use of prognostic calculators, and observed variability in patient prognostication and goals of care decisions. They felt that it would be beneficial for physicians to improve consensus on what constitutes an acceptable neurological outcome as well as what chance of achieving that outcome is acceptable. Panelists felt that the public should help to define what constitutes a good outcome and expressed some support for a “nihilism guard.” More than 50% of panelists felt that if it was certain to be permanent, a vegetative state or lower severe disability would justify a withdrawal of care decision, whereas 15% felt that upper severe disability justified such a decision. Whether conceptualizing an ideal or existing prognostic calculator to predict death or an unacceptable outcome, on average a 64-69% chance of a poor outcome was felt to justify treatment withdrawal. These results demonstrate important variability in goals of care decision making and a desire to reduce this variability. Our panel of recognized TBI experts opined on the neurological outcomes and chances of those outcomes that might prompt consideration of care withdrawal; however, imprecision of prognostication and existing prognostication tools is a significant impediment t

People have limited capacity to process and integrate multiple sources of information, so how do they integrate multiple contextual risk factors for Coronavirus disease (COVID-19) infection? In June 2020, we elicited risk perceptions from a nationally representative sample of the public (N = 800) using three psychologically-distinct tasks. Responses were compared to a sample of medical experts who completed the same tasks. Relative to experts, the public perceived lower risk associated with environmental factors (such as whether a gathering takes place indoors or outdoors) and were less inclined to treat risk factors as multiplicative. Our results are consistent with a heuristic simply to “avoid people” and with a coarse (e.g., “safe or unsafe”) classification of social settings. A further task, completed only by the general public sample, generated novel evidence that when infection risk competes with risk in another domain (e.g., a different medical risk), people perceive a lower likelihood of contracting the virus. These results inform the policy response to the pandemic and have implications for understanding differences between expert and lay perception of risk

Contact-tracing mobile phone apps can play a role in controlling the spread of COVID-19, but their success hinges on widespread public acceptance, uptake and use, which are difficult for public administrators to foresee. We report on a rapid behavioral pre-test of COVID Tracker, Ireland’s contact-tracing app, prior to its launch. A large sample of participants were randomized to receive different versions of a trial app. They responded to an online survey while downloading and using the app on their phones in real time. Experimental manipulations focused on: (i) the level of privacy assurance provided in the app, (ii) the goal-framing of the purpose of the app and (iii) the structuring of the exposure notification. Almost one in five participants mentioned privacy concerns in relation to their likelihood of downloading the app, but concerns were lower and engagement stronger in a condition that included additional assurances regarding the privacy of users’ data in the app. This finding informed the final version of the app. Overall, our results demonstrate the value and feasibility of pre-testing digital interfaces to improve public administration.

Encouraging consumers to switch to lower-rate mortgages is important both for the individual consumer's finances and for functioning competitive markets, but switching rates are low. Given the complexity of mortgages, one potential regulatory intervention that may increase switching rates is to provide independent advice on how to select good mortgage products and how to navigate the switching process. Working with a government consumer protection agency, we conducted an experiment with mortgage-holders to test whether such advice alters perceptions of switching. The experiment tested how the attributes of the offer, perceptions about the switching process, individual feelings of competence and comprehension of the product affect willingness to switch to better offers, both before and after reading the official advice. The advice made consumers more sensitive to interest rate decreases, especially over longer terms. It also increased consumers' confidence in their ability to select good offers. Overall, the findings imply that advice from policy-makers can change perceptions and increase switching rates. Moreover, the experiment demonstrates how lab studies can contribute to behaviourally informed policy development.

Accurate measurement of compliance with COVID-19 guidance is important for public health policy and communications. Responses to surveys, however, are susceptible to psychological biases, including framing effects and social desirability. Our aim was to measure the effects of these biases on estimates of compliance with public health guidance (eg, hand-washing, social distancing). Design We conducted two online experiments (n=1800) and varied whether questions were framed positively or negatively (eg, € I always wash my hands...' vs € I don't always wash my hands...'). We also varied the degree to which anonymity was assured, via a € list' experiment. Results Reported compliance, despite being generally high, was reduced by negatively framing questions and increasing anonymity using a list experiment technique. Effect sizes were large: compliance estimates diminished by up to 17% points and 10% points, respectively. Conclusion Estimates of compliance with COVID-19 guidance vary substantially with how the question is asked. Standard tracking surveys tend to pose questions in ways that lead to higher estimates than alternative approaches. Experimental tests of these surveys offer public health officials greater insight into the range of likely compliance estimates to better inform policy and communications.

Objective: Self-isolation is a vital element of efforts to contain COVID-19. We set out to test whether decision aids can support self-isolation. Design: We conducted a pre-registered online experiment with a nationally representative sample (n = 500). Three stages tested: (i) whether decision trees help people to decide whether they need to self-isolate; (ii) whether an online planning tool increases people’s confidence in their ability to self-isolate; and (iii) whether infographics help people to absorb advice on managing a household in which someone must self-isolate. Main Outcome Measures: (i) Accuracy of matching symptom patterns to a response scale for the need to self-isolate; (ii) self-reported confidence in coping with self-isolation; (iii) objective tests of recall and comprehension. Results: Decision trees improved decisions about when self-isolation was necessary, although participants systematically underestimated the need to self-isolate with less common COVID-19 symptoms (e.g. sore throat, fatigue). The online planning tool increased confidence about coping with self-isolation only among the adults aged under 40. Infographics improved recall and comprehension of how to manage self-isolation. Conclusion: Decision aids can be used to support self-isolation during COVID-19. The study also demonstrates how even an emergency public health response can benefit from rapid experimental pre-testing of interventions.