Introduction

The spread of COVID-19 has made the term "behavioral change" famous. As a certified clinical psychologist, I normally provide counseling on behavioral change¹⁾. Also, as a clinical and health psychologst, I engage in research on the factors that influence health behavior²⁾. For me, it is curious to see how often the academic term "behavioral change" appears in the news as a general term.

Health behavior and behavioral change

Behavioral change or behavior modification is an academic term originally used in the areas of physical and mental health (behavioral medicine, clinical psychology, health psychology, etc.). The term refers to the acquisition, execution, and maintenance of behaviors that affect health for the purpose of improving health conditions or preventing diseases.

Significant research has been done on the factors that influence behavioral change. Here, the term "behavioral change" means the process from when a person decides to engage in a certain behavior until the behavior is executed in a sustained manner. The research results show that three factors are important in behavioral change.

(1) Individual factors (impact of knowledge, beliefs, skills, feelings, etc., of each individual)
(2) Interpersonal factors (impact from people surrounding the individual)
(3) Environmental factors (impact of the surrounding environment, various information, politics, socio-economic situation, etc.)

Typical behavior related to COVID-19 is behavior intended to prevent infection. The Ministry of Health, Labour and Welfare is calling for behavior consisting of avoiding the so-called Three Cs (closed space, crowded places, and close contact), wearing masks, washing hands, and practicing coughing etiquette³⁾. How can we encourage people to engage in this behavior? Traditionally, it was believed that imforming correct knowledge and the risks associated with an action would cause people to change their attitude and engage in the desired behavior. However, many previous studies have revealed that knowledge provision and attitude changes alone (in other words, only addressing individual factors) do not result in sufficient behavioral changes. Even if such behavioral changes do take place, they do not last long.

Therefore, when promoting behavioral changes, we experts always consider whether it is possible to devise interpersonal factors and environmental factors, in addition to individual factors. In terms of behavior to prevent infection, the behavior of physical distancing cannot be reliably achieved simply by providing the knowledge that it is important to keep a distance of 1 to 2 meters from other people. Instead, the behavior of physical distancing can be reliably realized by devising an environmental factor; specifically, by drawing lines in intervals of 1 meter in front of cash registers and asking people to stand on the lines when waiting. The same applies to hand washing behavior. Even if a child learns at school that it is necessary to wash your hands with soap for 20 seconds (knowledge: individual factor), that child will not wash his/her hands if there is no soap in the bathroom at home (environmental factor) and if family members do not encourage the child to wash his/her hands upon returning home (interpersonal factor).

Is it effective to encourage people to change behavior from fear of illness?

Initially, the characteristics of COVID-19 were unknown and many people were frightened. Experiencing the fear (risk) of being infected is one factor that triggers a person to take preventive behavior. In behavioral change, a message that emphasizes fear--for example, "being infected is horrible, so let's behave in a manner to prevent infection"--is called "fear appeal". There are many studies on fear appeal in health behavior, and previous studies indicate that fear appeal alone has a limited effect on behavioral change, and that it therefore needs to be combined with other factors⁴⁾.

Currently, I am collaborating with researchers at other universities to conduct a psychological study of factors that influence behavior aimed at preventing COVID-19 infection. In addition to risk perception, our research focuses on factors such as confidence in engaging in a behavior, the degree to which taking action helps reduce the risk of infection, and social norms. We use statistical analysis to examine the combination of these factors. Furthermore, we conduct analysis in order to obtain useful information on related incentives and environmental developments that will increase confidence in engaging in behavior.

When reading results of psychology research

Today, in view of how academic results are often transmitted via the Internet, I believe that it is necessary to consider the following two points.

First, the entirety of complex human behaviors cannot be explained by a single study. In psychology, experiments and investigations are conducted assuming multiple factors that are likely to influence a certain behavior, and the effect of each factor on the behavior is examined by statistical analysis. For example, it is suppose that 60% of a certain behavior can be explained by the assumed factors. We would interpret this as a very high rate of explanation in a psychological research. However, it also means that the factors cannot explain 40% of the behavior. I would like to note the risk that we tend to simplify a single research result and spread it.

Secondly, behavioral changes related to COVID-19 also include sensitive factors. There is a possibility of prejudice or exclusion when revealing the characteristics of people who do not follow the desired behavior. Focusing on prejudice and exclusion related to COVID-19 (e.g. the attitude taken towards infected individuals) is also a necessary perspective when considering the new normal of living with COVID-19. Regarding this topic, please refer to information provided by domestic and international psychological societies⁵⁾⁶⁾.

Conclusion

In this article, I described behavioral change from a psychological point of view. However, in post-COVID-19 society, it is necessary to examine the very form of human beings through a multifaceted perspective. I belong to the Faculty of Letters, which is a faculty that examines human existence itself through a variety of approaches, with diverse academic fields having varied viewpoints. I will continue to consider important matters while working in this blessed academic environment.

Finally, the new lifestyles forced upon us by COVID-19 place enormous stress on our minds and bodies. Above all, it is necessary to take into account the chronic stress associated with lifestyle changes and the decrease in physical activity due to our tendency to spend more time at home. Please refer to the information provided by reliable experts in mental care⁷⁾, stress in children⁸⁾, and exercise/sports⁹⁾.

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Reference Literature

1) Nanako Nakamura-Taira, Junko Taki. Function of Clinical Psychologist of Behavioral-medical Team Approach in a Primary Care-based Diabetic Nephropathy Intervention; Japanese Journal of Behavioral Medicine, 2015; 21: 31-38.　https://doi.org/10.11331/jjbm.21.31
2) Masataka Higuchi, Nanako Nakamura. A RCT Study of Effects of Internet Training Using Watching-Video Method on Purchasing Condoms; The Journal of AIDS Research, 2018; 20: 146-154.　https://jaids.jp/pdf/2018/20182002/20182002046054.pdf
3) Ministry of Health, Labour and Welfare. Preventing COVID-19 Infections
https://www.mhlw.go.jp/stf/covid-19/kenkou-iryousoudan.html#h2_1
4) Sheeran P, et al. Does heightening risk appraisals change people's intentions and behavior? A meta-analysis of experimental studies. Psychological Bulletin 2014; 140: 511-543.
5) The Japanese Psychological Association. COVID-19 Website　https://psych.or.jp/special/covid19
6) American Psychological Association. APA COVID-19 Information and Resources https://www.apa.org/topics/covid-19
7) Department of Disaster and Community Psychiatry, Faculty of Medicine, the University of Tsukuba. Emotional Care Related to COVID-19　https://plaza.umin.ac.jp/~dp2012/covid19.html
8) National Center for Child Health and Development. Regarding COVID-19 and Stress in Children
http://www.ncchd.go.jp/news/2020/20200410.html
9) Japan Sports Agency. Preventing COVID-19: Points to Remember for Sports/Exercises and Case Examples of Exercise　https://www.mext.go.jp/sports/b_menu/sports/mcatetop05/jsa_00010.html

Nanako Nakamura-Taira
Professor, Faculty of Letters, Chuo University
Areas of Specialization: Clinical Psychology, Behavioral Medicine, and Health Psychology

Nanako Nakamura-Taira was born in Fukuoka Prefecture and raised in Saitama Prefecture. She is a certified clinical psychologist and a licencd psychologist. She holds PhDs in the human science and medicine.

In 1997, she graduated from the Faculty of Liberal Arts and Science, Tokyo Woman’s Christian University.
In 1999, she completed the Master’s Program in the Graduate School of Human Sciences, Waseda University.
In 2002, she acquired credits necessary for completion of the Doctoral Program in the Graduate School of Human Sciences, Waseda University.
In 2019, she assumed the position of Associate Professor in the Faculty of Letters, Chuo University, and assumed her current position in 2020.

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