Janet Hoek, Philip Gendall, Nick Wilson (author details*)
A feature of Aotearoa New Zealand’s COVID-19 elimination strategy is the rapid identification and then management of any COVID-19 cases arising from border system failures. Within the community, high QR code scanning rates enable rapid identification of contacts while wearing masks in indoor public settings, such as on public transport, reduces the risk of virus transmission. Yet scanning and mask wearing rates are variable, rising in response to immediate threats and falling off when those threats appear to diminish. While probably desirable to mandate these behaviours in high risk settings at raised Alert Levels, this blog considers the supplementary role for social marketing and environmental strategies that could “nudge” people towards these protective behaviours.
The re-emergence of COVID-19 in several Australian states and territories, and the recent threat of community transmission in Wellington, have focussed attention on QR scanning and mask-wearing. The Government has responded by reaffirming the requirement to wear masks on public transport and announcing it may mandate QR scanning in high-risk environments. However, a recent study that reported low scanning rates across varied settings raises important questions about how compliance could be improved in settings where scanning will likely remain voluntary.1 Furthermore, although mask-wearing on public transport is mandatory at Alert Level 1, media reports (and observations by some of us) suggest mask wearing by bus drivers is variable, which may lower compliance among passengers.
Efforts to improve scanning and mask-wearing compliance could use individually-targeted approaches, such as advertising that encourages people to protect themselves and others by doing the “right thing”, or that provides new information about why these behaviours are important. However, another approach would focus more on shaping the environments where scanning and mask wearing occur. This approach recognises that many behaviours are not planned but occur in response to stimuli within people’s environments. Integrating new stimuli, or “nudges”, into these environments can foster and then reinforce compliance, helping develop habits.2 Popularised by Thaler and Sunstein,3 nudging alters the “choice architecture” people encounter and makes some actions easier to perform than others.
Examples of successful social marketing “nudges” include printing the image of a housefly on the inside of urinals at Schiphol airport in Amsterdam, which reduced “spillage” on the bathroom floor by 80%. Other measures include reducing the size of plates in restaurants by 5cm, which reduced food waste by 22%, and turning the Stockholm Metro stairs into a grand piano, which increased commuter stair use.
How could “nudging” foster greater scanning compliance during the COVID pandemic? Currently, the Ministry of Health (MOH) recommends that QR Code posters are printed in A4 size, in two colours, located around 130cm off the ground, and placed on the left near building entrances in a space that is easy for people to reach.4 These are all important suggestions that will help ensure posters are easily noticed and accessed. A recent audit found all supermarkets and most churches examined had adopted this advice, though fewer restaurants, bars and cafés had.1 Clearly, adopting all the MOH display suggestions is an important first step in promoting QR scanning; however, could more be done to “nudge” people so they scan these codes more frequently? We believe several small environmental changes could enhance compliance.
First, the QR code itself could become more salient if posters were brightly coloured and thus more likely to attract attention. While the MOH encourages stores to provide copies of QR codes inside stores, casual observation suggests relatively few do. Locating additional QR codes at counters or checkouts, the places where people stop when making a purchase, could simplify scanning. For example, people may already be using their phones (to pay for an item or read messages) and could easily scan a QR code located next to the EFTPOS machine or alongside the aisles where they queue ahead of purchasing. Restaurants and cafés could place QR codes at counters, tables and on menus, and buses could locate codes on the back of each seat (as well as on entry and exit doors) to simplify scanning. Takeaway outlets could place QR codes on packaging (e.g. on paper bags) so people could scan these once they were back at their desk or wherever they planned to eat. These very simple measures could reduce the physical and time cost of scanning, which will make it easier for scanning to become habitual.
Scanning could also become more normalised if it became part of the everyday conversations people have when entering a store or stepping onto a bus. As well as greeting people, retail staff, drivers, and hosts could remind customers and passengers to scan, and point out the (many) handily located QR codes available to them. These messages could complement official promotions such as government advertising; the latter will have wide reach while the former will communicate with people as the opportunity to scan occurs: when they enter a store and can use a QR code. Everyday conversations such as these would remain casual and retail staff, drivers and hosts, would not become responsible for monitoring scanning. Nonetheless, simply by incorporating a reminder to scan in the everyday conversations they have with customers, these staff could play a core role in reminding people to scan and promoting point-of-entry compliance.
Similar measures could promote more widespread and regular mask-wearing. Public transport staff, such as bus drivers, could model appropriate mask-wearing, remind people not wearing masks to do so, and offer free masks to anyone who embarks without a mask (as airlines currently do). Drivers who have exemptions could place a sign noting their exemption where passengers can easily read it; this simple measure would recognise mask-wearing as normative and avoid an inadvertent message that mask-wearing is optional. More generally, NZ could adopt the sunflower-decorated lanyard and card system used in the UK to indicate an exemption from wearing a mask (e.g., due to an invisible disability).
These examples involve minor changes in the environment but could “nudge” people into greater compliance with QR scanning and mask wearing. However, as we and others have argued, “nudging” is not a replacement for regulation.5,6 Our suggestions would thus sit alongside measures mandating QR scanning and mask-wearing in high risk settings (bars, night clubs and gyms etc.), and help embed these two important practices in our daily lives.
* Authors: Hoek is a former Professor of Marketing and introduced the first social marketing courses taught in New Zealand universities; she is now a Professor of Public Health. Gendall is an Emeritus Professor of Marketing. Wilson is a Professor of Public Health.
- Parkin L, Singh A, Seddon E, et al. Audit of NZ COVID Tracer QR poster display and use in Dunedin. New Zealand Medical Journal. 2021;134(1532):67-76.
- Vlaev I, King D, Dolan P, Darzi A. The theory and practice of “nudging”: changing health behaviors. Public Administration Review. 2016;76(4):550-561.
- Thaler R, Sunstein C. Nudge: Improving Decisions about Health, Wealth and Happiness. New Haven, CT: Yale University Press; 2008.
- Ministry of Health. How to display your QR code poster. 2020; https://www.health.govt.nz/system/files/documents/pages/how_to_display_your_qr_code_poster.pdf. Accessed 29 June, 2021.
- Marteau TM, Ogilvie D, Roland M, Suhrcke M, Kelly MP. Judging nudging: can nudging improve population health? BMJ. 2011;342.
- Hoek J, Jones SC. Regulation, public health and social marketing: A behaviour change trinity. Journal of Social Marketing. 2011;1(1):32-44.