Mobile application-based behaviour change techniques to encourage quarantine compliance during the COVID-19 pandemic.

Coronavirus disease 2019 (COVID-19) is rapidly spreading in many countries. It has caused many deaths, which has forced governments to introduce measures that restrict movements within the population, including medical isolation and home quarantine. In some countries, during the rapid progression of the pandemic, residents were required to stay at home and only leave for essential activities. However, such strong quarantine measures greatly restrict activities and violate citizens' rights. Some reports have shown that not everyone is receptive to voluntary quarantine measures, and mental health, including anxiety and loneliness, may worsen during periods of quarantine. ,

This letter proposes the hypothesis that reward mechanisms based on behaviour change techniques (BCTs) through various mobile applications (apps) may encourage compliance with quarantine measures. Thus, individuals would actively and spontaneously adhere to the imposed restrictions, ultimately resulting in reduced transmission and control of the COVID-19 pandemic.

Behaviour change theories attempt to elucidate the mechanisms for behavioural changes and propose that environmental, personal and behavioural characteristics are the major factors in behavioural determination. BCTs are theory-based methods or techniques for behavioural changes; these interventions can be replicated and are the active components in the process of changing or regulating a certain behaviour. Behaviour change can be promoted by ‘increasing the factors that promote behavioural change’ or ‘reducing the factors that inhibit behavioural change’. BCTs have already been used in many health-improving apps, including apps for smoking cessation and increasing exercise. , Meanwhile, with the development of telecommunication, mobile apps and online games have become one of the most important pastimes during periods of home isolation and can alleviate feelings of loneliness and anxiety.

To design a guide and as per the classification of BCTs in the study by Michie et al., we chose to include (ⅰ) material incentive (behaviour) and (ⅱ) social incentive, which are in the category of ‘Reward’, and (ⅲ) identification of self as a role model, which is in the category of ‘Threat and Identity’ (see supplementary material).

Material incentive (behaviour): money, vouchers or other valuable items will only be delivered when effort and/or progress has been made in the execution of a behaviour (‘positive reinforcement’).

Social incentive: verbal or non-verbal rewards will only be provided when effort and/or progress has been made in the execution of a behaviour (‘positive reinforcement’).

Identification of self as a role model: inform that one's own behaviour may be an example to others.

There are two typical types of apps wherein BCTs can be used. The first is a social media app, such as Twitter. Two types of BCTs can be combined in these apps, namely, ‘social incentive’ and ‘identification of self as a role model’. By providing a special ‘title’ as a reward and identifying users who comply with quarantine as role models, individuals are encouraged to adhere to home quarantine restrictions. Specific measures could include the requirement to ‘sign in’ at the same location several times every day. After signing in for a certain number of consecutive days, a special ‘title’ could be granted and displayed on the user's homepage (see supplementary material).

The second type of app is a mobile game, such as ‘PUBG mobile’. The BCT ‘material incentive’ can be used well in such apps. Game companies can provide virtual items as rewards, such as game coins or special skins, to players who comply with home quarantine and sign in through the game page (see supplementary material).

Apps can also combine with the regional real-time risk levels; for example, increasing the consecutive number of sign-in days required for users in high-risk areas, in addition to providing more rewards to achieve better compliance with spontaneous ‘stay-at-home’ behaviours (see supplementary material).

Since the start of the COVID-19 pandemic, some apps have used conformity behaviour to encourage people to post their activities at home on social networks to promote quarantine at home, such as Instagram's Tussen Kunst En Quarantine. Many companies and institutions have provided free entertainment or academic resources to the public to support ‘staying at home’. However, at present, the measures for promoting adherence to quarantine in these apps are relatively mild, lacking strong indicators and sustainable incentives for users to stay at home spontaneously. The suggestions highlighted in this letter may encourage quarantine compliance, thereby further reducing population movement, reducing the risk of infection and reducing the economic cost of suppressing the pandemic.