Dr. Wiafe-Akenten Writes: COVID-19, Behavioural And Attitudinal Issues And Way Forward
Coronavirus is arguably the most topical issue in Ghana and throughout the world today. Though this is not the first time that such an outbreak has occurred, none of them has been as global and prevalent in recent times as is the case with COVID-19.
Besides, because of its novel nature, not all the relevant information is known, hence scientists continue to work diligently in the laboratory with the main objective of gaining more insight into the virus and to ultimately come out with a vaccine that will cure the disease.
The facts currently available on the disease include where it was first detected, its approximate incubation period, the major mode of transmission but its cure is not yet available.
Like any other disease, knowledge of the pathogen (bacterial, viral, fungal, etc.,), is very critical because it is the basis for understanding its nature and determining how it will be tackled. The Health Ministry, the National Emergency Response Team and related bodies must be commended for their efforts and the measures put in place to manage the situation and to eventually bring it under control.
From a social psychologist's perspective, the other important issues that need urgent attention include; behavioural, attitudinal, stigma, communication as well as the provision of support and firm assurance to our health officials. Behavioural and Attitudinal Issues:
For the purposes of this write-up, behaviour is defined as the outward actions exhibited by an individual. It is also important to further categorize these actions into conscious or purposive and automatic, habitual or 'off-consciousness'. Among the conscious or purposive ones are face washing, teeth brushing, talking, eating, walking and driving while the automatic ones include touching or picking one's nose, robing or scratching one's eyes, touching the face in general and scratching the head.
I am referring to these as automatic/habitual/off-consciousness behaviours mainly because a significant number of persons engage in them instinctively. In essence, these patterns of behaviours have been developed over the years and are usually acted automatically even in public or social settings where they are considered inappropriate. In other words, these behaviours are processed automatically without conscious effort and/or knowledge of the individual. Indeed, some people engage in such behaviours as if they are wired to though in reality they were learned.
Coincidentally, apart from avoiding handshake and maintaining the recommended social distance, one other key recommendation is for us to avoid touching our face (especially the mouth, nose and eyes) if we have not washed them thoroughly. This is where a significant number of us may be at greater risk because as indicated earlier, touching one's face, nose and eye, in particular, is usually done automatically. In light of this, there is an urgent need for all of us to make an extra conscious effort not to engage in any of these automatic behaviours.
I must admit that this will not be easy to change abruptly as habits die hard. To change or abandon entrenched habits involve a number of adjustments, purposive decisions and self-discipline. We can, however, surmount these difficulties in a number of ways.
The first one is self-consciousness and discipline. Now that we have been reminded or made aware/conscious that these behaviours are usually automatic, we must make strenuous efforts to remind ourselves of the need to avoid these unhealthy actions/behaviours. Secondary, we should ask those around us who we are comfortable with, and can also trust, to observe us and draw our attention (be one another's gate-keeper) the moment they see us engaging in any of these behaviours. We may also write and post reminders on vantage points in our offices, kitchen, halls and bedrooms or program it on our cellular phones to remind us periodically not to touch any part of our face if we have not scrupulously washed our hands/fingers with soap or sanitized them.
As humans, we have attitudes towards all known objects (animate, inanimate, situations, institutions, etc.,) Like, habits, these attitudes have been built up over the years to a point where some of them have become as solid as concrete pillars. In the context of the on-going discussions, we already have certain attitudes towards social distance, hand-washing and all the precautionary measures we have been advised to take. For instance, those whose attitude towards hand washing is positive and probably have been doing it in the past will not find it difficult at all to continue the habit and may even gladly increase the frequency as recommended. On the other hand, those who hold ambivalent and negative attitudes towards handwashing may not be willing (may even find it very difficult) to do so unless there are very compelling reasons or they are under compulsion with sanctions to act as expected.
Indeed, such persons will defend their prevailing attitude by coming out with reasons (cogent or illogical, rational, irrational, etc.,) why they do not have to bother themselves to wash their hands. A similar scenario will apply to keep the recommended social distance and to stay at home – except for a very urgent reason. With these in mind as some of the challenges that may adversely affect the fight against COVID-19 in Ghana, it is of critical importance to step up the on-going communication to the general public to reduce to the barest minimum the potential effect of automatic behaviours and uncomplimentary attitudes on the spread of COVID-19.
Attitudes are learned and to a greater extent are pre-programmed hence they pop-up in reaction to issues and situations mostly without much thought or analysis of the specific situation. Changing existing attitudes is like stopping habits. It is not easy because it involves doing some things differently, learning new things, dropping some of the things we like and are used to and even in some instances avoiding or reducing the number of contacts with some family members and friends. In other words, it affects our comfort zone. Stigma
Basically, stigma is the negative labelling of a person usually because the person's behaviour or attitude is out of the norm or goes against the status quo. Because COVID-19 is very contagious and fatal, those affected are likely to be perceived as 'dangerous' hence there is the high likelihood that they will be avoided for fear of contamination. This may, in turn, lead to a situation where those who are experiencing the symptoms may not only hide it from others but may also not seek professional help. If this happens it has a high potential of increasing community spread. In some instances, stigma may even be carried beyond the disease period. Either way, stigma can lead to psychological challenges in addition to negatively affecting the fight against the disease. Given this background, there is an urgent need for the on-going communication to address the issue of stigma in order not to complicate the anxiety those under contact tracing and those already affected may be going through.Communication
The next level in the country's stride to reduce the infection rate and fatality of the COVID-19 is for the relevant institutions to regularly up-date and equip the citizens with information that will enable them to act appropriately and also differentiate factual and reliable information from the numerous rumours and unreliable ones circulated on the various social media platforms. So far, so good but as with every teacher's favourite phrase on a report card 'there is more room for improvement'. Among others, we have been strongly urged to avoid handshake, keep social distance and avoid gathering unless it is very critical. Regular updates from the Ministry of Health or the Information Ministry are highly recommended. Vans from the Information Ministry should be deployed to deprived and crowded settlements/communities to provide relevant information to the population. Every important aspect of the disease must be emphasized with the use of everyday examples and analogies to enhance understanding and reduce the issue of invisibility – the perception by individuals (based on unexplained and/or illogical/irrational reason(s) that they are not vulnerable and therefore will not be affected.
In the light of the above, I would like to commend the Ghana Private Road Transport Union (GPRTU) for accepting to play recorded messages on the virus in their vehicles plying long-distance routes. Professionally, it will be more effective if the messages are played intermittently (especially interspersed with their usual movies) rather than being the only pieces of information to be provided throughout the journey. This would be boring and passengers are likely to tune off. In addition to the above, cautious sincerity must be exercised – nothing should be down-played nor should exaggerate fear be induced. For instance, the public must know and prepare their minds that in situations like this, it is likely to get worst before it gets better.
Thus, relevant information should not be kept away from the citizens just because it is believed or expected that it may create fear and panic. Neither should non-factual information also be provided because we want to put the citizens at ease. The key issue here is information management and the need to invoke one of the key communication and attitudinal change adages which states that 'fact-based alarm is better than hope-based (or non-factual-based – my emphasize) calm' When information is properly and professionally managed, extreme fear will be reduced because the individual will have a sense of control in terms of what to do to reduce his/her vulnerability.
It is also recommended that the information for the public should be in the major Ghanaian languages (as was the case of the re-denomination of the cedi and also fa semena ye advert) and also played on both radio and television and at different times of the day.
The President's updates (three so far) are very critical as they indicate the seriousness he attaches to the problem and the efforts being made to control it. With the passing of the Emergency Act, individuals and groups who violate any of them and put themselves and others at risk should be punished. We should take cognizance of the fact that not everyone will willing abide by laws hence the whip must be applied ruthlessly in this unusual period.
Those on contact tracing must be made to understand that it is in their own interest and that of the larger population to strictly go by what they have been asked to do – self or institutional quarantine. Looking at the general attitude of most of us – Ghanaians – it is time the health officials enforce institutional quarantine as most individuals cannot be trusted to do so in the interest of the general good/public. Welfare of our health officials
Another critical area is the welfare of our health officials. Personal protection equipment (PPE) and other relevant tools/kits must be made readily available to facilitate and enhance their work to provide the necessary care while at the same time giving them the assurance, security and comfort to work enthusiastically and thus reduce fear and apprehension. This is a national issue that requires everyone to contribute to ensuring that the situation is contained.
The state represented by the government, the various institutions and we the individuals have key roles to play. We should rather make suggestions on how to improve upon the measures put in place and what else to do rather than the usual criticism which are almost invariably not accompanied by suggestions. We are Ghanaians first and foremost – politics, ethnicity, social class and the rest are all secondary and not even important at this point. Multi-sectorial Approach
Per the scope and nature of the problem, there is the need for a multi-sectoral approach involving not only the health professionals but also researchers, national security, the police, the military, immigration, fire-service, national disaster management, religious bodies, civil society group/NGOs, the media, communication experts social workers and psychologists. Each of these bodies will tackle the issue from a different perspective and together we will achieve the expected results. As much as possible the media should restrict their interviews and radio/television discussions on the subject to individuals and groups with requisite knowledge and insight (professionals) to reduce misinformation. Information on the subject must also be crossed checked with the relevant individuals or office/institutions before it is made public to enhance proper information management.
The government. represented by the President and his Ministers, should be conscious of the fact that they are in charge of the affairs of the nation hence they carry the biggest burden in ensuring that the right decisions are taken and that those assigned to play roles in this critical period do not sabotage the process by doing business as usual. The buck stops with the government and they will, therefore, receive all the applause when Ghanaians have reason to believe that they have done their ultimate BEST. Conversely, if the assessment is that even their BEST was not good enough then, they should be ready for the punches which some Ghanaians are experts in delivering. These are extremely difficult and unusual times and therefore require tough decisions and, in some cases harsh measures.
May God Bless, Save and Be With Us.
Thank you for your time.
By: Wiafe-Akenten Brenya, PhD
(Senior Lecturer and a Social Psychologist,
Dept. of Psychology, Univ. of Ghana)