Exploring the Role of Enforcement in Promoting Adherence with Protective Behaviours During COVID-19

Purpose: To explore the conditions under which enforcement likely is, or is not, an effective strategy to increase adherence to recommended protective behaviours during COVID-19. Design/Methodology/Approach: Relevant search terms were entered into three key databases (Google Scholar, medXriv, psyArXiv) to identify both peer-reviewed and pre-publication articles that reported empirical data relating to the impact of enforcement on adherence with recommended public health behaviours. Findings: Enforcement is less effective when: it is applied inconsistently; rules are ambiguous; behaviours are unobservable. Providing food and financial support, creating social norms and increasing trust are more effective in addressing specific barriers and fostering voluntary adherence. Where enforcement forms part of the strategy for policing COVID-19 regulations, rules must be clear and local responders must be given time and opportunity to plan their response as new rules are implemented. Research limitations/implications: This narrative review was limited to papers published in English and available either via the databases searched, or via reference searching; some relevant studies may therefore not have been identified. Practical implications: Findings inform an understanding of the impact of enforcement on adherence and facilitate the development of recommendations for increasing adherence to protective behaviours during COVID-19. Given the importance of public adherence, these recommendations are not only useful in the context of COVID-19 but also for future public health emergencies. Originality/value: This narrative review is the first to explore the circumstances under which enforcement can increase or reduce adherence with COVID-19 guidelines, generating recommendations for improved public adherence.