Behavioral Science Strategies for Reducing the Spread of Illnesses in Organizations

Behavioral Science Strategies for Reducing the Spread of Illnesses in Organizations

By Jessica Nastasi, M.A., BCBA and Nicole Gravina, Ph.D.

On December 31st, 2019, the World Health Organization (WHO) was informed of an outbreak of pneumonia, now dubbed the coronavirus or COVID-19, in Wuhan, China. By January 20th, 2020, the first case of COVID-19 was reported in the US, and ten days later the WHO declared the coronavirus a public health emergency of international concern. On March 10th, the US surpassed 1,000 confirmed cases of COVID-19. On  March 11th, the WHO declared the outbreak a pandemic. The  rapid spread  of  COVID-19  indicates  a person-to-person mode of transmission, and reports of community spread cases (i.e., infection without a clear mode of transmission) continue to increase exponentially.

The workplace can serve as a hub of disease transmission if proper precautions are not enacted. Many  workplaces provide essential services to the community,  and some  employees cannot afford to miss work.  When workplaces  must stay open,  and employees cannot work remotely, the  Center for Disease Control and Prevention (CDC) recommends that all employers consider several  preventative and reactive strategies for decreasing the spread of COVID-19  and other illnesses  in the workplace. These recommendations  include:

  1. Encouraging sick employees, clients and customers to stay home
  2. Performing routine environmental cleaning to disinfect areas subject to frequent human contact
  3. Handwashing or hand-sanitizing
  4. Avoiding touching the face
  5. Avoiding close contact with others

Behavioral  science has studied strategies for increasing workplace behaviors that reduce the spread of illness. Below we outline recommendations  for encouraging some of these workplace behaviors  based on behavioral  science research.

Hand Hygiene

Teach  proper hand hygiene. If you were to enter any given bathroom  before  this pandemic, you’d probably  observe many  people washing their hands … improperly.  The CDC handwashing checklist recommends washing hands  while  rubbing all surfaces for at least 20 s; time roughly equivalent to singing the “happy birthday” song twice.  When handwashing isn’t an option, hand sanitizers with at least 60% alcohol can be used, covering every surface of the hands.  The CDC offers useful signs that can aid in training proper hand washing.  While  employees may need to learn  the appropriate  handwashing procedure, it is likely insufficient to create sustained behavior change without other intervention components.

Reduce response effort.  Employers  can reduce response effort by making  hand sanitizer readily available in the workplace.   For example, employers could place portable hand sanitizer in multiple locations in the workplace to reduce the effort required to clean  hands (Gould et al., 2017). A study conducted by Fournier and Berry (2012) found that well-placed hand sanitizer increased hand hygiene compliance among university students  from 0% to 60%,  when combined with informational signs.

Add reminders. Employees may need  reminders  to wash or sanitize their hands regularly.  Reminders  can  include  signs,  texts,  emails,  face-to-face  communications,  or  schedule-based  (e.g., start every meeting by passing around sanitizer). Cruz et al. (2019) increased staff handwashing by 2 out of 3 participants in a clinic that served children with autism by having supervisors remind them by email to wash their hands. The third participant required feedback to improve her performance.

Feedback. The most effective intervention for improving hand hygiene in the research literature is  feedback , meaning, giving employees information about their performance. Researchers have improved hand sanitizing in  a hospital  by using package interventions that included feedback.  A simple feedback intervention could involve inconspicuously observing employees when they should be washing hands (e.g., when returning from lunch) , and posting a feedback graph of the observations.  After a training intervention failed, Geller and colleagues doubled handwashing in a  university  cafeteria  by providing employees daily feedback on their performance.

Face Touching

Self-monitoring.  Self-monitoring involves recording your own behavior, which can occur after each behavior or at the end of a time interval.  In a series of studies conducted by Steve Hayes and Rosemary Nelson in the late 70’s and early 80’s, researchers found that self-monitoring was an effective intervention for reducing face touching by college students  during class. The intervention reduced student face touching   by 50% or more across studies  (e.g., Hayes & Cavior, 1777; Hayes & Nelson, 1983; Nelson et al., 1982)

Make it  salient. One challenge with reducing face touching is that we often  engage in the behavior without noticing it. We can make our behavior more salient by sitting in front of a mirror, putting something on our finger (e.g., bandage),  or by wearing a wristband with a bell attached. The  added  visual, tactile, or auditory  stimulus could  improve our  ability to  self-monitor,  and in turn, reduce the behavior.

Recruit a friend.  If we are having a difficult time noticing our own face touching, we may be able to recruit a friend  or family member  to  offer feedback  when we touch our face. Incentivize your friend for  mentioning the face touches  by offering them a quarter or another  reward  every time they catch you touching your face.  Send the cash  you owe  them  via Venmo, though – money is full of germs.

Workplace Cleaning

Create a checklist.  Almost every cleaning study we could find in the behavior analysis literature included a checklist  that clarified the cleaning tasks and expectations  (e.g.,  Anderson et al, 1988;  Doll et al., 2007; Pampino et al., 2004).  Checklists  should be simple  and can include photos of the space when it is clean.  Employees can use checklists as  self-monitoring tool, checking  off items as they complete  them.

Feedback.  Observations can be conducted throughout the day or at the end of the day to measure cleaning completion. Researchers have used public group feedback as well as  individualized feedback to improve cleaning performance.  In a study conducted at a university bar,  Anderson and colleagues (1988) assigned each employee a code and posted individual cleaning performance publicly so that employees could see their performance with respect to other employees, without being able to identify them. While task clarification improved cleaning performance by 13%, the addition of graphic feedback improved performance by 37% more.

Social Distancing

The CDC also recommends social distancing, which is a public health practice meant to prevent sick people from coming into contact with healthy people. Social distancing involves avoiding places where people congregate, and when in public, maintaining a distance of at least 6 ft.  However, this is not feasible for all occupations. 

If employees must be in the workplace, employers can still take steps to increase  the  distance between people  and decrease the number of people they contact by examining the process.  For example, librarians could select books for people who order them in advance and leave them at the front door.  Employees who work in autism clinics could work with one child for the full day in an isolated room, and supervision could be conducted remotely.  Grocery stores could encourage customers to use the automated checkout system and gas stations could request that people use credit cards at the pump.  Employers can examine their work process to identify all points of person-to-person contact and determine if changes in the process can reduce the amount of contact. Although these process changes may not be ideal for the organization, they are temporary solutions to reduce the spread of illness.


The number of COVID-19 cases continues  to increase exponentially in the US. Organizations can play a critical role in preventing disease transmission and protecting employees who are unable to avoid community exposure.   Researchers have demonstrated that simple antecedent and consequence-based interventions can markedly improve  behaviors that reduce the spread of illnesses at work.   We suggest employers enact some of these strategies right away  to help slow the spread of illness and protect the most vulnerable members of our communities.