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

The aim of this narrative review was 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. Relevant search terms were entered into four key databases (Google, Google Scholar, medXriv, and psyArXiv) to identify both academic and non-academic papers relating to the use of enforcement. Primary research, reviews, blogs, newspaper reports, and theoretical descriptions were included. This review suggests that enforcement is less effective when: it is applied inconsistently; rules are ambiguous; and 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. Due to the narrative nature of the review, and the rapidly changing nature of the COVID-19 pandemic, some evidence may have been inadvertently excluded. Findings inform an understanding of the impact of the public narrative 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. 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.