Facilitators and Barriers to Social Distancing for Young People living in Northern Ireland during the COVID-19 Pandemic

241 words 19 Main body: 5206 words (excluding tables and references) 20


Introduction 48
In response to the COVID-19 pandemic, social distancing guidelines were introduced in both 49 Northern Ireland (NI) and the Republic of Ireland (RoI) in March 2020 [1] and required fundamental 50 changes in how people interact with each other. Social distancing involves a wide range of strategies 51 designed to minimise the spread of the virus by reducing contact between individuals, involving but 52 not limited to, staying at home; reducing social contacts; and maintaining physical distance during 53 interactions with other people [2,3]. While guidance on whether individuals should remain one or two 54 meters apart differs across countries, the key principle is that individuals limit their contacts and keep 55 a physical distance between themselves and other people during any interaction. 56 Social distancing has been shown to be an important component of measures designed to reduce the 57 spread and impact of COVID-19. In NI, early distancing measures were estimated to have reduced the 58 R rate of transmissions from 2.8 to 0.8 [4]. A systematic review of early efforts to control the spread 59 of COVID-19 additionally estimated that physical distancing of over one meter was important in 60 reducing transmission (pooled adjusted OR 0.18, 95% CI 0·09 to 0·38) [5]. Furthermore, a review of 61 studies on the effect of social distancing alone on H1N1 also found a median reduction rate of 23% of 62 cases in the general population; combined with other measures this rose to a median reduction of 75% 63 While young people (e.g. <25) [7] who are deemed medically healthy may experience comparatively 65 lower risk of serious effects of COVID-19, they play an important role in preventing its spread. 66 Young people often have large social circles and are at a developmental stage in which social 67 interactions and relationship building are considered important [7]. Young people may be more 68 influenced by their peers, which may make adhering to social distancing regulations difficult should 69 other members of their social groups not comply with guidelines [7]. In NI in June 2020 there were 70 reports of large crowds of young people gathering on beaches and other public places raising concerns 71 that young people were not adhering to social distancing guidelines [8]. Recent research has also 72 indicated specific challenges faced by young people during the pandemic related to isolation, 73 loneliness and anxiety [7,9], which may impact on behaviours related to social distancing. 74 6 statistics. A report has been produced for the Public Health Agency by members of the HSC R&D 127 Behaviour Change Group, which presents the descriptive statistics and frequencies across responses in 128 full and can be found online [12]. 129 A combined approach to qualitative analysis was adopted to ensure that findings were 130 methodologically sound, while also providing practically and clinically useful results. Reflexive 131 thematic analysis [16,17], framed by a subtle realist approach [18], was used to inductively code and 132 develop subthemes. The qualitative analytic approach was informed by a review undertaken by 133 McGowan and colleagues [19], which recommends that behaviour change theory should be applied 134 flexibly in qualitative work, to ensure that codes and prospective themes are not limited by the 135 framework applied. This enabled the primary qualitative analysts in the team (EB and SA) to 136 inductively code, and develop subthemes liberally from the data. The analysis process followed the 137 key steps outlined by Braun and Clarke [16] which includes transcription and familiarisation with the 138 data, generation of initial codes, examining codes for themes, reviewing potential themes, defining 139 themes, and formulating the report. The data was coded initially by SA and crosschecked by EB. 140 Discussions took place to review codes, which led to the removal, addition, or amalgamation of codes. 141 Parent codes were reviewed and the units of meaning they represented helped to develop subthemes 142 that remained bound to the source code but provided a higher degree of abstraction. This was an 143 iterative process to ensure that the subthemes adequately captured the codes and were valid reflections 144 of the data. Acknowledging the subjective nature of the analytic process, thoughts and observations 145 were noted throughout the analysis and perspectives and interpretations were discussed during team 146 meetings to support a comprehensive reflexive process [20].

165
A total of 477 young people completed the survey. Of these, 96% were residents of Northern Ireland 166 and 73% were female. The average age was 21 years with a standard deviation of 2.4 (range= 9). further help to support social distancing more (the latter is discussed in brief but full list of subthemes 180 and supporting quotes can be found in Table 3). Subthemes extracted inductively are described under 181 the Capability, Opportunity, and Motivation components, to which they have been conceptually 182 mapped. 183

Barriers to social distancing (Q1) 184
Barrier-related subthemes mapped onto all three COM components, with the exception of physical 185 capability (see Table 1). 186

Psychological capability 187
Psychological capability refers to an individual's knowledge and skills to engage in the behaviour, 188 and includes elements of self-regulation [10]. Three subthemes aligned with psychological capability 189 presence of others such as hugging others and shaking hands. 204 "Habits -i.e. being able to freely hug family members before, reaching for something in a 205 shop where someone is also looking at the same item" (participant 352) 206 Subtheme three overlaps with subtheme two, capturing young people's thoughts around alcohol 207 consumption. Some young people felt that alcohol makes it more likely that people will revert to old 208 habits and forget to distance. 209 "When people simply disregard the rules and get close to you. Alcohol also makes it difficult 210 to stick to social distancing due to the loss of awareness." (participant 198) 211

Social opportunity 212
Social opportunity refers to the impact of an individual's social and cultural 'milieu' on behaviour 213 physical environment that make it harder to distance. In particular, young people find it hard to keep a 231 distance in small or busy spaces such as retail environments, friends' homes, and workplaces. 232 "Small spaces in shops, corridors, work, friends houses etc... it isn't always possible to 233 effectively socially distance in certain places. Some people are also not very considerate of 234 your own space" (participant 161) 235 Some young people also mentioned having to car share as an unavoidable barrier to keeping distance. 236 "Most of my friends don't drive so they have to get into my car" (participant 83) 237

Automatic motivation 238
Automatic motivation refers to feelings, habits, and 'innate dispositions' that affect behaviour [10]. Subthemes related to facilitators to social distancing behaviour were mapped onto all three COM 266 components, with the exception of physical capability (see Table 2). 267

Psychological capability 268
Two subthemes aligned with Psychological capability [42 total comments in total]: 1) 'Clear and 269 consistent guidelines' and 2) 'Adapting (pre-pandemic) lifestyle behavior'. Relating to the first 270 subtheme, young people felt that keeping a distance from others in social settings is easier when 271 public spaces like shops have clear instructions about how people are expected to behave and when 272 there is "Consistent guidance from the government on the news and social media" (participant 52). 273 Thus, clarity of instructions was important at a lower, rudimentary level e.g. shopping behaviour, 274 however, there was also the sense that coherent messages from authorities was also important. Some young people reported that adjusting their daily lifestyle by, for instance, "staying at home as 278 much as possible" (participant 287) and only going out when necessary helps them to keep distance 279 by avoiding situations where they need to ensure that they keep a distance from others. A small 280 number of young people also mentioned that adjusting forms of communication with family and 281 friends, for example talking to "friends through social media" and changing the setting of social 282 meetings by "meeting up with friends in quiet parks" (participant 233) helps them to avoid close 283 contact. 284

Social opportunity 285
One subtheme extracted aligned with social opportunity [55 comments in total]: 'Actions of others as 286 an incentive'. Many young people noted that it is easier to keep distance when others also keep 287 distance, and it was felt that others supporting this behaviour by "acting as good role models" 288 (participant 66) encouraged them to practice social distancing. The message underpinning this 289 subtheme compliments the social opportunity barrier previously acknowledged. 290 "Seeing others distancing make me distance" (participant 124) 291

Physical opportunity 292
One broad subtheme extracted aligned with physical opportunity [146 comments in total]: 293 'Environmental support for social distancing: cues and space'. This subtheme suggests that physical 294 environment has a large impact on young people's perceived ability to keep distance and their 295 capacity to remember to keep distance. One element of this subtheme related to how young people felt 296 that environmental cues and reminders and physical prompts facilitated their ability to keep a distance 297 from others and reminded them to keep a distance from others. 298 "Stickers on the ground, spaced out tables when eating, reminders on social media/billboards 299 etc" (participant 155) 300 Another aspect of this subtheme related to the need to have adequate space to practice social 301 distancing, which suggested that young people felt that keeping a distance from others is easier when 302 the physical environment aids this, for example by restructuring indoor spaces or meeting others in 303 outdoor settings. or others safe, to avoid deaths and "helping stop the spread" (participant 92). Some said they kept 319 distance because it was "the right thing to do from the news" (participant 228), which may relate to a 320 number of factors including news reports of contagion and death rates, as well as news coverage on 321 government guidelines around social distancing behavior. 322 "Knowing I'm less likely to make myself/others sick" (participant 64) 323 A small group of young people also reported feeling more motivated to keep a distance from others in 324 social situations after "Noticing that daily cases of covid are increasing" in their own "council area" 325 (participant 251). The final question asked respondents what could be improved or put in place to further facilitate 328 social distancing behaviour. Subthemes for this question were mapped onto all three COM 329 components, with the exception of physical capability and automatic motivation (see Table 3). 330 Subthemes largely complimented the subthemes identified for current/existing facilitators, with regard 331 to greater clarity of guidelines in different social circumstances, increased environmental supports, 332 increased visibility of the supportive behaviour of others, the need for more enforcement of 'rules', 333 and the importance of knowing the risks of contagion and contraction. 334 However, one subtheme, which aligned with reflective motivation, conveyed a different perspective to 335 any of the subthemes described previously [71 comments in total]: 'Sense that nothing (more) can 336 help'. The comments that led to the development of this subtheme tended to relate to the perspective 337 that there is "nothing that can make it [social distancing] easier" and that distancing from others was 338

Discussion 353
This study explores the commonly experienced barriers to and facilitators of social distancing 354 behaviour in young people predominantly from Northern Ireland, using the COM-B model to 355 organize and make sense of the data. This study focuses on a sample of young people, primarily 356 students, who recognize the supports needed to endorse social distancing behaviour, but who 357 experience a range of factors which impede the extent to which they implement this behaviour in 358 daily life. As reported in Berry et al. [12], while a large number of young people social distance 359 frequently, a substantial proportion reported that they do not. This is consistent with previous 360 evidence indicating that adherence to social distancing guidelines is generally lower in younger 361 populations [23,24]. The frequency data reported in Berry et al. [12] suggests that actions of peers, 362 forgetting to keep a distance from others, environmental constraints, and unhelpful emotions 363 contribute to intentions to, or perceived ability to social distance (see Berry et al. [12]). Qualitative 364 analysis of free-text survey responses provided the scope to further explore these observed 365

frequencies. 366
A large number of responses in relation to the barriers and facilitators of social distancing revolved 367 around physical opportunity, and more specifically, the importance of context, cues, and prompts in 368 helping young people to social distance. This is an important area to consider when designing 369 interventions to prompt behaviour and can be particularly effective when combined with clear and 370 simple guidance. Social distancing behavior among young people is influenced by the structure and 371 organization of businesses. For example, pubs, restaurants, and shops not accommodating and/or not 372 enforcing social distancing guidelines was a commonly reported factor among young people. 373