Cropped shot of an attractive young businesswoman getting her covid vaccination from a female nurse in the office
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Workplace requirements are one of the strongest tools for changing behaviors, especially when it comes to COVID-19 vaccinations and masking, according to a cognitive psychologist who spoke Wednesday during a LeadingAge membership call.

Gretchen Chapman, PhD, head of social and decision sciences at Carnegie Mellon University in Pittsburgh, highlighted the psychology of decision-making as it relates to COVID-19.

Although classic decision-making involves a cost-benefit analysis to compare options before making a choice, Chapman said, most decisions are made in a quick, intuitive and emotional way that involves the power of the situation and the influence of social factors.

Many people were “gleefully happy” to put away their masks, she said, arguing, however, that the increasing number of cases and highly transmissible variants means that it is time to mask up again.

But, Chapman said, mask-wearing is an example of the “power of situation.”

“We behave in different ways in different situations depending on the context. The important part of context is social norms, or what other people are doing,” she said. “If we can structure the situation so mask-wearing looks like the normative thing to do, then a lot of folks are going to follow along and follow that norm.”

Humans are social creatures, she said, making it important for people to signal what group they belong to through their behaviors. Along with the way people speak, and their clothing, masks are highly visible and communicate something about someone’s political beliefs, due to the politicized environment in the United States, Chapman said.

The power of situation similarly applies to vaccine mandates from employers, she said. 

Many employers, including long-term care providers, required employees to receive the primary COVID-19 vaccine, and some required the original booster shot, Chapman noted. Those requirements, however, did not extend to the latest bivalent booster, she said. 

The introduction of the booster shot also varied from the rollout of the primary COVID-19 vaccine series, which featured vaccine clinics nationwide and on-site vaccination options for many workplaces, especially long-term care facilities. Although pharmacies offer easy access to vaccines, getting a bivalent booster requires a little more effort by most people. 

“Workplace requirements are one of the strongest tools we have for changing behavior,” Chapman said. “Psychology shows that when you’re trying to persuade someone to take a behavior that they’re not super committed to, that even small differences in convenience can make a difference.”

Workplaces not requiring the bivalent booster also feeds into social norms and sends a message that it is not as important as the previous vaccines, she said. If coworkers have not received the booster and someone has a tendency to do what other people are doing, then the lack of a requirement to get the booster might encourage someone to wait or not get it at all, Chapman said.

“Any way in which we can make getting vaccinated the easy thing to do will be beneficial,” she said. “Will it bring everyone along? No, some people have very principled objections to COVID vaccines. But those people in the middle for whom it’s not a high priority, but they don’t have strong objections, those are the folks we can move along, especially if we can make it very convenient.”

Boosting boosters on many agendas

The renewal of the COVID-19 public health emergency on Wednesday comes as a new omicron variant is taking hold across the country, and only 38% of older adults have received a bivalent booster, according to the Centers for Disease Control and Prevention.

As the country enters the fourth year of dealing with COVID-19, the federal government earlier this month offered its assistance on testing access, vaccines and guidance on antiviral treatments. This action followed the White House release of a COVID-19 Winter Preparedness Plan to help long-term care facilities manage the virus, focusing on improving bivalent booster uptake, increasing access to testing and treatments, and improving indoor air quality.

LeadingAge recently set up a portal to allow providers across all care settings — including assisted living — to apply for free COVID-19 test kits.

In November, LeadingAge and the American Health Care Association / National Center for Assisted Living issued an “all hands on deck” rallying cry to boost booster shot rates in long-term care settings, especially nursing homes. The announcement was in response to a White House announcement regarding a campaign to urge Americans — particularly older adults — to get their updated COVID-19 vaccine.