Social distancing: barriers to its implementation and how they can be overcome - a rapid systematic review

AimTo systematically review qualitative literature on social distancing in order to identify and describe factors that enable or prevent its implementation.

MethodsA rapid systematic qualitative review was conducted for which a comprehensive systematic search was carried out across eleven databases. Included papers report on primary qualitative studies of the barriers and facilitators to the implementation of social distancing measures in potentially epidemic infectious diseases. An adapted meta-ethnographical approach was used for synthesis. Review findings were assessed for strength and reliability using GRADE-CERQual.

Results29 papers were included from the systematic search that yielded 5620 results and supplementary methods. The review identifies two broad categories of barriers to social distancing measures: individual- or community-level psychological or sociological phenomena, and perceived shortcomings in governmental action. Based on this, 25 themes are identified that can be addressed to improve the implementation of social distancing.

ConclusionThere are many barriers, on different levels, to the implementation of social distancing measures. Among other findings, the review identifies the need for good communication as well as the need for authorities to provide comprehensive support as two key opportunities to increase acceptability and adherence. High-quality research is needed during the COVID-19 pandemic to better describe mechanisms by which implementation of social distancing can be improved, and, more importantly, what is already known has to be put into practice.