Viral InfectionNCT04583449
Mental Imagery to Increase Face Covering Use in UK-based Public Places During the COVID-19 Pandemic
A study testing Mental imagery in people with Viral Infection and Covid19, run by University of East London at 1 site in United Kingdom.
Trial summary
Wearing face coverings in enclosed public spaces is a key public health measure to limit viral spread during the 2020 Covid-19 pandemic. Health psychologists are interested in developing interventions that can increase the likelihood of health-adherent and protective behaviours being consistently undertaken at a… Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Viral Infection, Covid19
- What is being tested?
- Mental imagery
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 250 participants
- Where
- 1 siteUnited Kingdom
- Study dates
- 19 Aug 2020to 1 Dec 2020
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- 18+ year old adults
Who cannot join
- Not currently living in the UK
Trial locations and contacts
1 site in 1 country.
United Kingdom1 site, 1 recruiting
- Recruiting
University of East London
London
Dominic Conroy, PhD
About this study
Wearing face coverings in enclosed public spaces is a key public health measure to limit viral spread during the 2020 Covid-19 pandemic. Health psychologists are interested in developing interventions that can increase the likelihood of health-adherent and protective behaviours being consistently undertaken at a general population level. Mental imagery interventions are one way in which behavioural scientists and health psychologists try to encourage behaviour change. Mental imagery involves thinking about, and then writing about, anticipated positive outcomes or key practical requirements of a defined health-related action (e.g. 'moderate alcohol consumption'; 'engaging in regular physical activity'). For this project, the investigators are exploring a mental imagery intervention created to encourage regular and consistent wearing of face coverings in public places where this is currently required in the UK. The investigators will test whether engaging in a mental imagery exercise results in any improvement in wearing a face covering (or intention to wear a face covering) one month later relative to reading a public health message about face coverings. In addition, the investigators will explore belief-based and personality-related factors that might make a difference to the effectiveness of the mental imagery intervention.
Read the detailed description
Background The 2020 Covid-19 pandemic has required wide-ranging efforts to minimize the spread of the virus and to protect those most vulnerable to becoming unwell as a result of viral infection. These measures include social distancing, regular hand washing and wearing face coverings in public places where an individual is, inevitably, in closer proximity to non-household others than when not in a public place.
The evidence base for using face coverings in the context of the Covid-19 virus has been mixed and is applied in different ways in different countries. However, there is scientific consensus has been that wearing a face covering is likely to decrease viral transmissibility and, relatedly, substantially reduce the death toll and economic impact of the pandemic. The scientific evidence suggests that face coverings primarily offer protection to other people from the person wearing the face covering (who may, knowingly or not, been infected with the virus) rather than offering the person wearing the face covering personal protection themselves. In the UK, the most recent government advice (at time of writing, published on 7th August 2020) supports the use of face coverings.
Previous studies have suggested that varied demographic and belief-based factors (including perceived benefits) may influence variation in individuals' willingness to wear a face covering in the context of a viral epidemic/pandemic past and present. The Covid-19 pandemic is particular in the sense that the risk of viral infection is understood to be greatest to individuals other than the wearer of the face covering and, for this reason, psychological theories concerned with risk susceptibility/vulnerability (e.g. Protection Motivation Theory; Health Belief Model) may have less predictive utility in the context of the 2020 pandemic. However, other social-cognitive psychological theory may offer valuable insights into factors linked to face covering adherence. For example, variation in face covering wearing adherence would be predicted by traditional behavioural science theory as closely linked to a range of key beliefs about the target behaviour. Relevant belief-related factors include attitudes towards face covering (i.e. whether an individual holds (un)favourable beliefs about face covering are held), subjective norms towards face covering (e.g. whether an individual believes that important others such as friends and family hold (un)favourable beliefs about face covering), and perceived behavioural control towards face covering (i.e. the extent to which an individual believes they possess control over deciding to wear a face covering). Whether an individual believes they possess a high level of skill in using face coverings in required situations (i.e. public places/spaces) would also be theorized to predict face covering behaviour.
A further consideration linked to individual adherence to face covering requirements is what 'type' of person that individual is in terms of various relevant personality traits. For example, a relatively conscientious person might be expected to be more likely to routinely wear a face covering to protect individuals in close proximity from the risk of viral infection. Similarly, face covering adherence might be more likely among individuals whose personalities are characterised by humanistic, beneficent orientations towards other people. By contrast, an individual who self-reports high levels of narcissism, may be less likely to wear a face covering given that wearing a face covering might clash with their relatively vain/egotistical self-image.
In summary, this study aims to determine if different types of mental imagery intervention impact on face covering intentions and face covering adherence at a follow-up time point. The second study aim is to explore, through exploratory analyses, whether individual differences in light triad traits, conscientiousness, and narcissism will influence the impact of imagery interventions. Thirdly, the moderating role of social-cognitive variables of intervention effects will be explored. Fourthly, variation in 'imagery ability' (how capable individuals are at visualizing future actions) will be examined as a mediator of potential intervention effects.
Research questions
- Do mental imagery exercises increase intentions to use face coverings in public where required?
- Do mental imagery exercises increase self-reported wearing of face coverings in public where required?
- Do light triad personality traits moderate the relationship between condition allocation (imagery or not) and self-reported face covering wearing intention or action?
- Do Theory of Planned Behaviour variables moderate/mediate the relationship between condition allocation (imagery or not) and self-reported face covering wearing intention or action?
- Does imagery ability moderate/mediate the relationship between condition allocation (imagery or not) and self-reported face covering wearing intention or action?
Hypotheses
It is hypothesised that individuals assigned to any imagery intervention condition will report:
- Significantly higher intentions to wear face coverings in public places where these are required, relative to the control condition at T2 (primary outcome; hypothesis 1).
- Significantly higher levels of self-reported face covering relative to the control condition at T3 (primary outcome; hypothesis 2).
- Significantly more favourable attitudes, subjective norms, barrier self-efficacy and perceived behavioural control linked to face covering wearing at T2 and T3 (hypotheses 3 and 4).
- Finally, it is hypothesied that imagery intervention effects on primary outcome variables at T2 and T3 will be conditional on being more conscientious, less narcissistic, and being characterised by higher levels of 'light triad' personality traits (hypothesis 5).
- Conditions
- Viral Infection, Covid19
- Being tested
- Mental imagery
- Medical subject headings
- Virus Diseases, COVID-19
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Mental imageryBehavioural
Mental imagery involves the mental representation of a future event, action, or task. By imitating or rehearsing this mental event or series of events" (Taylor et al., 1998, p. 430) mental imagery interventionists theorise that an individual's preparation for, and motivation toward, a future action can be made more likely. Mental imagery involves an individual following a set of pre-defined exercises involving thinking about, visualising and writing about a health-related action. Mental imagery exercises can involve focusing on anticipated positive/beneficial outcomes of an action (outcome imagery) or imagery relating to the anticipated strategies/preparation that would be required to successfully execute a pre-defined action (process imagery).
| Study group | Role | What they receive |
|---|---|---|
| Outcome imagery | Experimental | Outcome imagery condition participants will be asked to visualize themselves successfully wearing a face covering in all required public places/situations over coming week, and to imagine how they would feel. The importance of imagining distinctive relevant visual imagery linked to having successfully routinely worn face covering will be underscored in this passage. Outcome imagery participants will then be asked to write in a free-text box how they would feel having successfully worn a face covering in required public places/situations over the week ahead. Receives: Behavioral: Mental imagery |
| Process imagery | Experimental | Process imagery condition participants will be asked to visualize the kinds of strategies involved in successfully wearing a face covering in all required public places/situations over the coming week. The importance of imagining distinctive relevant visual imagery linked to having effective strategies involved in successfully wearing a face covering in required public places/situations over the week ahead will be underscored in this passage. Process imagery participants will then be asked to write in a free-text box about the kinds of strategies that would be involved in successfully wearing a face covering in all required public places/situations over the coming week. Receives: Behavioral: Mental imagery |
| Combined imagery (outcome imagery and process imagery) | Experimental | A third experimental condition will receive both outcome and process imagery exercises to read and complete in sequential order. Receives: Behavioral: Mental imagery |
| Public health message | No intervention | A fourth condition will involve viewing a UK Government public health message (HM Government, 2020) circulated on social media as an image concerning the importance of wearing face covering while in public places. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Face covering wearing consistency
Self-reported single item response statement with a Likert-type response. Minimum value = 1; maximum value = 5 (a higher score indicates a better outcome).
Measured: 4 weeks post-intervention
Face covering wearing intention
Self-reported three item response scale with Likert-type responses. Minimum value = 1; maximum value = 5 (a higher score indicates a better outcome).
Measured: 4 weeks post-intervention
Secondary outcomes (5)
Attitude toward wearing a face covering
Self-reported 3 item response scale with Likert-type responses. Minimum value = 1; maximum value = 5 (a higher score indicates a worse outcome).
Measured: 4 weeks post-intervention
Injunctive norm beliefs about wearing a face covering
Self-reported 2 item response scale with Likert-type responses. Minimum value = 1; maximum value = 5 (a higher score indicates a better outcome).
Measured: 4 weeks post-intervention
Descriptive norm beliefs about wearing a face covering
Self-reported 2 item response scale with Likert-type responses. Minimum value = 1; maximum value = 5 (a higher score indicates a better outcome).
Measured: 4 weeks post-intervention
Perceived behavioural control over wearing a face covering
Self-reported 3 item response scale with Likert-type responses. Minimum value = 1; maximum value = 5 (a higher score indicates a better outcome).
Measured: 4 weeks post-intervention
Barrier self-efficacy to wearing a face covering
Self-reported 6 item response scale with Likert-type responses. Minimum value = 1; maximum value = 5 (a higher score indicates a better outcome).
Measured: 4 weeks post-intervention
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted12 Oct 2020
- Study start19 Aug 2020
- Primary completion1 Dec 2020 (estimated)
- Study completion1 Dec 2020 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Viral InfectionStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Factorial
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 250 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University of East London
- Sponsor type
- University, hospital or other
- Collaborators
- University of Manchester
- Responsible party
- Principal investigator, Dominic Conroy, University of East London
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04583449
- Sponsor's protocol ID
- ETH2021-0006
- Status last verified
- Oct 2020
- First submitted
- 2 Oct 2020
- Last updated
- 12 Oct 2020
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: We will share the anonymised data as a Supplementary file when submitting a research write-up as an article to a suitable academic journal.
Publications
Conroy D. Mental imagery interventions to promote face covering use among UK university students and employees during the COVID-19 pandemic: study protocol for a randomized controlled trial. Trials. 2022 Jan 18;23(1):51. doi: 10.1186/s13063-021-05852-y.
PubMed 35042564
Study at a glance
From the registry record, last updated by the sponsor on 12 Oct 2020. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Mental Imagery to Increase Face Covering Use in UK-based Public Places During the COVID-19 Pandemic
- ClinicalTrials.gov ID
- NCT04583449
- Acronym / sponsor ID
- ETH2021-0006
- Conditions
- Viral Infection, Covid19
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 250 participants (estimated)
- Lead sponsor
- University of East LondonUniversity, hospital or other
- Collaborators
- University of Manchester
- Study start
- 19 Aug 2020 (actual)
- Primary completion
- 1 Dec 2020 (estimated)
- Study completion
- 1 Dec 2020 (estimated)
- First posted
- 12 Oct 2020 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Wearing face coverings in enclosed public spaces is a key public health measure to limit viral spread during the 2020 Covid-19 pandemic. Health psychologists are interested in developing interventions that can increase the likelihood of health-adherent and protective behaviours being consistently undertaken at a general population level. Mental imagery interventions are one way in which behavioural scientists and health psychologists try to encourage behaviour change. Mental imagery involves thinking about, and then writing about, anticipated positive outcomes or key practical requirements of a defined health-related action (e.g. 'moderate alcohol consumption'; 'engaging in regular physical activity'). For this project, the investigators are exploring a mental imagery intervention created to encourage regular and consistent wearing of face coverings in public places where this is currently required in the UK. The investigators will test whether engaging in a mental imagery exercise results in any improvement in wearing a face covering (or intention to wear a face covering) one month later relative to reading a public health message about face coverings. In addition, the investigators will explore belief-based and personality-related factors that might make a difference to the effectiveness of the mental imagery intervention.
Detailed description
Background The 2020 Covid-19 pandemic has required wide-ranging efforts to minimize the spread of the virus and to protect those most vulnerable to becoming unwell as a result of viral infection. These measures include social distancing, regular hand washing and wearing face coverings in public places where an individual is, inevitably, in closer proximity to non-household others than when not in a public place.
The evidence base for using face coverings in the context of the Covid-19 virus has been mixed and is applied in different ways in different countries. However, there is scientific consensus has been that wearing a face covering is likely to decrease viral transmissibility and, relatedly, substantially reduce the death toll and economic impact of the pandemic. The scientific evidence suggests that face coverings primarily offer protection to other people from the person wearing the face covering (who may, knowingly or not, been infected with the virus) rather than offering the person wearing the face covering personal protection themselves. In the UK, the most recent government advice (at time of writing, published on 7th August 2020) supports the use of face coverings.
Previous studies have suggested that varied demographic and belief-based factors (including perceived benefits) may influence variation in individuals' willingness to wear a face covering in the context of a viral epidemic/pandemic past and present. The Covid-19 pandemic is particular in the sense that the risk of viral infection is understood to be greatest to individuals other than the wearer of the face covering and, for this reason, psychological theories concerned with risk susceptibility/vulnerability (e.g. Protection Motivation Theory; Health Belief Model) may have less predictive utility in the context of the 2020 pandemic. However, other social-cognitive psychological theory may offer valuable insights into factors linked to face covering adherence. For example, variation in face covering wearing adherence would be predicted by traditional behavioural science theory as closely linked to a range of key beliefs about the target behaviour. Relevant belief-related factors include attitudes towards face covering (i.e. whether an individual holds (un)favourable beliefs about face covering are held), subjective norms towards face covering (e.g. whether an individual believes that important others such as friends and family hold (un)favourable beliefs about face covering), and perceived behavioural control towards face covering (i.e. the extent to which an individual believes they possess control over deciding to wear a face covering). Whether an individual believes they possess a high level of skill in using face coverings in required situations (i.e. public places/spaces) would also be theorized to predict face covering behaviour.
A further consideration linked to individual adherence to face covering requirements is what 'type' of person that individual is in terms of various relevant personality traits. For example, a relatively conscientious person might be expected to be more likely to routinely wear a face covering to protect individuals in close proximity from the risk of viral infection. Similarly, face covering adherence might be more likely among individuals whose personalities are characterised by humanistic, beneficent orientations towards other people. By contrast, an individual who self-reports high levels of narcissism, may be less likely to wear a face covering given that wearing a face covering might clash with their relatively vain/egotistical self-image.
In summary, this study aims to determine if different types of mental imagery intervention impact on face covering intentions and face covering adherence at a follow-up time point. The second study aim is to explore, through exploratory analyses, whether individual differences in light triad traits, conscientiousness, and narcissism will influence the impact of imagery interventions. Thirdly, the moderating role of social-cognitive variables of intervention effects will be explored. Fourthly, variation in 'imagery ability' (how capable individuals are at visualizing future actions) will be examined as a mediator of potential intervention effects.
Research questions
- Do mental imagery exercises increase intentions to use face coverings in public where required?
- Do mental imagery exercises increase self-reported wearing of face coverings in public where required?
- Do light triad personality traits moderate the relationship between condition allocation (imagery or not) and self-reported face covering wearing intention or action?
- Do Theory of Planned Behaviour variables moderate/mediate the relationship between condition allocation (imagery or not) and self-reported face covering wearing intention or action?
- Does imagery ability moderate/mediate the relationship between condition allocation (imagery or not) and self-reported face covering wearing intention or action?
Hypotheses
It is hypothesised that individuals assigned to any imagery intervention condition will report:
- Significantly higher intentions to wear face coverings in public places where these are required, relative to the control condition at T2 (primary outcome; hypothesis 1).
- Significantly higher levels of self-reported face covering relative to the control condition at T3 (primary outcome; hypothesis 2).
- Significantly more favourable attitudes, subjective norms, barrier self-efficacy and perceived behavioural control linked to face covering wearing at T2 and T3 (hypotheses 3 and 4).
- Finally, it is hypothesied that imagery intervention effects on primary outcome variables at T2 and T3 will be conditional on being more conscientious, less narcissistic, and being characterised by higher levels of 'light triad' personality traits (hypothesis 5).
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Factorial
- Masking
- Single blind (participant)
- Number of arms
- 4
| Arm | Type | Receives |
|---|---|---|
| Outcome imagery | Experimental | Behavioral: Mental imageryOutcome imagery condition participants will be asked to visualize themselves successfully wearing a face covering in all required public places/situations over coming week, and to imagine how they would feel. The importance of imagining distinctive relevant visual imagery linked to having successfully routinely worn face covering will be underscored in this passage. Outcome imagery participants will then be asked to write in a free-text box how they would feel having successfully worn a face covering in required public places/situations over the week ahead. |
| Process imagery | Experimental | Behavioral: Mental imageryProcess imagery condition participants will be asked to visualize the kinds of strategies involved in successfully wearing a face covering in all required public places/situations over the coming week. The importance of imagining distinctive relevant visual imagery linked to having effective strategies involved in successfully wearing a face covering in required public places/situations over the week ahead will be underscored in this passage. Process imagery participants will then be asked to write in a free-text box about the kinds of strategies that would be involved in successfully wearing a face covering in all required public places/situations over the coming week. |
| Combined imagery (outcome imagery and process imagery) | Experimental | Behavioral: Mental imageryA third experimental condition will receive both outcome and process imagery exercises to read and complete in sequential order. |
| Public health message | No intervention | –A fourth condition will involve viewing a UK Government public health message (HM Government, 2020) circulated on social media as an image concerning the importance of wearing face covering while in public places. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (1 listed)
- 18+ year old adults
Key exclusion criteria (1 listed)
- Not currently living in the UK
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Mental imageryMental imagery involves the mental representation of a future event, action, or task. By imitating or rehearsing this mental event or series of events" (Taylor et al., 1998, p. 430) mental imagery interventionists theorise that an individual's preparation for, and motivation toward, a future action can be made more likely. Mental imagery involves an individual following a set of pre-defined exercises involving thinking about, visualising and writing about a health-related action. Mental imagery exercises can involve focusing on anticipated positive/beneficial outcomes of an action (outcome imagery) or imagery relating to the anticipated strategies/preparation that would be required to successfully execute a pre-defined action (process imagery). | Behavioural | Combined imagery (outcome imagery and process imagery), Outcome imagery, Process imagery |
Primary outcome
Face covering wearing consistency
Time frame: 4 weeks post-intervention
Self-reported single item response statement with a Likert-type response. Minimum value = 1; maximum value = 5 (a higher score indicates a better outcome).
Face covering wearing intention
Time frame: 4 weeks post-intervention
Self-reported three item response scale with Likert-type responses. Minimum value = 1; maximum value = 5 (a higher score indicates a better outcome).
5 secondary outcomes
Attitude toward wearing a face covering
Time frame: 4 weeks post-intervention
Injunctive norm beliefs about wearing a face covering
Time frame: 4 weeks post-intervention
Descriptive norm beliefs about wearing a face covering
Time frame: 4 weeks post-intervention
Perceived behavioural control over wearing a face covering
Time frame: 4 weeks post-intervention
Barrier self-efficacy to wearing a face covering
Time frame: 4 weeks post-intervention
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 12 Oct 2020.
- Derived from this study: PubMed 35042564Conroy D. Mental imagery interventions to promote face covering use among UK university students and employees during the COVID-19 pandemic: study protocol for a randomized controlled trial. Trials. 2022 Jan 18;23(1):51. doi: 10.1186/s13063-021-05852-y.
- Individual participant dataSharing planned: Yes. We will share the anonymised data as a Supplementary file when submitting a research write-up as an article to a suitable academic journal.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Mental imagery in people with Viral Infection and Covid19, run by University of East London at 1 site in United Kingdom.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 12 Oct 2020. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Dominic Conroy, PhD (+44 7825704881, d.conroy@uel.ac.uk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Face covering wearing consistency (time frame: 4 weeks post-intervention). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04583449, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Oct 2020.