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

Sadjadi, M.; Moerschel, K. S.; Petticrew, M.

Aim: To systematically review qualitative literature on social distancing in order to identify and describe factors that enable or prevent its implementation. Methods: A rapid systematic qualitative review was conducted in accordance with PRISMA and ENTREQ guidelines. A comprehensive systematic search was carried out in MEDLINE, EMBASE, PsychINFO, Global Health, CINAHL and Web of Science. Included papers (i) report on primary qualitative studies (ii) of the barriers and facilitators to the implementation of social distancing measures (iii) in potentially epidemic infectious diseases. After critical appraisal and standardised data extraction, a meta-ethnographical approach was used for synthesis. Review findings were assessed for strength and reliability using CerQUAL. Results: 28 papers were included from the systematic search that yielded 5620 results. One additional paper was found by searching references. 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. Conclusion: There 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.