From knowledge to action

Question: During the COVID-19 pandemic, you became known for the COSMO study at the University of Erfurt, which examined the attitudes and behaviour of Germans. At the Bernhard Nocht Institute for Tropical Medicine, you and your working group are now expanding the focus to the Global South and the whole world, to planetary health. What is your overarching research goal?

Betsch: We are interested in climate-healthy behaviour. That is a very broad umbrella under which many topics fit. Because wherever we intervene in the environment, this has an impact on our health. This includes pandemics, climate-friendly nutrition, the use of antibiotics and much more. We want to understand behaviour in order to consider how we can change behaviour towards more climate-friendly behaviour.

Question: Why at the Bernhard Nocht Institute for Tropical Medicine?

Betsch: Firstly, the problems and challenges we face here must always be viewed globally. It's not enough to fight a pandemic in one country or only do climate protection in one country. On the other hand, we have fantastic opportunities here to work with partners in all parts of the world. For example, we are trying to implement a study on climate-friendly behaviour that we have set up in Germany with partners from other countries in order to understand: What prevents people in different countries from adopting climate-healthy behaviour?

Question: You are referring to the Planetary Health Action Survey, the PACE study. What exactly are you analysing?

Betsch: For example, we are looking at: What climate-friendly behaviour do people already show; i.e. eating behaviour, living behaviour; what political measures do they accept, do they want to participate politically for more climate protection, and what factors influence this? The next step is to consider: Where could we start with communication in order to better explain climate-friendly behaviour, does this also result in greater acceptance of political measures? How can people be empowered to adopt climate-friendly behaviour? And how can this be made more attractive?

Question: Your work also focuses on antimicrobial resistance and vaccination behaviour. The pandemic has shown that fears are similar internationally. What cultural differences have you found?

Betsch: Vaccination and antibiotic use have interesting similarities, because behaviour has consequences for others. If I get vaccinated, most vaccinations have a positive effect on others. With antibiotics, it's the other way round: if I take antibiotics that I don't absolutely need, then I contribute to the development of resistance. This means that my behaviour has a negative effect on others. We are interested in how our behaviour interacts with the behaviour of others and how this influences our decisions.

In our culture, for example, people are more willing to be vaccinated if they know that they are helping other people. But we have data from Asia that shows that vaccination is already seen as a pro-social act there and that additional communication has no extra benefit because people are more willing to be vaccinated anyway. This shows that you have to go to other cultures in order to understand where certain communication measures can be effective and where they are superfluous and perhaps another approach is necessary.

Question: Two of your research projects are taking place in Africa, in Zanzibar/Tanzania and in Gabon. What are you researching there?

Betsch: In Zanzibar, we are developing a questionnaire tool to record the use of antibiotics: How and when do people who work in the healthcare sector prescribe antibiotics, how do they dispense them, how do patients handle them. Many also have animals; chickens, for example, where antibiotics are also frequently used. We try to understand: What do people know about antibiotics, is there an awareness of the resistance issue? Zanzibar has developed monitoring targets for antibiotics together with the WHO in the AMR plan, which also include knowledge and behaviour. We want to contribute to this with our resources.

In Gabon, the focus is on vaccination. There, we want to replicate a study that was conducted in other cultural contexts, in America. We want to challenge supposedly established knowledge from health communication by testing different communication techniques in other cultural contexts with short explanatory films about vaccinations. For example, does emphasising risks or correcting myths have the same effect as in America? We want to test the idea that what we know about human behaviour applies everywhere.

Question: Sounds time-consuming.

Betsch: Yes, first we have to establish partnerships, submit ethics applications in other countries in other languages, produce culturally adapted material. That is a very interesting challenge. We can't repeat one-to-one the studies that took place in an American context. For example, how do you make a good film that we can use both in America and in Germany as well as in Gabon that basically explains the same thing so that we can make a really good comparison?

Question: What are the differences in dealing with the media?

Betsch: Communication actually works via other channels. But we are already in the area of implementation. We have to ask this question when we know: How do we get the message out? Now we first want to understand which message is actually received and how? What does it do to people's minds, feelings and behaviour? And then comes the media question. But when we were there, it was already very clear that the large billboards in the cities, for example, are used very differently than here.

Question: In recent decades, behavioural research has focused primarily on Western democracies: the so-called WEIRD countries (Western Educated Industrialised Rich Democratic). What consequences did this one-sided focus have, and what do you unveal now?

Betsch: We can't say for sure yet. 70 per cent of all research in psychology comes from these WEIRD countries. We talk a lot in psychology about generalising theories. That we have an idea of how "the human being" works on the basis of research... It is often simply not taken into account that the contexts in which research takes place are very specific. That's why we want to put what we know from health communication to the test again and examine it in other contexts, where social relationships perhaps have a different meaning or other media are used or behaviour takes place differently than in our contexts. Of course, others are also working on this, but we want to contribute to this. We have really fantastic working conditions here at the BNITM because the institute has many great relationships with fantastic partner countries and researchers. We benefit greatly from this and hope to make a contribution that perhaps raises awareness of the fact that we need to look in both directions and bring together both.

Question: Why do you have pictures of the Biennale on your website?

Betsch: (Laughs) I love Venice. I took the pictures at the 2021 Architecture Biennale. Many topics dealt with planetary health issues: how do we intervene on the earth, what do we use for building, why don't we actually implement what we know? We have an implementation problem in Germany, as we have also seen during the pandemic. We know a lot about health communication, but a lot of it was not implemented during the pandemic: how to do health communication, how to explain things well, how to get knowledge to the end users. I'm very concerned about that and I'm committed to it. And some of the pictures I was able to take there symbolise that for me.