Key factors for promoting protective behaviours in future pandemics: an umbrella review

The COVID-19 pandemic highlighted the critical importance of protective behaviours-such as mask-wearing, hand hygiene, and physical distancing-in managing public health crises. Understanding the factors that influence these behaviours is essential for improving preparedness and response in future health crises. This umbrella review aimed to synthesize evidence on determinants of protective behaviours during pandemics and to provide recommendations for policy and practice.

Following PRISMA 2020 guidelines, we conducted an umbrella review of peer-reviewed literature reviews and meta-analyses published up to June 2025. Searches in Epistemonikos, MEDLINE, and Scopus targeted reviews on "protective behaviours" and "COVID-19", including other infectious diseases. Eligibility criteria followed the Population-Concept-Context framework: general population, multifactorial determinants of protective behaviours, and pandemic contexts. Data extraction was performed in a table that included review characteristics, behavioural domains (general compliance, medical interventions, open dialogue promotion, information handling, hygiene, physical distancing, and other behaviours), and factor valence. We conducted a narrative synthesis organizing factors by sociodemographic, personal, and social-environmental categories, with valence classification based on consistency of findings across reviews. Quality appraisal used the Joanna Briggs Institute checklist.

From 86 records identified, 11 met inclusion criteria, covering COVID-19 and other diseases (e.g., H1N1, SARS, MERS, Ebola). Quality scores averaged 8.8/10. Protective behaviours were influenced by three categories of factors: (1) sociodemographic (age, gender, education, socio-economic status) (2), personal (perceptions, beliefs, trust in authorities and science, political orientation) and (3) social/environmental (access to protective materials, social norms, community support, health education and communication, policies). Enabling factors included trust in credible sources, perceived effectiveness of measures, and multimodal communication. Barriers comprised misinformation, conspiracy beliefs, and resource inaccessibility. Some factors (e.g., age, gender, education) showed inconsistent effects across behaviours. Findings underscore the need for culturally sensitive messaging, transparent communication, and targeted interventions for vulnerable populations.

This umbrella review identifies multi-level determinants of protective behaviours to inform pandemic preparedness. It highlights the need for transparent communication through trusted channels, culturally adapted messaging, equitable access to protective resources, and targeted interventions for low-engagement groups. Integrating these determinants early may enhance population-level adherence.

PROSPERO registration number: CRD42023467236.