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Original Article
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Pitchayanont Ngamchaliew M.D.*, Polathep Vichitkunakorn M.D., Ph.D.*, Phatthana Wangsapan**, Nantapat
Buppodom**, Narawit Junchoo**, Patitta Chanhom**, Gun Sudsangiam**, Manattra Patpoom**, Chanissara
Chaichana**
*Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, **Medical Student, Faculty of Medicine, Prince
of Songkla University, Hat Yai, Songkhla 90110, ailand.
Innovative Device for Enhancing Physical
Distancing in the COVID-19 Situation
ABSTRACT
Objective: During the COVID-19 pandemic, physical distancing is one of the non-pharmaceutical measures
that was recommended to reduce COVID-19 spread. Studies regarding physical distancing intervention and its
eectiveness in ailand have rarely been reported. is study aimed to evaluate physical distancing compliance
among newly developed media interventions.
Methods: We used accidental sampling and the data collection method was observation via CCTV, at the university
canteen. ree interventions, including an attractive picture, a ashing red-light, a speech alarm sound and the
conventional intervention were employed to 400 customers. Each intervention was monitored in non-prime hours.
Results: e quasi-experimental study of 400 participants, the success rate of developed intervention including
a ashing red light (6.0%, p = 0.279), an attractive picture (5.0%, p = 0.445) and a speech alarm sound (4.0%, p =
0.683) in promoting physical distancing compliance was not statistically signicant from conventional intervention
(2.0%). However, there was a statistically signicant enhancement of physical compliance in some marking positions
in our intervention.
Conclusion: e eectiveness of the innovative device was not statistically signicant to enhance physical distancing
compliance among customers of the university canteen. e compliance statistically signicantly enhances in some
marking points. e integration of the use of media into conventional interventions provides an alternative for
enhancing physical distancing.
Keywords: Physical distancing; COVID-19; innovative device (Siriraj Med J 2021; 73: 69-76)
Corresponding author: Pitchayanont Ngamchaliew
E-mail: pitchayanont@hotmail.com
Received 15 September 2020 Revised 15 October 2020 Accepted 16 October 2020
ORCID ID: http://orcid.org/0000-0003-1100-3138
http://dx.doi.org/10.33192/Smj.2021.10
INTRODUCTION
The COVID-19 pandemic has confronted an
unprecedented challenge to the world, our societies, health
care systems, and economies. Within six months (from
January to June 2020), 210 countries and territories around
the world have reported more than seven million conrmed
cases including almost four hundred thousand deaths as
of 8
th
June, 2020.
1
e SARS-CoV2, a highly infective
pathogen, causes moderate to severe clinical outcomes in
about 20% of all recognized infected individuals leading
to the risk of health system collapse due to overwhelming
medical resources.
2
In addition to the global health care
system threat, it also contributes to the risk of economic
recession (e.g., an 8.1% contraction of this year gross
domestic product according to the Bank of ailand
forecast, ailand’s biggest GDP decline ever.).
3
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70
In the absence of a vaccine, public health responses
have posed the use of varying level of non-pharmaceutical
interventions (e.g., hand hygiene, wearing face mask,
and physical distancing) to mitigate the impact of
the COVID-19 pandemic.
4
Physical distancing was
recommended to reduce COVID-19 spread.
5
e ai
government has correspondingly implemented social
distancing measures including stay at home, the closure of
schools, restaurants, and other public places since March
2020. When stringently applied and perpetuated, these
measures profoundly provoke societal and economic
disruption.
6
us, individual physical distancing is the
most eective way to balance competing risks between
health system collapse and economic risks.
Although there have been several previous studies
on eectiveness of non-pharmaceutical intervention
and factors aecting physical distancing compliance,
studies regarding physical distancing intervention and its
eectiveness in ailand during this ongoing COVID-19
pandemic have rarely been reported. Our study developed
media interventions based on behavioral change theory.
e study aimed to evaluate physical distancing compliance
among interventions.
MATERIALS AND METHODS
Setting and sample
is is a quasi-experimental study. e sampling
technique used is an accidental sampling by the rst
100 participants starting at 11.00 AM. e study was
conducted in the university canteen at Prince of Songkla
University, where there was conventional intervention
as a footprint standing sign to encourage people to keep
physical distancing (Fig 1A).
Measurement of key variables
Independent variable: innovative device
We developed three dierent media interventions to
be used in the university canteen setting. (1) An attractive
picture developed from original concept
7
, then designed
in a colorful adorable coronavirus graphic with a crying-
face and “COVID-19” text (Fig 1B). (2) A ashing red-
light developed from color psychology
8
and attention
theory
9-12
composed of exible 10 W ashing red LED
strip lights which are waterproof, silicone-coated and
battery-powered. e light strip was stuck in front of the
conventional marking standing positions and covered
with transparent adhesive tape (Fig 1C). (3) A speech
alarm sound based on attention theory
13,14
, “Please keep
at least 1-meter distance apart” in ai, delivered by
12-inch speaker within normal hearing intensity every
30 seconds (Fig 1D).
Each intervention was monitored over lunchtime for
four days in early August, 2020 until four interventions
were completed. e study outcome was physical distancing
compliance.
Fig 1. (A) Control (B) An attractive picture (C) A red ashing-light (D) A speech alarm sound.
Ngamchaliew et al.
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Dependent variable: physical distancing
Physical distancing is dened as at least 1-meter
distance among people.
5
Successful physical distancing
was dened according to the following criteria:
(1) Standing within the 40-centemeter-length marking
position along the process of queueing.
(2) Moving out of the marked position 3 seconds
and less each time is acceptable.
Other conditions which do not meet these criteria
above are dened as a failure to keep physical distancing.
Factors aecting physical distancing
is study is a comparative behavioral observation
study via CCTV. We established the protocol for CCTV
data collection. Aer piloting the protocol for CCTV
record, observers revised the established protocol to
validate inconclusive situations. e revised protocol
was applied in the data collection. We observed the
characteristics of participants including age group (by
observation), gender, university uniform, companion,
and carrying item. e accessibility of the records is
limited to our research team only at the study location
and the records will not be published. ese do not
contain personal identication and will be deleted within
7 days according to the organization’s security policy.
All analyses were carried out on anonymized data and
will be analyzed in aggregates. Moreover, the publication
will not mention the dates and specic places. erefore,
we guarantee the condentiality and the privacy of the
participants and communities.
Statistical analysis
e statistical analysis included both continuous
and categorized variables for physical distancing. e
median and interquartile range (IQR) were used to
describe the physical distancing as the data were not
normally distributed. e Wilcoxon signed-rank test
was used to compare the physical distancing regarding
dierent interventions within the same cluster. Categorical
variables were analyzed using a Chi-square or Fisher’s
exact test. e analysis was computed by R® 4.0.0.
e study was conducted in line with the Belmont
Report and was approved by the Human Research Ethics
Committee (HREC), Faculty of Medicine, Prince of
Songkla University (REC.63-272-9-1).
RESULTS
There was a total of 400 participants observed
over 4 interventions including the conventional one,
an attractive picture, a ashing red-light, and a speech
alarm sound. One quarter of the participants engaged in
each intervention. e participant demographic data was
recorded in Table 1 as gender, age group (by observation),
uniform wearing, coming with companion, and carrying
items categorized in number and types. Considering
characteristics, gender was solely not statistically dierent
in an attractive picture (p = 1.00), a ashing red-light
(p = 0.764), and a speech alarm sound (p = 0.114).
Comparing each intervention with the control
group, there was no signicant eect of all interventions
on physical distancing compliance (Table 2). e highest
average number of failures of physical distancing was
an attractive picture (3 times). e number of failures
of physical distancing of the other three interventions
was 2 on average.
According to Table 3 and Fig 2, the failure of physical
distancing at the rst two marking points in all interventions
were approximately 80% while the rest were apparently
lower. In the attractive picture intervention, the failure of
physical distancing went in an upward trend at marking
point 3, 4 and 5. e ashing red-light intervention
could signicantly decrease 25.4% failure of physical
distancing comparing to the control group at marking
point 3 (p = 0.011). At the latter marking points, the
failure of physical distancing in the speech alarm sound
intervention continuously attenuated, demonstrating a
similar trend to the control group. At the marking point
5, the failure of physical distancing declined. e decline
was statistically signicant (p = 0.044).
DISCUSSION
Our results demonstrated that failure of physical
distancing compliance in all interventions declined
compared to the control group. However, ndings did
not have enough strength to support the eectiveness
of interventions on delivering the encouragement of
behavioral change. Considering each marking point in
all interventions, the rst two positions bore noticeably
high percentage of failure of physical distancing due
to the distraction from menu selection. In position 3,
4 and 5 of the attractive picture intervention, there
was an increasing failure of physical distancing (Fig
3). A message from an attractive picture might not
eciently be delivered to the participants. Failure of
physical distancing at marking point 3 of the ashing
red-light intervention decreased signicantly since the
intervention could establish an eect to draw attention.
10–12
e speech alarm sound intervention could improve
behavior of participants in maintaining physical distance,
especially at the latter marking points. Despite the fact
that physical distancing, one of non-pharmaceutical
interventions, is key to preventing spread of respiratory
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72
TABLE 1. Background information of participant on the interventions (n=400).
An Aashing Aspeech
Characteristics Control attractive P-value red-light P-value alarm P-value
(n=100) picture (n=100) sound
(n=100) (n=100)
Gender,n(%)
Male 65 (65) 66 (66) 1
a
68 (68) 0.764
a
53 (53) 0.114
a
Female 35 (35) 34 (34) 32 (32) 47 (47)
Agegroupbyobservation,n(%)
Wearing university uniform 2 (2) 39 (39) < 0.001
a*
39 (39) <0.001
a*
8 (8) 0.105
a
Not wearing university uniform 98 (98) 61 (61) 61 (61) 92 (92)
Children (est. 0-11 years) 1 (1) 0 (0) 0.003
b*
0 (0) 0.608
b
0 (0) < 0.001
b*
Adolescences (est. 12-18 years) 12 (12.4) 0 (0) 4 (6.6) 1 (1.1)
Adult (est. 19-64 years) 83 (84.6) 61 (100) 56 (91.8) 91 (98.9)
Elderly(est.≥65years) 2(2.1) 0(0) 1(1.6) 0(0)
Withcompanion,n(%)
No 66 (66) 86 (86) 0.002
a*
82 (82) 0.016
a
72 (72) 0.445
a
Yes 34 (34) 14 (14) 18 (18) 28 (28)
Carryingitems,n(%)
No carrying item 38 (38) 78 (78) < 0.001
a*
70 (70) < 0.001
a*
82 (82) < 0.001
a*
Carrying items 62 (62) 22 (22) 30 (30) 18 (18)
Number and type of items, 1 [1,2] 1 [1,1] 0.093
c
1 [1,1] 0.005
c*
1 [1,1] 0.06
c
Median, [IQR]
1 41 (66.1) 19 (86.4) 0.09
b
28 (93.3) 0.01
b*
16 (88.9) 0.202
b
2 19 (30.6) 2 (9.1) 2 (6.7) 2 (11.1)
3 2 (3.2) 1 (4.5) 0 0
Type of items, n
Container 3 0 0 0
Book 0 0 1 0
Bag 44 12 20 12
Mobile 26 7 7 5
Other 7 6 3 2
Abbreviation: IQR = interquartile range
*
P-value < 0.05, compared with control group,
a
Chi-squared test,
b
Fisher’s exact test,
c
Wilcoxon rank-sum test
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TABLE 2. Eects of the interventions on failure of physical distancing practice (n=400).
Failureofphysicaldistancing Numberoffailureof
(n=100) physicaldistancing
n(%) P-value Median(IQR) P-value
Control 98 (98.0) - 2 (2,3) -
An attractive picture 95 (95.0) 0.445
a
3 (2,3) 0.293
b
Aashingred-light 94(94.0) 0.279
a
2 (2,3) 0.866
b
A speech alarm sound 96 (96.0) 0.638
a
2 (2,2,2) 0.006*
b
Failureofphysicaldistancing
Marking Control Anattractivepicture Aashingred-light Aspeechalarmsound
point No.of No.of P-value
a
No.of P-value
a
No.of P-value
a
failure/total failure/total failure/total failure/total
(%) (%) (%) (%)
1 87/99 (87.9) 76/99 (76.8) 0.062 85/97 (87.6) 1 80/95 (84.2) 0.596
2 81/99 (81.8) 84/100 (84.0) 0.825 85/99 (85.9) 0.562 81/98 (82.7) 1
3 22/42 (52.4) 32/71 (45.1) 0.578 20/74 (27.0) 0.011* 11/36 (30.6) 0.086
4 8/24 (33.3) 24/50 (48.0) 0.346 17/54 (31.5) 1 4/16 (25.0) 0.729
5 6/12 (50.0) 17/26 (65.4) 0.481 13/36 (36.1) 0.501 0/7 (0) 0.044*
Abbreviation: IQR = interquartile range
*P-value < 0.05, compared with control group,
a
Chi-square test,
b
Wilcoxon rank-sum test
TABLE 3. Failure of physical distancing practice by the marking point.
*P-value < 0.05, compared with control group,
a
Pearson's Chi-squared test
diseases including COVID-19 as reported in previous
studies
15–19
interventions on physical distancing are scarce
as a limited number of studies additionally investigated
the factors aecting physical distancing.
When assessing the compliance on physical distancing
at marking point 3, ashing red- light (73.0%, p-value =
0.011) could signicantly increase customers practicing
physical distancing compared to the control (47.6%).
ere were studies on the eect of ashing lights on
behavioral change. e results supported that ashing
lights were highly visible to draw enough attention with
the potential to induce positive attitudes and a level of
behavioral change, and attention.
10–12
Moreover, Hill
and Barton (2005) described the mechanism of the red
eect, is that dressing red increases one’s dominance,
aggressiveness and testosterone and nally improves
competitive outcome.
9
e use of ashing red-light was appropriate with the
university canteen setting. e red color was in contrast
to the oor and the ashing light could draw attentions
since there was ambient light without any stronger light
within the setting.
In the speech alarm intervention, the compliance on
physical distancing signicantly increased 2.0% compared
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Fig 3. Failure of physical distancing practice by the marking point.
Ngamchaliew et al.
Fig 2. Overall failure of physical distancing compliance.
to the conventional one. ere were two studies on the
eect of using auditory modality on compliance. e
results demonstrated that presenting warning information
using auditory modality may also lead to greater warning
attention and compliance.
13,14
In the attractive picture intervention, the compliance
in physical distancing improved 3.0%. e crying-face
of an adorable COVID-19 picture painted in pink could
bring out the cute emotion of customers. Jones et al.
7
recorded and written about the cute-emotion is mainly a
response to neotenic or baby-animal characteristics, such
as big round eyes, small size, and soness. Commercial
enterprises intentionally utilize adorable characteristics
to generate cute-emotion responses by their customers
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as it is such a powerful and eective approach. As in
our setting, with the use of cute-emotion approach, the
majority of adult customers could consequently perceive
and positively respond to an attractive picture. Besides
the control, the COVID-19 Figure tended to enhance
the level of self-awareness by reinforcing the correlation
between practicing physical distancing and the prevention
of ongoing COVID-19 pandemic.
Limitations
Our largest limitation was the inadequate sample
size since our study was part of the family medicine
course, which had a short timeline for performing this
study and the data collection from CCTV was a time-
consuming process. However, our research team could
not reach an adequate sample size regarding the marking
point 4 and 5. is interfered with the validity of data
interpretation. In addition, the results could be inuenced
by the researcher’s personal judgement contributing
to information bias, even though there were valid data
collection protocol for observers and inclusion criteria
documented to diminish this bias. Regarding to the small
sample size at some marking points, and the period of
data collection during zero COVID-19 cases, we dictate
caution in the interpretation of these ndings. In future
studies, it would be advisable to increase number of
times for each intervention exposure and extend the
data collection period to obtain adequate sample size,
in which subsequent subgroup analysis may provide a
more signicant outcome.
e second limitation was the inappropriate period
of study. e study was held during the period with
zero new COVID-19 infection reported in ailand
so that the participants’ level of awareness altered. e
researcher provided intervention correlating between
COVID-19 situation and disease prevention. ough, it was
inadequately promoting a behavioral change. erefore,
the result from our interventions might not characterize
the participants’ behavior during high incidence rate of
infection episode. With time restriction, our interventions
were not employed on scheduled workdays so that the
characteristics of participants in the control group were
varying and could not entirely be used to describe the
eect of factors aecting physical distancing compliance.
Lastly, the study was conducted at university canteen, mainly
composed of university students. e result of physical
distancing compliance among general population in this
setting might not be widely applicable. Our interventions
were simple and aordable to install and used locally
available materials. Henceforward, future studies should
be performed in other settings among general population
and containing a large number of participants would
compare the behavioral impact of our interventions.
Another explanation for limited generalizability of the
outcomes is the pattern of queueing process which is unique
in each setting. According to the size of intervention and
a criterion to keep 1-meter distance apart, the previous
compatible pattern of marking points was changed.
e customers were not accustomed to the provided
interventions. In consideration with the battery capacity,
the extended period of data collection might not be
practical for ashing red-light. Moreover, there was a
need of experts to create further interventions.
CONCLUSION
In this quasi-experimental study of 400 participants
over the eectiveness of innovative device on physical
distancing compliance in the university canteen setting,
the data suggests that innovative devices were statistically
insignicant to enhance physical distancing compliance.
e compliance was statistically signicant to enhance at
some marking points. Future studies containing a large
number of participants would compare the behavioral
impact of our interventions. e integration of the use
of media into conventional interventions provides an
alternative way of enhancing physical distancing.
ACKNOWLEDGMENTS
e authors thank the International Aairs Department,
Faculty of Medicine, Prince of Songkla University for
proofreading the English of the manuscript.
Funding/nancial support:
is work was supported by e Institute of Research
and Development for Health of Southern ailand (RDH)
(MED-PSU-005).
Conict of interest: e authors do not have any conicts
of interest to declare.
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