Characterizing Wuhan residents' mask-wearing intention at early stages of the COVID-19 pandemic

Psychological and psychosocial determinants of COVID related face covering behaviours: A systematic review

Background

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has resulted in illness, deaths and societal disruption on a global scale. Societies have implemented various control measures to reduce transmission of the virus and mitigate its impact. Individual behavioural changes are crucial to the successful implementation of these measures. One commonly recommended measure to limit risk of infection is face covering. It is important to identify those factors that can predict the uptake and maintenance of face covering.

Objectives

We aimed to identify and synthesise the evidence on malleable psychological and psychosocial factors that determine uptake and adherence to face covering aimed at reducing the risk of infection or transmission of COVID-19.

Search Methods

We searched various literature sources including electronic databases (Medline ALL, Child Development & Adolescent Studies, ERIC, PsycInfo, CINAHL & Web of Science), web searches, conference proceedings, government reports, other repositories of literature and grey literature. The search strategy was built around three concepts of interest including (1) context (terms relating to COVID19), (2) behaviour of interest and (3) terms related to psychological and psychosocial determinants of COVID Health-Related Behaviours and adherence or compliance with face covering, to capture malleable determines. Searches capture studies up until October 2021.

Selection Criteria

Eligibility criteria included observational studies (both retrospective and prospective) and experimental studies that measure and report malleable psychological and psychosocial determinants and handwashing at an individual level, amongst the general public. Screening was supported by the Cochrane Crowd. Studies titles and abstracts were screened against the eligibility criteria by three independent screeners. Following this, all potentially relevant studies were screened at full-text level by the research team. All conflicts between screeners were resolved by discussion between the core research team.

Data Collection and Analysis

All data extraction was managed in EPPI-Reviewer software. All eligible studies, identified through full-text screening were extracted by one author. We extracted data on study information, population, determinant, behaviour and effects. A second author checked data extraction on 20% of all included papers. All conflicts were discussed by the two authors until consensus was reached. We assessed methodological quality of all included studies using an adapted version of the Joanna Briggs Institute Quality appraisal tool for cross-sectional studies.

Main Results

Our initial searches yielded 23,587 results, of which 23 were included in this review. The included studies were cross-sectional in design, came from nine countries and had a combined sample of 54,401 participants. The vast majority of studies had samples from the general public, with five of the studies focusing on specific samples. All included studies considered people over the age of 18. The quality of 10 of the studies was rated as unclear, 10 were rated as low, and 3 rated high risk of bias, predominately due to lack of reporting of recruitment, sample characteristics and methodology. Ten studies were included in the meta-analysis and 16 in the narrative synthesis. Findings from the meta-analysis indicated that knowledge of COVID-19 (0.341, 95% confidence interval [CI] = 0.06, 0.530, I 2 = 100%) was the malleable determinant most associated with face covering behaviour. Perceived susceptibility of COVID-19 (r = 0.088, 95% CI = -0.004, 0.180, I 2 = 80%) and COVID-related worry and anxiety (r = 0.064, 95% CI = -0.066, 0.191, I 2 = 93% had little to no effect on face covering behaviour. In the narrative synthesis, the strongest association was found between perceived benefits and effectiveness of behaviours and mask wearing behaviour.

Authors' Conclusions

Understanding the effects of various malleable determinants on COVID-related face covering can aid in the development and implementation of interventions and public health campaigns to promote face covering behaviour in potential new waves of COVID-19 or other respiratory infections. Knowledge of COVID and perceived benefits of face coverings warrant further consideration in future research and policy.

Understanding the Role of Technology Anxiety in the Adoption of Digital Health Technologies (DHTs) by Older Adults with Chronic Diseases in Shanghai: An Extension of the Unified Theory of Acceptance and Use of Technology (UTAUT) Model

The unprecedented rapid growth of digital health has brought new opportunities to the health field. However, elderly patients with chronic diseases, as an important potential beneficiary group, are affected by the digital divide, leading to unsatisfactory usage of digital health technologies (DHTs). Our study focused on the factors influencing the adoption of DHTs among this vulnerable group. To extend the UTAUT theory, technology anxiety and several demographic predictors were included to address the age characteristics of the respondents. An on-site survey was conducted in general, district, and community hospitals in Shanghai (n = 309). Facilitating conditions negatively influenced technology anxiety. Technology anxiety hindered behavioural intention. Social influence had a significant but negative impact on behavioural intention. Education, whether older adults have had experience with DHTs and previous smartphone usage experiences were significantly associated with technology anxiety. The findings provide valuable information for multiple stakeholders, including family members of elderly users, product designers, and policymakers. Ameliorating facilitating conditions, improving devices' usage experience, encouraging attempts and focusing on groups with lower educational levels can help to reduce technology anxiety and promote DHT acceptance and use in older age groups.

Study on the logic and effectiveness of crisis learning in the promotion policy adjustment: an observation based on the adjustment of COVID-19 prevention policy in China

Background

As the impact of COVID-19 on normal production and living conditions diminishes, this serious emergency is come to an end. China's policy framework has facilitated positive adjustment over the past 3 years by timely modifying its emergency response to changes in viruses and epidemics. This paper aims to explore the logic of China's policy framework that promoted policy adjustment through crisis learning during COVID-19.

Methods

By gathering and classifying China's epidemic prevention policies throughout the past 3 years, integrating policy texts, and analyzing key events, this article examines the process of supporting policy adjustment through crisis learning in the policy system during COVID-19.

Results

The Chinese government's COVID-19 policy adjustment process can be divided into four stages, namely 'The period of stress response', 'The period of COVID-19 prevention and control', 'The period of regular prevention and control', and 'The period of overall adjustment'. The policy adjustments in each stage demonstrate the logic and effectiveness of crisis learning in the promotion policy adjustment. The study has determined that the motivational logic comprises three crucial elements: security requirements, accountability pressure, and reputation management. The institutional logic encompasses both the organizational and resourceful environments, and the institutional and cultural environment. Additionally, the behavioral logic of policy adaptation aligns with the strategy of crisis learning. Meanwhile, the logical framework of 'crisis learning-policy adjustment' can be verified using the Chinese government's policy adjustment in COVID-19 as an example.

Conclusion

Establishing an effective post-crisis learning system is crucial to improving the effectiveness of crisis response. There is a logical link between crisis learning and policy adjustment. The implementation of policy adjustment needs to be based on the results of crisis learning. Government departments are essential for crisis learning and policy adjustment.

Determinants of parental self-reported uptake of influenza vaccination in preschool children during the COVID-19 pandemic

In China, the coverage rate of influenza vaccination among the general population is significantly lower than that of high-income countries, with only 2.46% of the population vaccinated. Preschool-aged children are particularly susceptible to influenza viruses, yet the factors that influence parents' willingness to vaccinate their children are not well understood. To address this research gap, we developed a theoretical model grounded in the Unified Theory of Acceptance and Use of Technology (UTAUT), which explores six key factors influencing parental self-reported uptake of influenza vaccination in preschool children: performance expectancy, effort expectancy, social influence, facilitating conditions, knowledge, and behavioral intention. We collected data from 872 parents of children in five major cities in China and employed structural equation modeling to examine the significance of the theoretical model and explore the potential moderating effects of demographic variables on path relationships. Our analysis revealed that several positive factors influenced parents' intention of influenza vaccination for preschool children, including effort expectancy (β = 0.38), social influence (β = 0.17), and knowledge (β = 0.52). Facilitating conditions (β = 0.34), knowledge (β = 0.40), and behavioral intention (β = 0.34) were found to be associated with self-reported uptake. Furthermore, we observed significant moderating effects of the child's gender and age, as well as the guardian's category and income, on the theoretical models. Parents' willingness to vaccinate preschool children against influenza is influenced by both psychological and demographic variables. Further studies are needed to determine if these relationships persist over time and across different regions.

Comparing the Effect of Declarative vs. Procedural Knowledge on Health Behavior Moderated by Outrage Factors

Knowledge's effect on behavioral responses in a health crisis has been a point of inquiry in many empirical studies that obtained significant findings. However, a variety of knowledge types has been considered in these studies rarely. This study compared the effect of declarative vs. procedural knowledge on behavioral responses to the COVID-19 pandemic. In addition, we examined whether outrage factors, which refer to perceived risk characteristics that are likely to elicit emotional responses, can moderate cognitive knowledge's effect. Data were collected with a survey conducted five months after the first COVID-19 case was confirmed in South Korea. A total of 1,000 respondents completed questions on the two types of knowledge, risk perception, and health behaviors in the pandemic crisis, and three different outrage factors. The results showed that procedural knowledge on how-to-do something was associated significantly with the health behaviors in the crisis, while the declarative knowledge that involves knowing that "something is the case" was not. Further, the outrage factors moderated knowledge's effect in such a way that procedural knowledge's influence on health behaviors diminished when the respondents perceived that the pandemic was uncontrollable. On the other hand, procedural knowledge's effect increased when the outrage factor of fairness was heightened. The implications are discussed in the context of studies of knowledge's effect and the outrage factors' moderation.

Factors influencing user acceptance of weight management apps among Chinese obese individuals during the COVID-19 pandemic

Background

During the COVID-19 epidemic, the number of obesities increased rapidly in China. Weight management apps have potential value in controlling obesity.

Objective

Explore the mechanisms behind the adoption of weight management applications by overweight and obese individuals, including psychological factors and demographic variables.

Methods

The theoretical model was extended from the technology acceptance model (TAM), and the structural equation model was used for hypothesis testing. From January 2020 to December 2021, we conducted a cross-sectional survey in six megacities in mainland China during the COVID-19 pandemic by an online questionnaire.

Results

1364 participants completed the questionnaire, and the proposed theoretical model explained 55.7% of the variance in behavioral intention. Perceived usefulness was predicted by perceived ease of use (β = 0. 290), attitude was jointly predicted by perceived usefulness (β = 0.118) and perceived ease of use (β = 0.159). Behavioral intention was predicted by perceived usefulness (β = 0. 256), perceived ease of use (β = 0. 463), attitude (β = 0. 293), and perceived risk (β = -0.136). Health awareness (β=0.016) did not significantly affect behavioral intention. Four demographic variables gender, age, education, and residence exerted significant moderating effects in theoretical model.

Conclusions

During the COVID-19 epidemic, the health awareness and behavior patterns of obese people have changed significantly. Psychological factors and demographic characteristics dynamically interact to generate user behavioral intentions of weight management applications. Weight management application developers and marketers should focus on perceived usefulness, safety, ease of use, and health awareness.

Assessing the consequences of prolonged usage of disposable face masks

Due to the SARS-CoV-2 outbreak, wearing a disposable face mask has become a worldwide daily routine, not only for medical operators or specialized personnel, but also for common people. Notwithstanding the undeniable positive effect in reducing the risk of virus transmission, it is important to understand if a prolonged usage of the same face mask can have effectiveness on filtering capability and potential health consequences. To this aim, we present three investigations. A survey, carried out in central Italy, offers an overview of the distorted public awareness of face mask usage. A functional study shows how prolonged wearing leads to substantial drops in humid air filtration efficiency. Finally, a morphological analysis reports the proliferation of fungal or bacteria colonies inside an improperly used mask. Our study highlights therefore that wearing a face mask is really beneficial only if it is used correctly.

Compliance with Barrier Gestures during COVID-19 Pandemic as a Function of the Context: A Longitudinal Observational Survey at the University of Liège

During the COVID-19 pandemic, barrier gestures such as mask wearing, physical distancing, greetings without contact, one-way circulation flow, and hand sanitization were major strategies to prevent the spread of SARS-CoV-2, but they were only useful if consistently applied. This survey was a follow-up of the first survey performed in 2020 at the University of Liège. We aim to evaluate the compliance with these gestures on campuses and examine differences in the extent of the compliance observed in different educational activities and contexts. During 3.5 months, the counting of compliant and non-compliant behaviors was performed each week in randomly selected rooms. Using data collected during both surveys (2020 and 2021), binomial negative regression models of compliance depending on periods (teaching periods and exam sessions), type of rooms, and campuses were conducted to evaluate prevalence ratios of compliance. The percentage of compliance in this second survey was the highest for mask wearing and physical distancing during educational activities (90% and 88%, respectively) and lowest for physical distancing outside educational activities and hand sanitization (45% and 52%, respectively). Multivariate analyses revealed that the compliance with most gestures was significantly higher in teaching rooms than in hallways and restaurants and during exam sessions. The compliance with physical distancing was significantly higher (from 66%) in auditoriums, where students had to remain seated, than during practical works that allowed or required free movement. Therefore, the compliance with barrier gestures was associated with contextual settings, which should be considered when communicating and managing barrier gestures. Further studies should specify and confirm the determining contextual characteristics regarding the compliance with barrier gestures in times of pandemic.

Motivating COVID-19 mitigation actions via personal norm: An extension of the norm activation model

OBJECTIVE

Given the prosocial nature of COVID-19 mitigation actions, the norm activation model (NAM) provides a theoretical framework to understand how these mitigation behaviors may be driven by activating personal norms. Aimed at delineating the relationship between awareness of consequences and ascription of responsibility, two key variables in the model, the present study examined to what extent this relationship was moderated by political ideology, individual efficacy, and collective efficacy.

METHOD

A cross-sectional online survey (N = 560) was implemented with a sample that matched the demographics of the national population in the U.S.

RESULTS

The relationship between awareness of consequences and ascription of responsibility was stronger among liberals and those reporting low levels of individual efficacy and collective efficacy.

CONCLUSION

Health behaviors such as COVID-19 mitigation actions can be motivated by activating individuals' sense of moral obligation, but the effectiveness of this approach depends on their political ideology and efficacy beliefs.

PRACTICE IMPLICATIONS

Campaigns can promote health behaviors by triggering the moral responsibility of the target audience through emphasizing severity of the consequences. This approach can be more effective for liberals and those that lack confidence in individual and collective abilities to avert the threat.

The Social Meanings of Artifacts: Face Masks in the COVID-19 Pandemic

Since the beginning of the COVID-19 pandemic, research has explored various aspects of face mask use. While most of the research explores their effectiveness to prevent the spread of the virus, a growing body of literature has found that using face masks also has social meaning. But what social meaning does it have, and how does this meaning express itself in people's practice? Based on 413 qualitative interviews with residents in five European countries (Austria, Belgium, Germany, Ireland, and Switzerland), we found that the meanings of face masks have changed drastically during the first months of the pandemic. While in spring 2020 people wearing them had to fear stigmatization, in autumn of 2020 not wearing masks was more likely to be stigmatized. Throughout the first year of the pandemic, we found that mask wearing had multiple and partly seemingly contradictory meanings for people. They were perceived as obstacles for non-verbal communication, but also a way to affirm friendships and maintain social contacts. They also signaled specific moral or political stances on the side of face mask wearers and non-wearers alike, expressed their belonging to certain communities, or articulated concern. In sum, our findings show how face masks serve as scripts for people to navigate their lives during the COVID-19 pandemic. We conclude that public and political discussions concerning face masks should include not only evidence on the epidemiological and infectiological effects of face masks, but also on their social meanings and their social effects.

Mask-wearing intentions on airplanes during COVID-19 - Application of theory of planned behavior model

The COVID-19 pandemic has devastated the air transport industry, forcing airlines to take measures to ensure the safety of passengers and crewmembers. Among the many protective measures, mask mandate onboard the airplane is an important one, but travelers' mask-wearing intentions during flight remain uninvestigated especially in the US where mask use is a topic of on-going debate. This study focused on the mask use of airline passengers when they fly during COVID-19, using the theory of planned behavior (TPB) model to examine the relationship between nine predicting factors and the mask-wearing intention in the aircraft cabin. A survey instrument was developed to collect data from 1124 air travelers on Amazon Mechanical Turk (MTurk), and the data was statistically analyzed using structural equation modeling and logistic regression. Results showed that attitude, descriptive norms, risk avoidance, and information seeking significantly influenced the travelers' intention to wear a mask during flight in COVID-19. Group analysis further indicated that the four factors influenced mask-wearing intentions differently on young, middle-aged, and senior travelers. It was also found that demographic and travel characteristics including age, education, income, and travel frequency can be used to predict if the airline passenger was willing to pay a large amount to switch to airlines that adopted different mask policies during COVID-19. The findings of this study fill the research gap of air travelers' intentions to wear a mask when flying during a global pandemic and provide recommendations for mask-wearing policies to help the air transport industry recover from COVID-19.

Investigating the Adoption of Precautionary Behaviors Among Young Rural Adults in South Iran During COVID-19

COVID-19 is an unprecedented challenge for public health worldwide. Reducing the incidence of the disease requires protective measures to prevent virus transmission. Understanding those factors influencing preventive behavior is the first step in preventing the spread of the disease. This study investigates factors affecting youth intention and preventive behaviors in the face of COVID-19 through the health belief model by using a cross-sectional survey collected through an online questionnaire. The sample comprises 304 rural youth in South Iran who were selected through a random sampling technique. The results reveal that perceived severity, perceived benefits, public health beliefs, perceived self-efficacy, and the cue to act positively and significantly affect preventive behaviors. The model explains 59% of variance changes in rural youth preventive behaviors during COVID-19. Cue to action is the strongest and self-efficacy was the weakest determinant of youth's preventive behavior. This study confirms that the HBM framework has appropriate predictive power and is an effective tool for investigating preventive behaviors during COVID-19. These results provide important policy implications for the development of policies that aim to avoid the further spread of COVID-19 between young citizens.

Contracting COVID-19: a longitudinal investigation of the impact of beliefs and knowledge

Recent work has found that an individual's beliefs and personal characteristics can impact perceptions of and responses to the COVID-19 pandemic. Certain individuals-such as those who are politically conservative or who endorse conspiracy theories-are less likely to engage in preventative behaviors like social distancing. The current research aims to address whether these individual differences not only affect people's reactions to the pandemic, but also their actual likelihood of contracting COVID-19. In the early months of the pandemic, U.S. participants responded to a variety of individual difference measures as well as questions specific to the pandemic itself. Four months later, 2120 of these participants responded with whether they had contracted COVID-19. Nearly all of our included individual difference measures significantly predicted whether a person reported testing positive for the virus in this four-month period. Additional analyses revealed that all of these relationships were primarily mediated by whether participants held accurate knowledge about COVID-19. These findings offer useful insights for developing more effective interventions aimed at slowing the spread of both COVID-19 and future diseases. Moreover, some findings offer critical tests of the validity of such theoretical frameworks as those concerning conspiratorial ideation and disgust sensitivity within a real-world context.

The Intentions to Wear Face Masks and the Differences in Preventive Behaviors between Urban and Rural Areas during COVID-19: An Analysis Based on the Technology Acceptance Model

The SARS-CoV-2 virus first emerged in late 2019 and has since spread quickly throughout China and become a global pandemic. As the situation with COVID-19 has evolved, wearing a face mask in public has grown commonplace. Using the technology acceptance model (TAM) as a foundation, this study introduces three new variables, namely, perceived risk, social pressure, and social image, to establish an extended model for investigating the factors that influence if residents wear masks. A total of 1200 questionnaires were distributed in China, from 1 February to 30 May 2020, through China’s largest online platform. The results indicate the following: 1. Residents’ positive attitude towards mask wearing promotes their behavioral intention to wear masks. 2. Perceived risk, social pressure, and social image have a positive impact on attitude towards mask wearing. 3. The intention to wear masks and attitude were both positively influenced by perceived usefulness. 4. The perceived usefulness is more influential in rural than urban groups, in terms of behavioral intention. This article proposes that public education on the facts related to the coronavirus, the threats posed by the COVID-19 pandemic to health, and the usefulness of face masks in preventing the transmission of COVID-19 could increase residents’ intention to wear a mask.

Intention-Based Critical Factors Affecting Willingness to Adopt Novel Coronavirus Prevention in Pakistan: Implications for Future Pandemics

Since human beings have a long tradition of coexistence with pandemics, which may profoundly impact them, adopting preventive measures is crucial for humankind's survival. This study explores the intention-based critical factors affecting the willingness of individuals to adopt pandemic prevention. To this end, a representative sample of 931 Pakistanis filled in an online questionnaire. However, only 828 questionnaires were found to be complete and valid for path modeling analysis. The core findings are as follows: Firstly, peer groups' beliefs, self-efficacy, perceived risk, pandemic knowledge, ease of pandemic prevention adoption, and risk-averse behavior are revealed as driving forces of the individuals' willingness to adopt pandemic prevention. Contrastingly, a lack of trust in political will and mythical attitude towards pandemics are uncovered as inhibitors. Nevertheless, moral values depict a neutral role. Secondly, the peer groups' beliefs are highest ranked, followed by the lack of trust in political will and a mythical attitude towards pandemic prevention. Finally, moral values are determined as the lowest-ranked critical factor. Based on these results, the government should promote awareness campaigns on lethality and fatality of the pandemic at both centralized and decentralized levels to win people's trust at the grass-roots level and overcome the mythical attitude of individuals at all societal levels. Besides, access to personal protective gears should be made feasible since an easier pandemic prevention adoption would increase the individuals' willingness to adopt such preventative measures.

The effect of cognition and affect on preventive behaviors during the COVID-19 pandemic: a cross-sectional study in China

BACKGROUND

The global outbreak of COVID-19 has become an international public health crisis. Specific antiviral treatments for COVID-19 are not yet available, and prevention is of particular importance to fight the virus. This study tends to explore and compare the roles of cognitive and affective factors in predicting preventive behavior adoption during the COVID-19 pandemic in China.

METHODS

An online survey using a quota sampling method to collect responses from 3000 Chinese adults was conducted from March 2, 2020 to March 23, 2020. Questions included sociodemographic features, coronavirus knowledge, negative emotion, risk perception, and behavioral responses. Multiple regression analyses were conducted to examine the predictors of behavioral responses toward COVID-19.

RESULTS

On average, respondents had low levels of knowledge about COVID-19 (the overall correct response rate was 7.5%). Most respondents reported moderate to strong negative emotions towards the virus (3.47 out of 5). The average reported perceived chance of infection was 23.89%. For behavioral responses, respondents reported low frequencies of going out for activities (1.98 out of 4) and high frequencies of taking preventive measures (3.22 out of 4). Behavioral responses toward COVID-19 were found to be determined by cognitive and affective variables. Knowledge was negatively related to frequency of going out for activities (β = - 0.11, p < .001). Negative emotion (β = 0.34, p < .001), and risk perception (β = 0.05, p = .007) were positively associated with going out for activities. The explanatory power of affective variables (ΔR2 = 12.1%) was greater than cognitive variables (ΔR2 = 1.0%). For preventive behaviors, knowledge was positively associated with preventive behaviors (β = 0.22, p < .001). Negative emotion (β = - 0.28, p < .001) and risk perception (β = - 0.05, p = .002) were all negatively associated with preventive measures. Affective variables still showed stronger explanatory power (ΔR2 = 8%) than cognitive variables (ΔR2 = 4.4%) in predicting preventive behaviors.

CONCLUSIONS

After the rising period of the COVID-19 outbreak in mainland China, cognitive and affective variables still played important roles in predicting behavioral responses. Compared with cognitive factors, affective factors demonstrated stronger explanatory power in predicting behavioral responses toward COVID-19. The findings may have implications for enhancing individual compliance with guidelines of adopting preventive behaviors in response to COVID-19.