Motivations and Barriers for the Use of Face Coverings during the COVID-19 Pandemic: Messaging Insights from Focus Groups
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Use of Face Coverings
3.2. Motivations for Wearing Face Coverings
3.2.1. Protection
3.2.2. Community Responsibility and Norms
3.2.3. Fear, Anxiety, and Controlling the Situation
3.2.4. Compliance and Recommendations
3.3. Reasons for Not Using Face Coverings
3.3.1. Perceived to be Unnecessary
3.3.2. Difficulty Navigating Social Situations
3.3.3. Confusion or Misinformation
3.3.4. Physical Challenges
3.3.5. Low Perceived Susceptibility
3.3.6. Identity and Autonomy
3.4. Insights for Messaging Strategies
3.4.1. Message Tone
3.4.2. Message Content
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Data Available on Request Due to Restrictions
Conflicts of Interest
References
- Dong, E.; Du, H.; Gardner, L.M. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect. Dis. 2020, 20, 533–534. [Google Scholar] [CrossRef]
- Centers for Disease Control and Prevention. COVID-19: Considerations for Wearing Masks. Available online: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html (accessed on 30 July 2020).
- Chu, D.K.; Akl, E.A.; Duda, S.; Solo, K.; Yaacoub, S.; Schünemann, H.J. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: A systematic review and meta-analysis. Lancet 2020, 395, 1973–1987. [Google Scholar] [CrossRef]
- Lyu, W.; Wehby, G.L. Community Use of Face Masks And COVID-19: Evidence from A Natural Experiment of State Mandates in The US: Study examines impact on COVID-19 growth rates associated with state government mandates requiring face mask use in public. Health Aff. 2020, 39, 1419–1425. [Google Scholar] [CrossRef] [PubMed]
- Greenhalgh, T.; Schmid, M.B.; Czypionka, T.; Bassler, D.; Gruer, L. Face masks for the public during the covid-19 crisis. BMJ 2020, 369, m1435. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Gandhi, M.; Beyrer, C.; Goosby, E. Masks Do More Than Protect Others During COVID-19: Reducing the Inoculum of SARS-CoV-2 to Protect the Wearer. J. Gen. Intern. Med. 2020, 35, 1–4. [Google Scholar] [CrossRef] [PubMed]
- Arp, N.L.; Nguyen, T.H.; Graham Linck, E.J.; Feeney, A.K.; Schrope, J.H.; Ruedinger, K.L.; Gao, A.; Miranda-Katz, M.; Kates, A.E.; Safdar, N.; et al. Use of face coverings by the public during the COVID-19 pandemic: An observational study. medRxiv 2020. [Google Scholar] [CrossRef]
- Knotek, I.I.E.; Schoenle, R.; Dietrich, A.; Müller, G.; Myrseth, K.O.R.; Weber, M. Consumers and COVID-19: Survey Results on Mask-Wearing Behaviors and Beliefs. Econ. Comment. 2020. [Google Scholar] [CrossRef]
- Gallup. Americans’ Face Mask Usage Varies Greatly by Demographics. Available online: https://news.gallup.com/poll/315590/americans-face-mask-usage-varies-greatly-demographics.aspx (accessed on 30 July 2020).
- Mackert, M.; Lazard, A.; Love, B. Designing Effective Health Messages; IA Kendall Hunt: Dubuque, IA, USA, 2017. [Google Scholar]
- Czeisler, M.É.; Tynan, M.A.; Howard, M.E.; Honeycutt, S.; Fulmer, E.B.; Kidder, D.P.; Robbins, R.; Barger, L.K.; Facer-Childs, E.R.; Baldwin, G.; et al. Public attitudes, behaviors, and beliefs related to COVID-19, stay-at-home orders, nonessential business closures, and public health guidance—United States, New York City, and Los Angeles, May 5–12, 2020. Morb. Mortal. Wkly. Rep. 2020, 69, 751. [Google Scholar] [CrossRef]
- Czeisler, M.É.; Howard, M.E.; Robbins, R.; Barger, L.K.; Facer-Childs, E.R.; Rajaratnam, S.M.W.; Czeisler, C.A. COVID-19: Public Compliance with and Public Support for Stay-at-Home Mitigation Strategies. medRxiv 2020. [Google Scholar] [CrossRef] [Green Version]
- Ölcer, S.; Yilmaz-Aslan, Y.; Brzoska, P. Lay perspectives on social distancing and other official recommendations and regulations in the time of COVID-19: A qualitative study of social media posts. BMC Public Health 2020, 20, 1–9. [Google Scholar] [CrossRef]
- Fisher, K.A.; Barile, J.P.; Guerin, R.J.; Esschert, K.L.V.; Jeffers, A.; Tian, L.H.; Garcia-Williams, A.; Gurbaxani, B.; Thompson, W.W.; Prue, C.E. Factors Associated with Cloth Face Covering Use Among Adults During the COVID-19 Pandemic—United States, April and May 2020. MMWR Morb. Mortal. Wkly. Rep. 2020, 69, 933–937. [Google Scholar] [CrossRef] [PubMed]
- Utych, S.M. Messaging Mask Wearing During the COVID-19 Crisis: Ideological Differences. J. Exp. Politi. Sci. 2020, 1–11. [Google Scholar] [CrossRef]
- Utych, S.M.; Fowler, L. Age-based messaging strategies for communication about COVID-19. J. Behav. Public Adm. 2020, 3. [Google Scholar] [CrossRef] [Green Version]
- State of North Carolina. Executive Order No. 147: Extension of Phase 2 Order and New Measures to Save Lives in the COVID-19 Pandemic. 2020. Available online: https://files.nc.gov/governor/documents/files/EO147-Phase-2-Extension.pdf (accessed on 3 September 2020).
- Ulin, P.R.; Robinson, E.T.; Tolley, E.E. Qualitative Methods in Public Health: A Field Guide for Applied Research. Med. Sci. Sports Exerc. 2005, 37, 1249. [Google Scholar] [CrossRef] [Green Version]
- Fisman, D.N.; Greer, A.L.; Tuite, A.R. Bidirectional impact of imperfect mask use on reproduction number of COVID-19: A next generation matrix approach. Infect. Dis. Model. 2020, 5, 405–408. [Google Scholar] [CrossRef] [PubMed]
- Missoni, E.; Armocida, B.; Formenti, B. Face Masks for All and All for Face Masks in the COVID-19 Pandemic: Community Level Production to Face the Global Shortage and Shorten the Epidemic. Disaster Med. Public Health Prep. 2020, 2020, 1–5. [Google Scholar] [CrossRef] [PubMed]
- Fischer, E.P.; Fischer, M.C.; Grass, D.; Henrion, I.; Warren, W.S.; Westman, E. Low-cost measurement of facemask efficacy for filtering expelled droplets during speech. Sci. Adv. 2020, 6, eabd3083. [Google Scholar] [CrossRef]
- Ghinai, I.; Woods, S.; Ritger, K.A.; McPherson, T.D.; Black, S.R.; Sparrow, L.; Fricchione, M.J.; Kerins, J.L.; Pacilli, M.; Ruestow, P.S.; et al. Community Transmission of SARS-CoV-2 at Two Family Gatherings—Chicago, Illinois, February–March 2020. Health. C (Ill.). D of P, Service. C for DC and P (U. S). EI, Center for Surveillance and Laboratory Services (U.S.) E, Team. C-19 R, Eds. 2020; p. 69. Available online: https://stacks.cdc.gov/view/cdc/86627 (accessed on 3 September 2020).
- Liu, T.; Gong, D.; Xiao, J.; Hu, J.; He, G.; Rong, Z.; Ma, W. Cluster infections play important roles in the rapid evolution of COVID-19 transmission: A systematic review. Int. J. Infect. Dis. 2020, 99, 374–380. [Google Scholar] [CrossRef]
- Champion, V.L.; Skinner, C.S. The health belief model. Health Behav. Health Educ. Theory Res. Pract. 2008, 4, 45–65. [Google Scholar]
- Brehm, J.W. A Theory of Psychological Reactance; Academic Press: New York, USA, 1966. [Google Scholar]
- Bonell, C.; Michie, S.; Reicher, S.; West, R.; Bear, L.; Yardley, L.; Curtis, V.; Amlôt, R.; Rubin, G.J. Harnessing behavioural science in public health campaigns to maintain ’social distancing’ in response to the COVID-19 pandemic: Key principles. J. Epidemiol. Community Health 2020, 74, 617–619. [Google Scholar]
- Hall, M.G.; Sheeran, P.; Noar, S.M.; Boynton, M.H.; Ribisl, K.M.; Parada, H., Jr.; Johnson, T.O.; Brewer, N.T. Negative affect, message reactance and perceived risk: How do pictorial cigarette pack warnings change quit intentions? Tob. Control. 2017, 27, e136–e142. [Google Scholar] [CrossRef] [PubMed]
- Yang, B.; Liu, J.; Popova, L. Feeling Hopeful Motivates Change: Emotional Responses to Messages Communicating Comparative Risk of Electronic Cigarettes and Combusted Cigarettes. Health Educ. Behav. 2019, 46, 471–483. [Google Scholar] [CrossRef] [PubMed]
- Wang, M.L.; Behrman, P.; Dulin, A.; Baskin, M.L.; Buscemi, J.; Alcaraz, K.I.; Goldstein, C.M.; Carson, T.L.; Shen, M.; FitzGibbon, M. Addressing inequities in COVID-19 morbidity and mortality: Research and policy recommendations. Transl. Behav. Med. 2020, 10, 516–519. [Google Scholar] [CrossRef] [PubMed]
Characteristic | n = 34 Mean (Min–Max) or % (n) |
---|---|
Age–young adult | 21 years (19–24) |
Age–adult | 43 years (26–64) |
Sex | |
Male | 15% (5) |
Female | 82% (28) |
Other or prefer not to answer | 3% (1) |
Race 1 | |
White | 47% (16) |
Black or African American | 41% (14) |
Other | 15% (5) |
Missing | 6% (2) |
Ethnicity | |
Latino/a/x | 44% (15) |
Non-Latino/a/x | 56% (19) |
Location | |
Urban | 29% (10) |
Suburban | 44% (15) |
Rural | 26% (9) |
Region | |
Western NC/Mountains | 26% (9) |
Central NC/Piedmont | 53% (18) |
Eastern NC/Coastal Plains | 21% (7) |
Face covering use | |
Never | 0% (0) |
Some of the time | 9% (3) |
Most of the time | 35% (12) |
All of the time | 56% (19) |
Category | Motivation | Example Quote |
---|---|---|
Protection | To protect others | “It goes back to people’s…family and their loved ones and why we’re putting on masks, because we want to protect other people, because we care about other people.” (Latinx English) |
To protect high-risk individuals | “You don’t know what someone else is like dealing with…Whether they are younger, old, it doesn’t matter. I have a family member that’s asthmatic, I have older family members with other health issues. So I try to wear it out of respect for them.” (Young adult BIPOC) | |
To protect myself | “I [have] an autoimmune disorder, and I am under extreme immunosuppressants...I do have to wear a face mask for my own safety.” (Young adult BIPOC) | |
Community responsibility and norms | Sense of responsibility | “I feel like it’s important for us to all be role models, and I’ve been wearing it because I think it’s the right thing to do.” (Rural white) |
To follow community norms | “If someone’s going to get annoyed if they see me in a store and they’re going to feel unsafe even though I’m healthy, and I’m going to cause some kind of problem, well, I prefer to have the mask, more than anything to keep the peace.” (Latinx Spanish) | |
Fear, anxiety, and controlling the situation | For safety or in response to fear | “[It’s] supposed to be…if you feel any symptoms…then don’t go around people. And some people don’t follow that…So [I wear one] just, I guess, out of partly fear.” (Latinx English) |
For a sense of control | “We are in charge at this point of our own safety…I don’t think…we could really depend on our government officials and leadership…and so our PPE [personal protective equipment] is really all we have right now.” (Black or African American) | |
Compliance and recommendations | To comply with requirements | “I wear a mask wherever it’s required to wear a mask. When I go to the store, or if I go to the doctor’s office…If it’s not required, I do not…That’s the only reason I’m wearing it, is because it’s required.” (Rural white) |
Based on data/experts | “If the data is saying that it helps to wear it, then I’m going to do what the researchers are saying that we should do.” (Black or African American) | |
Reopen business and schools | To resume activities | “I would love to be able to go back into the office…And so whatever steps I can take myself to get back to that. Like, that’s what I’ll do.” (Young adult white) |
Category | Reason | Example Quote |
---|---|---|
Perceived to be unnecessary | Social distancing is possible | “I’ll go for a walk around the neighborhood…and I’m typically able to stay like far away from people. So I don’t feel like I need to wear one.” (Young adult white) |
With people they trust | “In the visits with other family members, we haven’t worn face masks… since they’ve been making wise decisions…and they’ve been saying that they are doing the right things, then we feel comfortable not wearing a mask.” (Young adult BIPOC) | |
Difficulty navigating social situations | Fear offending others | This week we decided, ‘we appreciate your friendship, don’t get offended, but we think it would be better if we didn’t see each other anymore, for now, this closely.’…They got offended.” (Latinx Spanish) |
Confusion or misinformation | Mixed messages | “People are confused and they’re saying, well, you said it 4 months ago it was okay. We didn’t have to worry about a mask, and now you’re saying we need to wear them…That’s how people are getting mixed messages.” (Rural white) |
Don’t protect the wearer | “You also have to remember, the mask doesn’t protect you…It protects other people. And I think that that’s a problem in general. I think you would have a lot more compliance if people thought that the mask was protecting them…because we look to protect ourselves first.” (Rural white) | |
Myths and conspiracy theories | “I have family members that think that it’s a propaganda for profit. Other theories they have are that it’s just another way for us to have our immunity inhibited. They think there’s a larger harmful agenda behind the scenes.” (Latinx English) | |
Physical challenges | Uncomfortable | “It’s very uncomfortable…it’s very hot, but I’ll pull it off or away from my face for a couple of seconds. And I’ll put it right back on.” (Black or African American) |
Respiratory issues | “I haven’t been running or exercising in a while, but like when I did…I would just keep my distance most of the time, because like I have asthma. So if I were running like I feel like the mask would bother me.” (Young adult BIPOC) | |
Forgot a face covering | “Sometimes they say that they forgot to bring a face mask or like they don’t have one.” (Young adult BIPOC) | |
Low perceived susceptibility | Not sick with COVID-19 | “A friend who wanted to come help me…she took off her mask, and she said, “Take off your mask, there’s no problem, I’m healthy.” (Latinx Spanish) |
Believe it wouldn’t happen to them | “A lot of people maybe still have the mentality of, well, it won’t happen to me or like, you know, I couldn’t imagine that happening in my family.” (Rural white) | |
Religious or spiritual beliefs | “I’ve also heard a few people say based on their religious beliefs, who’ve said well ‘God will protect me. You know, I’m safe, he’s protecting me.’” (Rural white) | |
Identity and autonomy | Peer pressure | “My son refused to wear it because he felt the peer pressure… and he didn’t want to be the only one wearing a mask. It wasn’t even spoken or verbal. It was just, he didn’t want to be the uncool one wearing a mask.” (Latinx English) |
Masculinity | “I’ve noticed it’s mostly men who seem to be against wanting to wear masks. I don’t know if it’s a pride type of thing, or like I’m too cool for this or whatever.” (Rural white) | |
Political affiliation | “I mean, honestly, at this point, like the people that I work with, the only person they’re going to listen to is Trump. So unless Trump tells them to wear a mask, they’re not gonna wear a mask.” (Young adult white) | |
Individual rights and freedom | “I like you know having the choice to do it. And having the choice, I’m still going to do what I can to protect people. But it being required, I don’t necessarily like that.” (Rural white) |
Category | Insight |
---|---|
General areas of focus | Focus on protection as a motivator for the use of face coverings |
Promote and normalize the use of face coverings in social and work settings | |
Emphasize face covering requirements | |
Encourage not only the use but the correct use of face coverings | |
Message content | Harness the power of personal experiences with COVID-19 |
Support messages with data | |
Clarify mixed messages and answer nuanced questions about the use of face coverings | |
Balance attention to high-risk groups with inadvertently promoting invincibility | |
Focus on recovery, but do not promise a return back to normal | |
Message tone | Frame messages as positive and encouraging |
Promote unity and diversity | |
Use language that resonates with specific communities |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Shelus, V.S.; Frank, S.C.; Lazard, A.J.; Higgins, I.C.A.; Pulido, M.; Richter, A.P.C.; Vandegrift, S.M.; Vereen, R.N.; Ribisl, K.M.; Hall, M.G. Motivations and Barriers for the Use of Face Coverings during the COVID-19 Pandemic: Messaging Insights from Focus Groups. Int. J. Environ. Res. Public Health 2020, 17, 9298. https://doi.org/10.3390/ijerph17249298
Shelus VS, Frank SC, Lazard AJ, Higgins ICA, Pulido M, Richter APC, Vandegrift SM, Vereen RN, Ribisl KM, Hall MG. Motivations and Barriers for the Use of Face Coverings during the COVID-19 Pandemic: Messaging Insights from Focus Groups. International Journal of Environmental Research and Public Health. 2020; 17(24):9298. https://doi.org/10.3390/ijerph17249298
Chicago/Turabian StyleShelus, Victoria S., Simone C. Frank, Allison J. Lazard, Isabella C. A. Higgins, Marlyn Pulido, Ana Paula C. Richter, Sara M. Vandegrift, Rhyan N. Vereen, Kurt M. Ribisl, and Marissa G. Hall. 2020. "Motivations and Barriers for the Use of Face Coverings during the COVID-19 Pandemic: Messaging Insights from Focus Groups" International Journal of Environmental Research and Public Health 17, no. 24: 9298. https://doi.org/10.3390/ijerph17249298
APA StyleShelus, V. S., Frank, S. C., Lazard, A. J., Higgins, I. C. A., Pulido, M., Richter, A. P. C., Vandegrift, S. M., Vereen, R. N., Ribisl, K. M., & Hall, M. G. (2020). Motivations and Barriers for the Use of Face Coverings during the COVID-19 Pandemic: Messaging Insights from Focus Groups. International Journal of Environmental Research and Public Health, 17(24), 9298. https://doi.org/10.3390/ijerph17249298