Face mask use during the COVID-19 pandemic: how risk perception, experience with COVID-19, and attitude towards government interact with country-wide policy stringency

Abstract

Background During the 2020 COVID-19 pandemic, governments imposed numerous regulations to protect public health, particularly the (mandatory) use of face masks. However, the appropriateness and effectiveness of face mask regulations have been widely discussed, as is apparent from the divergent measures taken across and within countries over time, including mandating, recommending, and discouraging their use. In this study, we analyse how country-level policy stringency and individual-level predictors associate with face mask use during the early stages of the global COVID-19 pandemic. Method First, we study how (self and other-related) risk perception, (direct and indirect) experience with COVID-19, attitude towards government and policy stringency shape face mask use. Second, we study whether there is an interaction between policy stringency and the individual-level variables. We conduct multilevel analyses exploiting variation in face mask regulations across countries and using data from approximately 7000 students collected in the beginning of the pandemic (weeks 17 through 19, 2020). Results We show that policy stringency is strongly positively associated with face mask use. We find a positive association between self-related risk perception and mask use, but no relationship of mask use with experience with COVID-19 and attitudes towards government. However, in the interaction analyses, we find that government trust and perceived clarity of communication moderate the link between stringency and mask use, with positive government perceptions relating to higher use in countries with regulations and to lower use in countries without regulations. Conclusions We highlight that those countries that aim for widespread use of face masks should set strict measures, stress self-related risks of COVID-19, and use clear communication.

Development and initial validation of the attitudes toward face mask use scale (ATFMUS)

“…These results are consistent with those reported in other studies on attitudes towards face mask use (e.g. Duong et al., 2021 ; Larebo and Abame, 2021 ; Taylor et al., 2020 ; Wismans et al., 2022 ). Considering the novelty of the ATFMUS, further studies are needed to confirm these interesting results.…”

“…The model further proposes that attitude toward mask-wearing is an important predictor of continuance intention to wear masks. Literature shows that the factors under the three categories are crucial in shaping face mask attitudes and use ( Wismans et al., 2022 ).…”

Insights for COVID-19 in 2023

“…It should be noted that a recent study in our country shows that up to 89% of the surveyed population correctly followed the rules of use [ 59 ]. This is in line with other publications that show that the existence of clear and strict regulations, such as those in our environment after the hesitant beginnings, favor adherence and the perception of risk (high in the Spanish population) [ 60 ].…”

Face mask use in the city of Chennai, India: Results from three serial cross-sectional surveys, 2021

“…The young wore masks due to the perceived risk and also for social preferences, while the old wore masks due to only the perceived risk [ 30 ]. Studies have proved a positive association between higher self-related risk perception and better face mask compliance [ 31 ].…”