Population Adherence to Infection Control Behaviors during Hong Kong’s First and Third COVID-19 Waves: A Serial Cross-Sectional Study

Abstract

Background: Although COVID-19 has affected over 220 countries by October 2021, there is limited research examining the patterns and determinants of adherence to infection control measures over time. Aims: Our study examines the sociodemographic factors associated with changes in the frequency of adherence to personal hygiene and social distancing behaviors in Hong Kong. Methods: A serial cross-sectional telephone survey in the general population was conducted during the first (March 2020) (n = 765) and third wave (December 2020) (n = 651) of the local outbreak of the COVID-19 pandemic. Respondents were asked about their level of compliance with various personal hygiene and social distancing recommendations. Results: By the third wave, mask use increased to 100%, and throughout the study periods, >90% practiced frequent hand hygiene. However, adherence to social distancing measures significantly waned over time: avoidance of social gatherings (80.5% to 72.0%), avoidance of public places/public transport (53.3% to 26.0%), avoidance of international travel (85.8% to 76.6%) (p < 0.05). The practice of ordering food takeout/home delivery, however, increased, particularly among high-income respondents. Higher education, female gender and employment status were the most consistently associated factors with adherence to COVID-19 preventive practices in the multivariable models. Conclusions: In urban areas of this region, interventions to improve personal hygiene in a prolonged pandemic should target males and those with low education. In addition to these groups, the working population needs to be targeted in order to improve adherence to social distancing guidelines.

Challenges of Data Availability and Use in Conducting Health-EDRM Research in a Post-COVID-19 World

“…A follow-up cross-sectional study conducted after the city’s third wave of COVID-19 indicated an increase in population-wide fatigue for adhering to anti-pandemic behaviour and practices, although the belief in the importance of these measures with regard to disease protection did not vary [ 9 ]. Planning and policymaking over the course of a protract crisis will evolve, following real-time interval-based monitoring.…”

Too much to mask: determinants of sustained adherence to COVID-19 preventive measures among older Syrian refugees in Lebanon

“…Chan et al (2021) use repeated cross-sectional data to examine the socio-economic and demographic correlates of changing adherence to social distancing and personal hygiene measures in Hong Kong during the first and third waves of COVID-19. They find improved adherence to mask wearing and decreasing compliance with social distancing measures (including avoidance of gatherings, of public places, and of international travel).…”

“…This is in line with evidence from multi-country studies which suggests that adherence to sensitizing behaviors such as physical distancing has decreased, while adherence to habituating behaviors such as mask wearing has increased (Petherick et al, 2021). Like Chan et al (2021), Petherick et al (2021) also base their results on observational data, but their repeated cross sections are more frequent and span 14 countries.…”

“…Unlike both Chan et al (2021) and Petherick et al (2021), we do not seek to measure cross-population changes in compliance over time. Instead, we focus on one subgroup (older adults) in one subpopulation (Syrian refugees), follow the same individuals over time, and track their self-reported compliance behavior on two occasions that are 6 months apart.…”

“…Instead, we focus on one subgroup (older adults) in one subpopulation (Syrian refugees), follow the same individuals over time, and track their self-reported compliance behavior on two occasions that are 6 months apart. The timing of our sample means that unlike Chan et al (2021), we are not limited to observations only during periods of surges of COVID-19 cases.…”