Abstract
Background: Recommendations and policies, regarding the use of face coverings, have been instituted to control transmission of coronavirus disease 2019 (COVID-19). Understanding of psychosocial factors related to the use of face coverings within the context of COVID-19 is needed. This study aimed to conceptualize mask-wearing behavior among students using the Multi-theory Model (MTM) of behavior change. Methods: In October 2020, students (n = 595) enrolled in a large public southeastern US university were recruited to participate in a cross-sectional survey, using a valid and reliable instrument. Univariate, bivariate, and multivariate techniques described mask-wearing behavior and differentiated theoretical drivers of mask-wearing between individuals compliant and non-compliant with guidelines. Results: Compliant individuals reported significantly higher scores (P <0.05) for initiation and sustenance of mask-wearing, participatory dialogue, behavioral confidence, emotional transformation, practice for change, changes in the social environment, and significantly lower scores for disadvantage. Among multivariable models, all theoretical predictors exhibited significant relationships to their respective outcomes (initiation and sustenance). Specifically, MTM constructs explained approximately 35% of variance in initiation (R2 = 0.346, F(3,526) = 94.32, P <0.001) and 33% of variance in sustenance of mask wearing (R2 = 0.328, F(3,529) = 87.71, P <0.001) for compliant individuals. Behavioral confidence and emotional transformation exhibited the strongest relationships to initiation (ß = 0.403, P <0.001) and sustenance (ß = 0.450, P <0.001), respectively. Conclusion: Findings suggest a need to design educational programming based on the MTM to promote mask-wearing behavior among laggards who defy face mask guidelines, recommendations, and mandates.
Highlights
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is responsible for the current global pandemic
The United States (US) has documented more than 25 million cases and approximately 420 000 deaths due to COVID-19.1 SARS-CoV-2 spreads much more readily than SARS-CoV (SARS) which was responsible for a similar epidemic in 2003.2,3 The most recent pandemic prior to COVID-19 was due to the influenza A (H1N1) virus that occurred between 2009 and 2010.3 The Centers for Disease Control and Prevention (CDC) estimates between 151 700 and 575 400 deaths globally in the first year of the H1N1 pandemic.[4]
Because a primary route of transmission of SARSCoV-2 occurs through small droplets ejected when speaking, coughing, or sneezing,[4,6] the CDC has developed individual level guidelines to prevent the spread of COVID-19.4 The CDC recommends that individuals wash their hands often, sanitize surfaces regularly, socially distance, and protect their mouth and nose with a face covering when around others
Summary
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is responsible for the current global pandemic. Results: Compliant individuals reported significantly higher scores (P < 0.05) for initiation and sustenance of mask-wearing, participatory dialogue, behavioral confidence, emotional transformation, practice for change, changes in the social environment, and significantly lower scores for disadvantage. MTM constructs explained approximately 35% of variance in initiation (R2 = 0.346, F(3,526) = 94.32, P < 0.001) and 33% of variance in sustenance of mask wearing (R2 = 0.328, F(3,529) = 87.71, P < 0.001) for compliant individuals. Conclusion: Findings suggest a need to design educational programming based on the MTM to promote mask-wearing behavior among laggards who defy face mask guidelines, recommendations, and mandates
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