Abstract
BackgroundHealth behavior is influenced by culture and social context. However, there are limited data evaluating the scope of these influences on COVID-19 response.ObjectiveThis study aimed to compare handwashing and social distancing practices in different countries and evaluate practice predictors using the health belief model (HBM).MethodsFrom April 11 to May 1, 2020, we conducted an online, cross-sectional survey disseminated internationally via social media. Participants were adults aged 18 years or older from four different countries: the United States, Mexico, Hong Kong (China), and Taiwan. Primary outcomes were self-reported handwashing and social distancing practices during COVID-19. Predictors included constructs of the HBM: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action. Associations of these constructs with behavioral outcomes were assessed by multivariable logistic regression.ResultsWe analyzed a total of 71,851 participants, with 3070 from the United States, 3946 from Mexico, 1201 from Hong Kong (China), and 63,634 from Taiwan. Of these countries, respondents from the United States adhered to the most social distancing practices (χ23=2169.7, P<.001), while respondents from Taiwan performed the most handwashing (χ23=309.8, P<.001). Multivariable logistic regression analyses indicated that self-efficacy was a positive predictor for handwashing (odds ratio [OR]United States 1.58, 95% CI 1.21-2.07; ORMexico 1.5, 95% CI 1.21-1.96; ORHong Kong 2.48, 95% CI 1.80-3.44; ORTaiwan 2.30, 95% CI 2.21-2.39) and social distancing practices (ORUnited States 1.77, 95% CI 1.24-2.49; ORMexico 1.77, 95% CI 1.40-2.25; ORHong Kong 3.25, 95% CI 2.32-4.62; ORTaiwan 2.58, 95% CI 2.47-2.68) in all countries. Handwashing was positively associated with perceived susceptibility in Mexico, Hong Kong, and Taiwan, while social distancing was positively associated with perceived severity in the United States, Mexico, and Taiwan.ConclusionsSocial media recruitment strategies can be used to reach a large audience during a pandemic. Self-efficacy was the strongest predictor for handwashing and social distancing. Policies that address relevant health beliefs can facilitate adoption of necessary actions for preventing COVID-19. Our findings may be explained by the timing of government policies, the number of cases reported in each country, individual beliefs, and cultural context.
Highlights
The severity and rapid transmission of COVID-19 has forced most regions to implement community mitigation strategies
Self-efficacy was the strongest predictor for handwashing and social distancing
Some have suggested that concepts from social and behavioral sciences can provide insight into adherence to guidelines, but current data evaluating these hypotheses in multiple countries and in the context of COVID-19 using relevant behavior change theories, such as the health belief model (HBM), are limited [9]
Summary
The severity and rapid transmission of COVID-19 has forced most regions to implement community mitigation strategies These strategies have ranged from government guidelines on personal protective measures and social distancing to strict lockdown orders that closed schools and businesses [1]. Nationwide school closures in 194 countries in early April 2020 demonstrated the extent of these interventions [2] These measures have reduced transmission or delayed the peak of infection of past pandemics to varying degrees, which were estimated to have prevented at least 60 million COVID-19 cases [3,4]. These interventions reduce the stress on health care systems, they incur high economic and societal costs, making adherence more difficult for those under financial strain [3,5]. There are limited data evaluating the scope of these influences on COVID-19 response
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