Barriers to and Facilitators of COVID-19 Prevention Behaviors Among North Carolina Residents

Abstract

COVID-19 was the third leading cause of death in the United States in 2020. Prior to the wide dissemination of SARS-CoV-2 vaccines, individual prevention behaviors, such as wearing face masks, have been the primary non-pharmaceutical interventions to reduce infections. We surveyed 404 North Carolina residents recruited through Amazon MTurk in July 2020 to assess adherence to key prevention behaviors (6-foot distancing, mask wearing, and gathering limits) and barriers to and facilitators of adherence. Participants reported past 7-day prevention behaviors and behavioral barriers and facilitators informed by the Integrated Behavior Model and the Health Belief Model (perceived risk, perceived severity, behavioral attitudes, injunctive and descriptive norms, and personal agency). Reported adherence to each behavior in the past 7 days was generally high, with lower adherence to 6-foot distancing and mask wearing in the work context. The most commonly endorsed barriers to 6-foot distancing included physical impediments, forgetting, and unfavorable descriptive norms. For mask wearing, ability to keep a distance, discomfort/inconvenience, and forgetting were most commonly endorsed. In logistic regression models, injunctive social norms followed by perceived personal agency were the strongest independent correlates of 6-foot distancing. Behavioral attitudes and injunctive social norms were independently associated with mask wearing. For gathering size limit adherence, perceived personal agency was the strongest independent predictor followed by perceived severity of COVID-19. Messaging campaigns targeting these barriers and facilitators should be tested. Interventions improving the convenience and salience of physical distancing and mask wearing in high-density public places and places of work may also promote prevention behaviors.

Understanding healthcare workers’ experiences of face mask and RPE use in healthcare settings: an interview study

“…Participants also reported that they would be less likely to comply with guidance in situations they perceived to be lower risk, and that guidance should be in line with the risk associated with the situation. This is also in line with previous research which demonstrates that perceived risk is a key factor in predicting compliance with wearing a mask [17]. Finally, participants highlighted some factors that made it physically difficult to comply with guidance.…”

“…Participants also mentioned that they would be more likely to comply if they felt the guidance was proportionate to the risk. This is in line with previous research which suggests that perceived efficacy of masks is associated with increased compliance [17]. Interestingly, while most participants reported that they themselves complied with mask guidance, they felt that others were less likely to comply -with some citing this as a reason for preferring mandatory mask wearing policies.…”

COVID-19 Infection Risk Among Previously Uninfected Adults: Development of a Prognostic Model

“… 10 – 16 Community studies of adherence to behavioral and nonpharmaceutical interventions contributed to building an evidence base about the uptake of the nonvaccine guidelines. 9 , 12 , 17 – 27 …”

“…[10][11][12][13][14][15][16] Community studies of adherence to behavioral and nonpharmaceutical interventions contributed to building an evidence base about the uptake of the nonvaccine guidelines. 9,12,[17][18][19][20][21][22][23][24][25][26][27] Utilizing the power of extant databases (eg, formal registries, electronic health records, or various types of surveys), data of all types can be fed into programs that model the risk of a given outcome, such as hospitalization or death 28,29 . However, few models exist that incorporate measures from an array of individual characteristics, including clinical and sociodemographic features and use of CDC-recommended protective behaviors, among other items, to predict the risk of COVID-19 infection in the general previously uninfected population.…”

Mitigation behavior prior to COVID-19 vaccination availability is associated with COVID-19 infection and time to vaccination

“…Most Americans reported using social distancing, sheltering in place, and wearing face coverings [23]. Hill et al examined mitigation behavior habits of North Carolinians [24]. In their study, most individuals wore a mask while at work and away from home and practiced six-feet distancing from members outside of their household at work and while away from home.…”