Community mask wearing as a COVID-19 preventive measure, its barriers, and motivators among rural households of Uganda: A mixed methods approach

Abstract

Adherence to mask wearing has the potential to reduce coronavirus disease 2019 acquisition risk. However, there is limited information about community mask wearing and its predictors among rural populations. This study aimed to assess the level of adherence to community mask wearing as a COVID-19 prevention measure, its barriers, and motivators among the Ugandan rural population of Wakiso District. This cross-sectional study utilised both quantitative and qualitative data collection methods. The quantitative component employed a semi-structured interviewer-administered questionnaire among 400 participants, to assess the level of adherence and associated predictors towards mask wearing. Modified Poisson regression with robust standard error estimates was used to obtain crude and adjusted prevalence ratios associated with mask wearing. Quantitative data analysis was performed using Stata 15.0 Statistical software. The qualitative component was used to further explore the barriers and motivators of community mask wearing whereseven focus group discussions among 56 community health workers were conducted. Data was analysed using a thematic approach with the help of Nvivo Version 12 software. The quantitative results showed that 70.8% (283/400) of the participants were adherent to mask wearing. Furthermore, reusable (cloth masks) were the most common form of face masks worn by the participants; 71.9% (282/400). Adequate knowledge about mask wearing as a COVID-19 prevention measure was positively associated with mask wearing (adjusted prevalence ratio (95% CI); 3.2 (1.19–8.56)). The qualitative results revealed; sensitization from health workers, provision of free masks, and fear of fines and arrests as motivators to mask wearing. Barriers to mask wearing included: inability to buy masks due to financial constraints, one-time provision of free masks, ill-fitting and worn-out masks, discomfort, and bribery. The practice of community mask wearing was sub-optimal among the study rural communities. Initiatives to scale up the practice need to be feasible for rural communities.

Exploring the Barriers and Facilitators of Mask-Wearing Behavior During the COVID-19 Pandemic in Taiwan, the United States, the Netherlands, and Haiti: A Qualitative Study

“…Regarding intrapersonal impeding factors, consistent with previous studies, 21–23 perceived physical and social interaction barriers when wearing a mask were reported by participants from all 4 countries. Individual-level interventions can be introduced to educate people on how to conquer these barriers.…”

What Sustains Mask-Wearing Behavior among Elders in a Rural Community in the Post-COVID-19 Era: An Exploratory Mixed-Methods Study

“…A survey based on 708 Malaysian adults also demonstrated that the prevalence of wearing a face mask outside while it was not mandatory was 66.0% [ 27 ]. Several studies in Uganda reported that mask-wearing prevalence in rural communities ranged from approximately 33.0 to 70.3% in the later phase of the COVID-19 pandemic [ 2 , 28 ]. Furthermore, the study in Uganda, similar to ours, revealed that knowledge of mask-wearing as a COVID-19 prevention measure was positively associated with mask-wearing adherence [ 2 ].…”

“…Since the COVID-19 pandemic, face masks have played a vital role globally in preventing the spread of the disease [ 1 ]. Epidemiologic evidence demonstrates that mask use is 50 to 70% effective in preventing the spread of COVID-19 within a community [ 2 ]. Furthermore, surgical masks are known to inhibit PM2.5, which is a major health-related problem in Thailand [ 3 , 4 , 5 ].…”

“…Numerous studies have investigated the various factors influencing mask-wearing, including demographic factors and individual beliefs [ 2 , 7 , 8 , 9 , 11 , 12 ]. However, it is worth noting that previous research conducted in Thailand has primarily focused on demographic data and has been limited to urban areas.…”

Religion and Health in a COVID-19 Context : Experiences from Zimbabwe

“…The fact that the police officers were accepting bribes and allowing those who flouted COVID-19 measures to go scot-free was also reiterated by the General Commissioner of police when he appeared before the Health and Child Care Parliamentary Portfolio Committee in June 2020 (Mutanda, 2022). Non-compliance to face masking is also prevalent in Uganda and they also had to use law enforcement agents to promote compliance (Lubenga, et al 2022). Paradoxically, the law enforcement agents who are supposed to police people also violate the COVID-19 protocols by not wearing face masks and practicing social distancing (Maulani, Nyadera & Wandeka, 2021).…”