Factors associated with COVID-19 masking behavior: an application of the Health Belief Model

Abstract

Wearing a face mask is effective in minimizing the spread of coronavirus disease 2019 (COVID-19) among unvaccinated individuals and preventing severe illness among the vaccinated. Country, state and local guidelines promote, and at times mandate, mask-wearing despite it being publicly perceived as an individual’s choice. Guided by the Health Belief Model (HBM), structural equation modeling was used to analyze longitudinal data in a sample of US adults aged 18–49 years to identify constructs that contribute to face mask-wearing. Results indicated that perceived COVID-19 severity, perceived masking benefits and self-efficacy were positively associated with masking behavior, and masking barriers were negatively associated with masking behavior. Perceived susceptibility to COVID-19 and cues to action were nonsignificant correlates of masking behavior. These results’ theoretical and practical implications contribute to the literature on the HBM and the COVID-19 pandemic. Future directions and limitations are discussed.

Factors associated with wearing a facemask in shops in England following removal of a legal requirement to do so during the COVID‐19 pandemic

“…This analysis of 31,490 responses from 24,100 adults in England between August 2020 and April 2022 showed that wearing facemasks in shops was strongly associated with the eight psychological predictors measured: worry about COVID-19, perceived risk of COVID-19 to self, perceived risk of COVID-19 to people in the United Kingdom, perceived severity of COVID-19, perceived exposure to COVID-19, perceived effectiveness, self-efficacy and perceived behavioural impact. This is in line with previous research (Armitage et al, 2023;Chen & Lei, 2022;He et al, 2022;White et al, 2022), and theories of health behaviour (Rogers, 1975). Similar to previous research, we found that rates of wearing a facemask were higher when it was legally obligated (Badillo-Goicoechea et al, 2021;He et al, 2022).…”

“…In the United Kingdom, there was much debate at the start of the pandemic about the effectiveness of wearing a facemask (BBC News, 2020). This is likely to have reduced the public's perceived effectiveness of wearing a face covering, a belief we and others have found to be associated with wearing a facemask (Chen & Lei, 2022;White et al, 2022). Ultimately, this is likely to have had the effect of reducing engagement with this protective behaviour.…”

“…The Protection Motivation Theory would propose that threat appraisal (i.e., perceived susceptibility and severity of COVID‐19) and coping appraisal (i.e., perceived effectiveness of wearing a facemask and perceived self‐efficacy for wearing a facemask [capacity to wear a facemask]) affect intention to engage in facemask wearing, with intention ultimately affecting behaviour (Rogers, 1975). Wearing a facemask was associated with higher perceived severity of COVID‐19, higher perceived susceptibility to COVID‐19, higher perceived effectiveness of masks and higher self‐efficacy (Chen & Lei, 2022; White et al, 2022). Qualitative data have also identified the influence of government recommendations, perceived effectiveness and perceived vulnerability to infection in the decision to wear a facemask (He et al, 2022).…”

Influence of Cognitive Factors on Adherence to Social Distancing and the Use of Masks during the COVID-19 Pandemic by Young Adults: A Systematic Review

“…The studies under analysis evaluate the influence of cognitive factors on adherence to social distancing (Hsing et al 2021;Barrett and Cheung 2021;Coroiu et al 2020;Müller and Rau 2020;Nivette et al 2021), use of mask (Hunt et al 2022;White et al 2022), and several preventive behaviors mainly related with social distancing (Luo et al 2021). The cognitive factors considered in the studies were: fear/severity/risk of COVID-19 (Hunt et al 2022;White et al 2022;Barrett and Cheung 2021;Hsing et al 2021;Luo et al 2021;Müller and Rau 2020) and susceptibility to be infected (White et al 2022;Hsing et al 2021); self-efficacy to carrying out protective behaviors or to avoid infection (Barrett and Cheung 2021;Hsing et al 2021;Müller and Rau 2020); social norms for carrying out protective behaviors (Barrett and Cheung 2021;Müller and Rau 2020); perceived barriers to comply (White et al 2022;Barrett and Cheung 2021;Hsing et al 2021); perceived benefits (Barrett and Cheung 2021;Hsing et al 2021;Müller and Rau 2020); and knowledge/information about COVID-19 and protective measures (Barrett and Cheung 2021;Müller and Rau 2020;Luo et al 2021).…”

“…Table 4 reports the characteristics of the eight included studies. Of the eight studies, three were conducted in the United States of America (Luo et al 2021;White et al 2022;Hunt et al 2022), one in Switzerland (Nivette et al 2021), one in Germany (Müller and Rau 2020), another one in the United Kingdom (Barrett and Cheung 2021). Two were international studies, one involving several European countries and North America (Coroiu et al 2020), and the other was carried out with the United States, Mexico, China, and Taiwan population.…”