Understanding Physical Distancing and Face Mask Use Across High-Risk African American Subgroups During the COVID-19 Pandemic: Application of Health Belief Model

Abstract

Physical distancing and face masks remain frontline prevention strategies due to suboptimal vaccine uptake and the highly infectious COVID-19 variants. Communities of color are disproportionately impacted by a chronic disease burden that places them at higher risk of severe COVID-19 disease. Therefore, they can greatly benefit from face mask use and physical distancing, especially if the individual(s) have not received the vaccine. We applied the Health Belief Model to explore barriers and motivators influencing physical distancing and face mask use among high-risk, Black American subgroups during the early COVID-19 pandemic stages. We conducted 62 semi-structured interviews among four Black American subgroups: young adults, individuals with underlying medical conditions, essential workers, and parents. Thematic analysis, guided by the Health Belief Model, yielded six themes: (1) Knowledge on Face Mask Use and Physical Distancing, (2) Perceived Susceptibility and Severity Varies by Subgroup, (3) Experience with and Perceived Self-Efficacy to Engage in Preventive Behavior, (4) Perceived Benefits to engaging in preventive behaviors, (5) Perceived Barriers to engage in preventive behaviors, and (6) Cues to action to increase participation. Each subgroup’s unique experience informed multilevel, tailored approaches that can be used by health promotion practitioners to improve face mask use and physical distancing among uniquely vulnerable Black American subgroups in the current and future pandemic.

Attitudes, Beliefs, and Perceptions Associated with Mask Wearing within Four Racial and Ethnic Groups Early in the COVID-19 Pandemic

“…In this case, outcome expectations (protecting others) is the motivation, personal agency is the sense of capability, and cue to action (having heard messaging about the importance of masks) is the contextual opportunity to act. This is consistent with a recent qualitative study that found both a desire to protect others and cues to action as related to mask wearing among Black participants [54]. Direct communication with Black communities (cue to action) was also found to be an effective strategy for promoting COVID-19 vaccine uptake among Black populations, in contrast to vaccination mandates or incentive-based programs [55].…”

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

“…In terms of racial or ethnic minorities and mask-wearing, the findings suggest that black people might be treated negatively when wearing a mask, which is consistent with previous studies. 61,62 The dilemma between choosing mask-wearing to protect themselves from COVID-19 and racially related threats among black people should be addressed to reduce racial discrimination related to mask-wearing and protect minorities. In this study, the results suggest that political leadership has a strong impact on people's mask-wearing behavior, particularly in the United States and the Netherlands.…”