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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 50-54

To wear or not to wear? Factors influencing wearing face masks in Germany during the COVID-19 pandemic


Department IV, University of Trier, Trier, Germany

Date of Submission06-Mar-2020
Date of Decision07-May-2020
Date of Acceptance08-May-2020
Date of Web Publication9-Jun-2020

Correspondence Address:
Prof. Marc Oliver Rieger
Department IV, University of Trier, Trier
Germany
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/SHB.SHB_23_20

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  Abstract 


Introduction: During the COVID-19 pandemic, it has been advised to wear masks. Attitudes toward wearing masks have not been investigated well. We want to provide data on whether and why people would be willing to wear masks in order to suggest ways for enhancing compliance. Methods: We conducted a survey among 206 participants on April 20 to 22, 2020. The sample mean age was 28 years, 63% of the participants were female, 64% were undergraduate or graduate students, and 51% had a university degree. Data from a previous study (n = 241, mean age of 26 years, 66% females, 83% students, 52% with a university degree) have also been used. Results: Fifty to eighty percent of the participants stated they would (probably) wear a mask (if they had one) in most scenarios. On the street, only 21% said they would. Demographic factors did not prove to be significant, whereas a university degree increased the likelihood of wearing a mask. Determining factors included worries about the current situation, self-protection, protecting others, thinking that wearing a mask looks strange, and being afraid of others' judgment when wearing a mask. The significance of these factors varies strongly between the age groups. Nearly all participants stated they would wear a mask if it were legally required, but compliance would be lower if the law required them to wear masks on the street. Surprisingly, there is no difference in attitudes toward masks as compared to the results of the previous survey from March 24 to 25, 2020. Conclusion: Legally requiring people to wear face masks seems to be an essentially effective instrument in this case. Studying the voluntary use of masks, we find that in different groups, wearing (or not wearing) a mask can be attributed to various reasons. Potential campaigns should therefore be tailor-made for different demographic groups.

Keywords: COVID-19, disease contagion, mask, SARS-CoV-2, social behavior


How to cite this article:
Rieger MO. To wear or not to wear? Factors influencing wearing face masks in Germany during the COVID-19 pandemic. Soc Health Behav 2020;3:50-4

How to cite this URL:
Rieger MO. To wear or not to wear? Factors influencing wearing face masks in Germany during the COVID-19 pandemic. Soc Health Behav [serial online] 2020 [cited 2020 Jul 12];3:50-4. Available from: http://www.shbonweb.com/text.asp?2020/3/2/50/286262




  Introduction Top


The current SARS-CoV2 pandemic is a challenge not only for physicians and medical research, but also for political communication.[1] After at first, many countries and also the WHO did not recommend using face masks for the general public as a mean to reduce the spread of the virus; this has changed after scientific evidence supported that face masks do indeed reduce the spread.[2],[3],[4] Another reason that could explain the initial advice against the use of face masks that has been discussed is the shortage of face masks during the early stages of the pandemic that requested to limit their use to prevent the shortage of masks for health-care workers, following the WHO guidelines.[2]

Wearing face masks in public is extremely uncommon in Western countries (whereas it has been a common phenomenon in East Asia for a long time to help reduce the spread of common cold or influenza[5]). In order to illustrate the acceptance of face masks in the current situation and to determine the factors that influence it, it is important to assess the compliance with recommendations or laws requiring to wear face masks and to develop programs that would promote their use. To this end, we conducted an online survey and will present our findings in this article.

In Germany, wearing face masks in certain situations was announced compulsory on April 27, around 5 days after our survey took place. We hope that our results can help assess the best instruments to promote the use of face masks among different groups of people. Policy suggestions derived from the study are summarized in the concluding section.


  Methods Top


We conducted an online survey on April 20 to 22, 2020, among the students and employees of the University of Trier, Germany. The study was approved by Trier University statutes of the ethic committee (Ref Code: Trier, 02.06.2020 VP M-F/MC) Of the total 274 participants, after removing incomplete and inconsistent responses, 206 responses remained for further analysis. We had conducted a similar survey on March 24–25. Some of its results will be briefly mentioned later. The sample characteristics of both surveys are summarized in [Table 1]. Both samples are certainly not representative, but cover a broad range of the population.
Table 1: Sample characteristics for the two surveys

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Besides standard demographic questions, the participants were asked whether they personally knew anyone with COVID-19 or persons who were tested for SARS-CoV-2.

The main questions of the current study were designed to be able to illustrate attitudes and expectations regarding wearing a face mask. They are listed in [Table 2].
Table 2: List of the most relevant questions of the survey

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The participants were also asked whether they held the opinion that one could learn from the East Asian countries how to handle epidemics (because wearing face masks is a common practice in these countries, we would expect to see a certain positive correlation with the willingness to wear masks, although this might be reduced due to sentiments[6]).

Finally, the participants were asked how much they were worried about the corona crisis, as such fears have been found to be an important issue in many countries.[7],[8],[9]

The survey also contained other items that are not subject to the current study.


  Results Top


Descriptive results

The key outcomes of the survey can be summarized as follows: participants have rather mixed but slightly positive attitude toward wearing masks [Figure 1]. Fifty to eighty percent of the participants stated that they would “probably” wear a mask in four out of five situations. Only when asked if they would wear the mask “in the street,” the percentage drops to 20%. The percentages seem to reflect the infection risks reasonably well.
Figure 1: Wearing face masks in public without it being legally required

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The picture changes dramatically for the case where it is legally required to wear a mask [Figure 2]. In this case, the overwhelming majority would do so – or at least they say they would, whereas we should bear in mind that the participants tend to state they would behave in accordance with the law when asked such a question, even if in reality they might not. There is also a substantial minority (20%) who would probably not wear a face mask in the street even if it were legally required. This suggests that policymakers should be rather cautious about making it compulsory, as compliance could become a larger issue.
Figure 2: Wearing face masks when it is legally required

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What about the controversial attitude toward wearing a face mask? Nearly 64% of the participants agree at least partially that it is strange to wear a mask in public [Figure 3]a. Only 25% worry that others will (probably) think they looked strange wearing a mask, but 41% do not rule out this possibility either [Figure 3]b.
Figure 3: (a and b) Psychological and social reasons against wearing a mask

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How about the effectiveness of the masks? Here, the high heterogeneity of responses reflects the high level of uncertainty on this matter and the conflicting opinions of experts [Figure 4]. In any case, people more widely believe that masks help protect others rather than protect oneself from contracting the virus.
Figure 4: Perceived benefits of wearing face masks

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In view of the fact that masks are a common mean to prevent the spread of diseases in East Asia, and that the success of most East Asian countries in the fight against the pandemic is remarkable and is sometimes commented positively in German media, but also considering that some of the measures (particularly those which restrict personal freedom and data privacy) are controversial in Germany, we were curious what participants thought about these measures. [Figure 5] shows the results: while 78% agree at least partially to this, the percentage of people who mostly or totally agree, is only 31%.
Figure 5: Handling of epidemics in East Asian countries – something to learn from?

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Comparison to previous survey wave

We had asked one question about wearing masks already in an earlier survey with different participants on March 24–25, prior to the lockdown and the discussions about a law requiring people to wear face masks. The process of sampling and the demographics of the participants were very similar [Table 2], with only slight (but statistically significant) differences in age and the proportion of students, thus making the direct comparison of the results possible. We were expecting to see a more positive attitude toward masks in the recent survey, but the results are all in all observationally equivalent [Figure 6]. Statistical tests also revealed absolutely no significant difference in the distribution of responses: a t-test on the mean answers had a P = 0.95; an ordinary least squares regression analysis for the demographic factors (age, gender, student, and university degree) also showed no significant effect of the survey wave (P = 0.65). It seems that attitudes change more slowly, while the behavior of people can, as it appears, be changed much faster.
Figure 6: Attitudes toward wearing masks show no significant difference over time (standard errors shown as bars)

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Factors influencing the decision to wear a face mask; age and gender differences

We have already seen that state interventions in the form of laws are very promising in enforcing the use of masks, at least in situ ations where a real risk is perceivable (”Descriptive results” section). What other factors play a role?

To this end, we conducted a regression analysis to detect factors contributing significantly to the decision to wear a mask [Table 3]. As dependent variable, we used the sum of all responses to the likelihood of wearing a mask (without law) where the responses to each item were encoded on a scale from 1 to 4.
Table 3: Regression results

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We thereby find that the most significant factor are the worries about the current crisis: more worries lead to more people wearing a face mask, as could be expected. Other significant factors are the own aversion against wearing a mask, the perception of others' judgments, self-protection, and protection of others. Demographic factors (age, gender, and university student) did not play a role, besides a university degree which increased the likelihood of wearing a mask.

The results become more interesting as we focus on subgroups of the sample. While worries about the crisis and the own aversion to wearing a mask are relevant for all groups, we find striking differences in the other motives for wearing a mask: when studying only young people (age ≤25 years), the judgment of other people and self-protection are very important, but protecting others does not play a significant role. For other subgroups (>25 years), on the other hand, self-protection and the judgment of other people did not play a role, yet the motive of protecting others did.

This result is surprising, and somehow unsettling because young people are less likely to contract the virus, so for them protecting others should be of higher priority, but the opposite seems to be the case.

We also find gender differences: while for men protecting others plays a significant role, for women, self-protection is more important. In that respect, average women are more similar to average young people.

We also examined whether these differences were due to the differences in perception of the effectiveness of a face mask, but we did not find any significant differences in that respect between women and men or between young participants and others.


  Conclusion Top


We focus in our conclusions on policy suggestions that could help increase the willingness of people to wear face masks, assuming that this is an effective method for reducing the spread of infections (given that social distancing by itself can only be sustained for a limited time due to its economic impact[10] and a decrease in compliance over time,[11] this measure becomes even more important).

We find that the fastest way to make people were masks may be enforcement by law. We do see limitations to this, however, if the law is too strict. Requiring people to wear masks in the street would not (at least in the not very densely populated areas of Germany) lead to high compliance rates.

To self-motivate people, a more tailor-made approach has to be adopted:

  • Young people tend to be more sensitive to the perceived judgment of others. Having popular role models wearing masks might help in this case, and essentially everything that could comfort the worries that others “will think strange of them” if they wear a mask
  • For young people and also for women, self-protection is also important. Stressing this function may help to enhance compliance
  • For older people (>25 years old in our study) and for men, the aspect of protecting others seems to be more important. Again, this can be emphasized when addressing this group.


We have no reason to believe that our key findings cannot be generalized to a more representative sample of the population and to other comparable countries, particularly given that the results seem to be very robust. Nevertheless, further studies would be desirable.

Acknowledgments

We thank Karine Nanyan for her proofreading, and the anonymous referee for the very speedy and helpful report.

Financial support

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Greenhalgh T, Schmid MB, Czypionka T, Bassler D, Gruer L. Face masks for the public during the covid-19 crisis. BMJ 2020;369:m1435.  Back to cited text no. 1
    
2.
World Health Organization. Rational use of Personal Protective Equipment for Coronavirus Disease (COVID-19): Interim Guidance, 27 February 2020. No. WHO/2019-nCov/IPCPPE_use/2020.1. World Health Organization; 2020.  Back to cited text no. 2
    
3.
World Health Organization. Non-Pharmaceutical Public Health Measures for Mitigating the Risk and Impact of Epidemic and Pandemic Influenza. World Health Organization; 2019. Available from: https://www.who.int/influenza/publications/public_health_measures/publication/en/. [Last accessed on 2020 May 15].  Back to cited text no. 3
    
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Bavel JJ, Baicker K, Boggio PS, Capraro V, Cichocka A, Cikara M, et al. Using social and behavioural science to support COVID-19 pandemic response. Nat Hum Behav 2020:1-12. https://doi.org/10.1038/s41562-020-0884-z.  Back to cited text no. 4
    
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Ying Sin MS. Masking fears: SARS and the politics of public health in China. Crit Public Health 2016;26:88-98.  Back to cited text no. 5
    
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Chung-Ying L. Social reaction toward the 2019 novel coronavirus (COVID-19). Soc Health Behav 2020;3:1-2.  Back to cited text no. 6
    
7.
Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The fear of COVID-19 scale: Development and initial validation. Int J Ment Health Addict 2020:1-9. doi:10.1007/s11469-020-00270-8.  Back to cited text no. 7
    
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Sakib N, Mamun MA, Bhuiyan AK, Hossain S, Mamun FA, Hosen I, et al. Psychometric validation of the Bangla Fear of COVID-19 Scale: Confirmatory factor analysis and Rasch analysis. Int J Mental Health Addict 2020:1-12. doi:10.1007/s11469-020-00289-x.  Back to cited text no. 8
    
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Soraci P, Ferrari A, Abbiati FA, Del Fante E, De Pace R, Urso A, et al. Validation and psychometric evaluation of the Italian version of the fear of COVID-19 scale. Int J Ment Health Addict 2020:1-10. doi:10.1007/s11469-020-00270-8.  Back to cited text no. 9
    
10.
Atkeson A. What will be the Economic Impact of COVID-19 in the US? Rough Estimates of Disease Scenarios. No. w26867. National Bureau of Economic Research; 2020.  Back to cited text no. 10
    
11.
Rieger MO, Wang M. Secret Erosion of the “Lockdown”? Patterns in Daily Activities During the SARS-Cov2 Pandemics Around the World, Review of Behavioral Economics; 2020.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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