|Year : 2020 | Volume
| Issue : 2 | Page : 209-215
Social perception and practices of households regarding mask use in public places during COVID-19 postquarantine period
Abhishek Singh1, Ram Kumar Panika2, Vikas Gupta2, Pawan Kumar Goel1, Rakesh Kumar Mahore3, Mansi Singal4
1 Department of Community Medicine, SHKM Government Medical College, Nalhar, Haryana, India
2 Department of Community Medicine, Government Medical College, Shahdol, Madhya Pradesh, India
3 Department of Community Medicine, Bundelkhand Medical College, Sagar, Madhya Pradesh, India
4 ESIC Medical College and Hospital, Faridabad, Haryana, India
|Date of Submission||24-Jul-2020|
|Date of Decision||19-Aug-2020|
|Date of Acceptance||21-Sep-2020|
|Date of Web Publication||18-Dec-2020|
Dr. Vikas Gupta
Department of Community Medicine, Government Medical College, Shahdol, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
INTRODUCTION: Cases have been reported of people affected with COVID-19, facing discrimination on account of heightened fear and misinformation about infection. Hence, this global health crisis of COVID-19 pandemic offers a unique opportunity to investigate the level of perceptions and practices ??regarding the use of mask in public places among ?households of quarantined individuals following COVID-19 postquarantine period.
MATERIALS AND METHODS: The study included household members of COVID-19-affected patients following postquarantine period during the 1st week of July 2020. After obtaining informed consent from 123 participants, a structured questionnaire was used to collect the data. All the tests were performed at a significance level of 5%.
RESULTS: More than one-third of the participants (34.1%) were not using mask/personal protective equipment (PPE) at all in public places. Around two-third of the participants were willing to wear mask/PPE in public places such as local markets/street (64.2%), bus/train/flight (73.2%), neighborhood/institution (60.2%), and malls/shopping complex (72.4%). Only half of the study participants (50.4%) had an overall good perception score for wearing mask/PPE.
CONCLUSIONS: The present study made an attempt to find the perceptions and practices of household personnel of quarantined individuals during postquarantine period regarding mask/PPE use while they are in public place, and it was observed that perception and practices were not satisfactory in this regard. The major cause might be increased stigma and violence, which might have created hesitation among them for using mask in public places. The study findings might help local administration to enhance psychological and social support.
Keywords: COVID-19 pandemic, households, perception, stigma
|How to cite this article:|
Singh A, Panika RK, Gupta V, Goel PK, Mahore RK, Singal M. Social perception and practices of households regarding mask use in public places during COVID-19 postquarantine period. BLDE Univ J Health Sci 2020;5:209-15
|How to cite this URL:|
Singh A, Panika RK, Gupta V, Goel PK, Mahore RK, Singal M. Social perception and practices of households regarding mask use in public places during COVID-19 postquarantine period. BLDE Univ J Health Sci [serial online] 2020 [cited 2021 Apr 14];5:209-15. Available from: https://www.bldeujournalhs.in/text.asp?2020/5/2/209/303977
The COVID-19 has emerged from the Wuhan province of China and took the form of a pandemic affecting all the continents including most of the countries. As of now, worldwide, there are a total of 11,591,595 confirmed COVID-19 cases and 537,859 deaths from COVID-19, and in India, count is rising exponentially, with total confirmed cases counting to 721,774 and deaths are 20,642., Although the case-fatality rates of COVID-19 (2.3%) are lower as compared to SARS (9.5%) and MERS (34.4%), infection transmission rates are far higher when compared to those diseases.,,
The most common preventive measures used against COVID-19 among the general population are personal protective equipment (PPE) and hand hygiene. The Ministry of Health and Family Welfare (MoHFW), Government of India (GoI), has released guidelines for use by the public. Although each item of PPE is essential to prevent COVID-19 infection, face mask (triple-layer surgical mask or N-95 mask) is being mostly used or wore when compared to other items.
Cases have been reported of people affected with COVID-19 facing discrimination on account of heightened fear and misinformation about infection. Even those who have recovered from COVID-19 face such discrimination. Such stigma can undermine social cohesion and prompt possible social isolation of groups, which might contribute to a situation where the virus is more, not less, likely to spread. Stigma can drive people to hide the illness to avoid discrimination, prevent people from seeking health care immediately, and discourage them from adopting healthy behaviors such as the use of the mask in the public place.
Hence, this global health crisis of pandemic offers a unique opportunity to investigate the ?social perception and practices regarding the use of a mask or PPE in public places among households of quarantined individuals following postquarantine period and also exploring the various factors in shaping perceptions which will be overall the first step in identifying the potential areas for developing a structured social program to be prepared for the future such instances.
| Materials and Methods|| |
Study setting and design
This present cross-sectional study was conducted at SHKM Government Medical College, Nalhar, district Nuh, Haryana, during the 1st week of July 2020. Nuh was among the worst affected district among all 22 districts of Haryana state with maximum number of positive cases. A large number of persons were sent on quarantine including household members.
Study population and sample size
The study participants included? household members of COVID-19-positive patients who have completed the duration of quarantine period as being sent on home quarantine, and it counted to around 139 eligible participants.
The minimum required sample size was calculated (n = 97) considering the proportion of general public having practice of using mask in public place as 50% (studies not found in Haryana) with a confidence level of 95% and 10% absolute allowable error by applying the following formula: n = (Z1 - a/2) 2 × p (1 - p)/d2, where Z = Standard normal variate for level of significance (at 5% type I error [P < 0.05], Z = 1.96 for two-sided test), a = Level of significance (0.05), P = Prevalence (proportion – 50%), d = absolute allowable error (4%), and n = sample size, so all eligible study participants which counted to be 139 were included in the study.
A 16-element structured questionnaire with closed-ended responses was developed which covered the domains of participants' sociodemographic characteristics,? mask/PPE practices in public places, and perception toward mask/PPE usage in public places during COVID-19 postquarantine period. The questionnaire was first prepared in English. Then, it was translated into Hindi by an expert in that language keeping semantic equivalence. To check the translation, it was back translated into English by two independent researchers who were unaware of the first English version.
The collected questions 43 were subjected to content validation by a panel of 10 medical experts. The purpose was to identify the items with a high degree of agreement among experts. Aiken's V was used to quantify the concordance between experts for each item. Only 26 questions that had an Aiken's V >0.7 were selected for the study. A pilot study was done among ten attendants visiting the outpatient department, and it took on an average 20 min for completing questionnaire. All efforts were made to keep the questions simple and unambiguous according to the objectives of the study.
The questionnaire had 4 divisions and consisted of total 16 elements. Division 1 consisted of five elements and gathered information regarding participants' characteristics such as current age in years, gender, literacy status, religion, type of family, and socioeconomic status. Division 2 ?consisted of one element and aimed to gather practices for mask/PPE usage in public places. Division 3 consisted of 8 elements and aimed to reveal the attitude ?toward mask/PPE usage in public places such markets/streets, bus/train/flight, malls/shopping complex, and neighborhood/workplace. Division 4 consisted of 5 elements and aimed to obtain the participants' perception/beliefs when mask/PPE is used either by him/herself or by somebody else in public places and preventive perceptions of mask/PPE. The responses for divisions 3 and 4 were based on a 4-point Likert scale pattern, and the participants were suggested to respond to each element of that division based on it. Positive statements were scored on a 3-0 scale with “most positive” responses yielding points, whereas negative statements were scored on a 0–3 scale. A combined score was obtained on the basis of response to each of the elements of divisions 3 and 4, which ranged between 0 and 39. Equal or more than median of the attained score was considered good, whereas less than median of the attained score was considered poor.
The socioeconomic status was obtained using the modified B.G. Prasad socioeconomic status classification (revised for the year 2019, CPI 2001 as base). It is based on per capita monthly income and based on it has five categories such as Class I (Rs. 7008 and above), Class II (3504–7007), Class III (2102–3503), Class IV (1051–2101), and Class V (1050 and below).
A complete list of individuals sent on home quarantine (adults aged 18 years or more) by “flu corner” was obtained, and their address and contact numbers were noted down. A few days after completion of their quarantine period (14 days), they were contacted telephonically for their availability to conduct this study. They were explained about the purpose of this study and were requested to participate. Out of 139 participants, only 123 participants provided their written consent after understanding the study objectives and were included in the study. The questionnaire for participants was administered by the investigator himself by face-to-face interview technique. Furthermore, the filled questionnaires were then checked for the completeness. Being elective and not requite were the properties for participating in the study. The study was initiated after obtaining the ethical approval from IEC, SHKM GMC, Nalhar.
Collected data were entered in the MS Excel spreadsheet, coded appropriately, and later cleaned for any possible errors. The analysis was carried out using IBM SPSS Statistics for Windows, version 22.0 (IBM Corp. Armonk, NY, USA). During data cleaning, more variables were created so as to facilitate the association of variables. Clear values for various outcomes were determined before running frequency tests. Categorical data were presented as percentages (%) and quantitative data were presented as mean (standard deviation). Pearson Chi-square test was applied to find the strength of association between perception score and independent variables. All tests were performed at a 5% level of significance; thus, an association was significant if the P < 0.05.
| Results|| |
A total of 123 participants were assessed in the study. Male gender (66.7%) participation was more as compared to females (33.3%). Surprisingly?, more than one-third of the participants (34.1%) were not using mask/PPE at all while in public place or home [Table 1].
Around two-third of the participants were willing to wear mask/PPE in public places such as local markets/street (64.2%), bus/train/flight (73.2%), neighborhood/institution (60.2%), and malls/shopping complex (72.4%). However, when participants were enquired in-depth if there is a strict law for wearing mask in public places, then also there was no change in attitude, and still, nearly one-third of the participants were not willing to wear the mask/PPE [Figure 1].
|Figure 1: Distribution of willingness responses of participants toward wearing of mask/personal protective equipment in public place (n = 123)|
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When participants' perception of strangeness toward wearing of mask/PPE by either him/herself or somebody else was assessed, it was observed that about one-third of the participants (26.8%) disagreed on the fact that “when I wear mask/PPE in public place, it makes others to think strange about me” and more than two-third of the participants (66.7%) disagreed on the fact that “it looks strange when somebody wears mask/PPE in public place,” and in fact, responses from male and female participants were nearly coherent [Figure 2].
|Figure 2: Distribution of perceptions regarding strangeness on wearing mask/personal protective equipment among participants (n = 123)|
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It was noticed in [Figure 3] that more than two-third of the participants strongly agreed on the fact of perceived benefits of ?wearing mask/PPE, i.e., self-protection (66.7%) and protected others (72.4%). The overall mean perception score for wearing mask/PPE among participants was 32?.5 ± 4.8, whereas the mean score among male and female participants was 32.7 ± 4.9 and 32.2 ± 4.4, respectively. The median perception score for wearing mask/PPE in public places was 34.0, with an interquartile range between 30.0 and 36.0. The median score was higher among females when compared to males [Figure 4].
|Figure 3: Distribution of participants' responses for perceived benefits of wearing mask/personal protective equipment and learning from western countries (n = 123)|
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|Figure 4: Distribution of perception score using box and plot (median and interquartile range) among participants (n = 123)|
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Out of 123 study participants, 61 participants (49.6%) had a median score for wearing mask/PPE <34.0, which means that only 50.4% had an overall good perception for wearing mask/PPE. Pearson Chi-square test analysis, in [Table 2], revealed that the poor perception score for wearing mask/PPE was significantly associated with only mask/PPE usage practice.
|Table 2: Independent association of variables and mask/personal protective equipment perception score among study participants (n=123)|
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| Discussion|| |
Currently, COVID-19 is a global topic of discussion in the media and among the public, and no single person or group of people are more likely than others to spread COVID-19. Public health emergencies, such as this pandemic, are stressful times for people and communities. Fear and anxiety about a disease can lead to social stigma, which is negative attitudes and beliefs toward people, places, or things. Stigma can lead to labeling, stereotyping, discrimination external icon, and other negative behaviors toward others; since widespread public measures are key to timely control the infection, the good perceptions and practices among the public regarding COVID-19 are vital, and at present, there is no study being conducted to assess the same. Through this study, the investigator gained a deeper understanding of participant perceptions and practices that are necessary for protection against infection. The study revealed that only half of the study participants had both good perception scores and practices for the prevention of COVID-19 transmission in public places.
In the present study, around more than one-third of the participants (34.1%) were not using mask/PPE when they are in a public place, and it was incoherent with the study done by Nepal et al. where the good practice of mask was observed among more than 80.0% of the study participants. In a study by Gunasekaran et al., a high saturation (99.7%) of face mask usage in a public place was observed and 78.8% were wearing a medical-grade mask which indicates high social adaptability among the general population in response to the local disease outbreak. The high saturation of facemask usage should be welcomed as the rationale behind wearing facemasks has been widely discussed in preventing human-to-human transmission. A similar previous study by Gunasekaran et al. has revealed that 96.9% of the hospital visitors were wearing the mask during this COVID-19 pandemic period.
In the present study, around two-third of the participants were willing to wear mask/PPE in public places such as local markets/street, bus/train/flight, institution/college, and malls/shopping complex, which was in coherence with the study done by Rieger, where 50%–80% of the participants stated that they would (probably) wear a mask (if they had one) in most scenarios.
Even though there are guidelines for the use of the mask in public places introduced by the MoHFW, India, and also, rational use of mask/PPE was advocated by Lyu and Wehby, Greenhalgh et al., and Eikenberry et al., then still nearly one-third of the participants were willing to wear mask/PPE in public place supposing that if there is strict law for the same.,,
The World Health Organization (WHO) has raised concerns regarding the shortage of PPE endangering health workers worldwide. To overcome such shortage, retailers have shifted production to make masks and gowns for health-care workers in coronavirus pandemic (CNBC).
The effectiveness of mask/PPE in preventing the COVID-19 infection has been documented in studies done by Brainard et al., and Leung et al. demonstrated that surgical face masks significantly reduced the detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets., However, in a study by Xiao et al. and Jefferson et al., it was stated that although mechanistic studies support the potential effect of hand hygiene or face masks, evidence from several randomized controlled trials of these measures did not support a substantial effect on the transmission of laboratory-confirmed influenza.,
In a study done by Cowling et al., which consisted of two surveys and it was observed that 98.8% and 97.5% of the general adult population wore masks when going out respectively, a proportion higher than other measures of hand washing or crowd avoidance, whereas in the present study, only 50.4% of the participants had good perception score for wearing mask/PPE. The reason might be the stigma being faced by the public, and it was clear from the present study observation as only one-third of the participants disagreed with the strangeness toward wearing a mask/PPE by him/herself.
Stigma can negatively affect the emotional, mental, and physical health of stigmatized groups and the communities they live in. Stigmatized individuals may experience isolation, depression, anxiety, or public embarrassment. Stopping stigma is important for making all communities and community members safer and healthier. Education is one way to fight stigma. It helps dispel harmful stereotypes. You can help reduce stigma by getting the facts about COVID-19 from reputable sources such as the MoHFW, GoI, Centers for Disease Control and Prevention, and WHO and share it with family and friends; cross-check any information related to CoVID-19 from reliable sources before forwarding any messages on social media; reach out to people who may feel stigmatized; and share positive stories of those who have recovered from COVID-19.
Around the globe, fear among the general population is being evaluated using various newly developed such as “The Fear of COVID-19 Scale” by Ahorsu et al. and their adaptations by Sakib et al.,
Apart from providing education, there is a need to support mental health, and various guidelines are being released by GoI and WHO.,
| Conclusion|| |
Hence, the present study made attempted to find the perceptions and practices of household personnel of quarantined individuals during the postquarantine period regarding mask/PPE use while they are in a public place, and it was observed that perception and practices were not satisfactory in this regard. The major cause might be increased stigma and violence, which might have created hesitation among them for using the mask in public places. The study findings might help local administration to enhance the psychological and social support.
This study was novel in concept and attempted to reveal the perceptions of household personnel regarding the use of masks/PPE in public places. The limitation of the study is that due to the novel in nature, comparable studies were not available, so comparison of perception scores was not highlighted to that extent.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]