How the public used face masks in China during the coronavirus disease pandemic: A survey study.

BACKGROUND

Universal face mask use was recommended owing to the growing pandemic of the coronavirus disease (COVID-19). However, little is known about the public's compliance with mask-wearing behaviours.

OBJECTIVE

To evaluate the public's mask-wearing behaviours in the context of COVID-19.

DESIGN

Cross-sectional study.

SETTING

Online survey from 6 April 2020 to 5 May 2020 in China.

PARTICIPANTS

This study included 10,165 persons who lived in China, understood Chinese, and were not health care providers.

METHODS

Descriptive statistics were used to assess the public's mask-wearing behaviours. A binary logistic regression analysis was performed to identify the risk factors affecting the mask-wearing behaviours.

RESULTS

Nearly all (99%) people wore a mask during the covid-19 pandemic, with most (73.3%) demonstrating good compliance with face mask use. However, 41.8% of the participants seldom cleaned their hands before putting on a face mask, and more than half (55.3%, 62.1%) of those who touched (n=8108, 79.8%) or adjusted (n=9356, 92.0%) their mask while using it failed to consistently wash their hands afterward. When removing a used mask, 7.6% of the participants discarded it into a garbage bin without a lid and 22.5% discarded it into a garbage bin in their reach regardless of presence of a lid. Participants reported wearing disposable medical masks (93.8%), followed by N95 respirators (26.2%), and cloth face masks (8.5%). Some participants wore multiple masks simultaneously (occasionally 26.5%, often 2.1%, always 1.5%). A total of 5,981 (58.8%) participants reported reusing disposable masks, with nearly two thirds (n=3923, 65.6%) indicating they would hang the used masks in well-ventilated places. More than one-third (37.6%) of the respondents did not replace mask when it had been used for more than 8 hours. Exposure to instructions on face mask use was the strongest predictor of good compliance (odds ratio=4.13, 95% confidential interval= 3.60-4.75, p=0.000). Other factors included specific situations, location, and gender. The influence of age needs further investigation. Most participants (76.4%) accessed information mainly via social media platforms.

CONCLUSIONS

Nearly all people wore face mask and most of them used it properly during the COVID-19 pandemic. Hand hygiene before and during mask-wearing, choosing an appropriate type of face mask, reusing disposal face mask, and disposing of used face masks should be particularly emphasized in future evidence dissemination or behaviour-change interventions. Information on social media platforms for evidence dissemination and behaviour change may benefit the public the most, but this initiative requires further research to investigate its effectiveness.