Press the play button above to watch the video.
The perception of mask wearing, an effective part of a comprehensive public health strategy to prevent the spread of COVID-19, has become an intense talking point in American discourse.
Because messaging has a large impact on community adherence to public health guidance, many agencies are now seeking the most effective strategies to communicate the importance of wearing a mask during the pandemic. Experts at UNC-Chapel Hill have published a new study that suggests positive messages could be critical to supporting this effort.
“As science evolved during the pandemic, it became clear wearing masks was going to be a critical step,” said Allison Lazard, associate professor at the UNC Hussman School of Journalism and Media. “But there just isn’t much out there for evidence-based messaging, especially not for what might motivate people in North Carolina to wear face coverings.”
The study was led by Lazard and Victoria Shelus, doctoral student in health behavior at the UNC Gillings School of Global Public Health and a predoctoral trainee at the Carolina Population Center. Published in the International Journal of Environmental Research and Public Health, the study conducted six virtual focus groups with residents in North Carolina to gain a better understanding of when and why they are using face coverings, as well as potential insights for messaging that might improve rates of usage.
The six focus groups featured participants from many demographics, including Latinx (English- and Spanish-speaking); Black, Indigenous and people of color; white and living in a rural area; and young adults aged 18-25.
Focus group participants reported that they wore face coverings frequently when in public, indoor settings — including grocery stores, health care facilities and religious services — but did not wear them when outside and able to practice physical distancing. Participants also reported forgoing masks while home alone or with household members, as well as in indoor office settings with co-workers.
Study participants were primarily motivated to wear masks to protect and respect the safety of fellow community members, especially family who are at higher risk of complications from infection. Focus groups commonly believed that masks were effective and that wearing one was a matter of personal responsibility. The authority of mask mandates and public health guidance also played a motivating role.
Conversely, participants did not use masks in situations where they did not feel their use was necessary, such as around family and trusted friends or colleagues. The study reported that “these interactions were not perceived as occurring in public. These perceptions are problematic, as cluster infections among family, friends and colleagues remain a common pattern for COVID-19 transmission.”
Social challenges prevented some from wearing masks or asking others to wear them out of fear of causing offense. Some cited barriers related to physical challenges and low perception of susceptibility. In addition to confusion about whether masks protected the wearer or only others around them, some participants were confused by guidance at the beginning of the pandemic that called for masks to be reserved only for health care personnel. And while infrequent, myths and conspiracy theories surrounding facial coverings caused concern.
Issues related to identity — such as political affiliation, or the perception that masks were “uncool,” “not masculine” or an infringement on individual rights — also created challenges. According to the study, “even participants who consistently wore face coverings disliked being told what to do.”
In discussion of potential communication strategies with the focus groups, concise and positive messages about togetherness and unity were more appealing than messages of fear or instructiveness. Stories that conveyed the personal effects of COVID-19 were particularly impactful, such as accounts from health care workers or those who had lost a loved one to the virus.
“As COVID-19 cases continue to rise in N.C. and across the United States, there is an urgent need for effective messaging to encourage the use of face coverings,” said Shelus. “Among our recommendations is a need for public health messaging to normalize the use of masks in social settings. We’re seeing a rise in COVID-19 cases from unmasked indoor interactions with family and friends over the holidays, and this may continue over the winter months.”
The study gives public health experts, leaders and communicators critical insight to craft messaging that could potentially increase mask usage during the pandemic. It also serves as a foundation for further research into messaging strategies with larger populations.
Following the focus groups, the study team launched a broader survey to ask more individuals in N.C. about what might help to motivate them to wear a face mask. The insights from this survey were similar to those gained in the study — residents want to protect others and themselves, and they want positive messages to encourage them to do so.
“We are pleased to see our insights incorporated in the ‘Whatever Your Reason’ campaign that the N.C. Department of Health and Human Services has launched statewide to encourage everyone to ‘get behind the mask,’” said Lazard.
Additional researchers in the study include Simone Frank, engagement and outreach coordinator at the N.C Translational and Clinical Sciences Institute; Isabella Higgins, research project manager at the Carolina Population Center; health behavior graduate students Marlyn Pulido and Ana Paula Richter; Sara Vandegrift, research specialist at the UNC Gillings School of Global Public Health and the Lineberger Comprehensive Cancer Center; Rhyan Vereen, doctoral student and research assistant at the UNC Hussman School of Journalism and Media; Kurt Ribisl, Jo Anne Earp Distinguished Professor and department chair of health behavior; and Marissa Hall, assistant professor of health behavior.