The use of facemasks to prevent respiratory infection: a literature review in the context of the Health Belief Model

Share this Article

Singapore Med J 2014; 55(3): 160-167; http://dx.doi.org/10.11622/smedj.2014037

Sim SW, Moey KS, Tan NC
Correspondence: Ms Shin Wei Sim, simshinwei@gmail.com

ABSTRACT
INTRODUCTION Acute respiratory infections are prevalent and pose a constant threat to society. While the use of facemasks has proven to be an effective barrier to curb the aerosol spread of such diseases, its use in the local community is uncommon, resulting in doubts being cast on its effectiveness in preventing airborne infections during epidemics. We thus aimed to conduct a literature review to determine the factors that influence the use of facemasks as a primary preventive health measure in the community.
METHODS A search for publications relating to facemask usage was performed on Medline, PubMed, Google, World Health Organization and Singapore government agencies’ websites, using search terms such as ‘facemask’, ‘mask’, ‘influenza’, ‘respiratory infection’, ‘personal protective equipment’, ‘disease prevention’, ‘compliance’ and ‘adherence’. Findings were framed under five components of the Health Belief Model: perceived susceptibility, perceived benefits, perceived severity, perceived barriers and cues to action.
RESULTS We found that individuals are more likely to wear facemasks due to the perceived susceptibility and perceived severity of being afflicted with life-threatening diseases. Although perceived susceptibility appeared to be the most significant factor determining compliance, perceived benefits of mask-wearing was found to have significant effects on mask-wearing compliance as well. Perceived barriers include experience or perception of personal discomfort and sense of embarrassment. Media blitz and public health promotion activities supported by government agencies provide cues to increase the public’s usage of facemasks.
CONCLUSION Complex interventions that use multipronged approaches targeting the five components of the Health Belief Model, especially perceived susceptibility, are needed to increase the use of facemasks in the community. Further studies are required to evaluate the effectiveness of implemented interventions.

Keywords: facemask, Health Belief Model, prevention, respiratory infection
Singapore Med J 2014; 55(3): 160-167; http://dx.doi.org/10.11622/smedj.2014037

REFERENCES

1. World Health Organization. Global and Alert Response (GAR), Disease outbreaks by year [online]. Available at: http://www.who.int/csr/don/archive/year/en/index.html. Accessed April 20, 2013.

2. Burgess A, Horii M. Risk, ritual and health responsibilisation: Japan's 'safety blanket' of surgical face mask-wearing. Sociol Health Illn 2012; 34:1184-98. http://dx.doi.org/10.1111/j.1467-9566.2012.01466.x

3. Müller MA, Raj VS, Muth D, et al. Human corona virus EMC does not require the SARS-coronavirus receptor and maintains broad replicative capability in mammalian cell lines. MBio 2012; 3:e00515-12. http://dx.doi.org/10.1128/mBio.00515-12

4. Chan JF, Li KS, To KK, et al. Is the discovery of the novel human betacoronavirus 2c EMC/2012 (HCoV-EMC) the beginning of another SARS-like pandemic? J Infect 2012; 65:477-89. http://dx.doi.org/10.1016/j.jinf.2012.10.002

5. Wiemken TL, Peyrani P, Ramirez JA. Global changes in the epidemiology of community-acquired pneumonia. Semin Respir Crit Care Med 2012; 33:213-9. http://dx.doi.org/10.1055/s-0032-1315633

6. Ministry of Health, Singapore. Top 4 Conditions of Polyclinic Attendances [online]. Available at: https://www.moh.gov.sg/content/moh_web/home/statistics/Health_Facts_Sing.... Accessed August 9, 2012.

7. Jefferson T, Foxlee R, Del Mar C, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review. BMJ 2008; 336:77- 80. http://dx.doi.org/10.1136/bmj.39393.510347.BE

8. Aiello AE, Perez V, Coulborn RM, et al. Facemasks, Hand hygiene, and influenza among young adults: a randomized intervention trial. PLoS One 2012; 7:e29744. http://dx.doi.org/10.1371/journal.pone.0029744

9. Aledort JE, Lurie N, Wasserman J, Bozzette SA. Non-pharmaceutical public health interventions for pandemic influenza: an evaluation of the evidence base. BMC Public Health 2007; 7:208. http://dx.doi.org/10.1186/1471-2458-7-208

10. Kiliç S, Gray GC. Nonpharmaceutical Interventions for Military Populations During Pandemic Influenza. Turk Silahli Kuvvetleri Koruyucu Hekim Bul 2007; 6:285-90.

11. Luby SP, Agboatwalla M, Feikin DR, et al. Effect of handwashing on child health: a randomised controlled trial. Lancet 2005; 366:225-33. http://dx.doi.org/10.1016/S0140-6736(05)66912-7

12. White CG, Shinder FS, Shinder AL, Dyer DL. Reduction of illness absenteeism in elementary schools using an alcohol-free instant hand sanitizer. J Sch Nurs 2001; 17:258-65. http://dx.doi.org/10.1177/10598405010170050501

13. Jefferson T, Del Mar C, Dooley L, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev 2010; (1):CD006207.

14. Furuya H. Risk of transmission of airborne infection during train commute based on mathematical model. Environ Health Prev Med 2007; 12:78-83. http://dx.doi.org/10.1007/BF02898153

15. Eastwood K, Durrheim D, Francis JL, et al. Knowledge about pandemic influenza and compliance with containment measures among Australians. Bull World Health Organ 2009; 87:588-94. http://dx.doi.org/10.2471/BLT.08.060772

16. van der Sande M, Teunis P, Sabel R. Professional and home-made face masks reduce exposure to respiratory infections among the general population. PLoS One 2008; 3:e2618. http://dx.doi.org/10.1371/journal.pone.0002618

17. Tang JW, Liebner TJ, Craven BA, Settles GS. A schlieren optical study of the human cough with and without wearing masks for aerosol infection control. J R Soc Interface 2009; 6 suppl 6:S727-36. http://dx.doi.org/10.1098/rsif.2009.0295.focus

18. Taylor M, Raphael B, Barr M, et al. Public health measures during an anticipated influenza pandemic: Factors influencing willingness to comply. Risk Manag Healthc Policy 2009; 2:9-20. http://dx.doi.org/10.2147/RMHP.S4810

19. MacIntyre CR, Cauchemez S, Dwyer DE, et al. Face mask use and control of respiratory virus transmission in households. Emerg Infect Dis 2009; 15:233- 41. http://dx.doi.org/10.3201/eid1502.081166

20. Quah SR, Hin-Peng L. Crisis prevention and management during SARS outbreak, Singapore. Emerg Infect Dis 2004; 10:364-8. http://dx.doi.org/10.3201/eid1002.030418

21. Rosenstock IM. Why people use health services. Milbank Meml Fund Q 1966; 44:94-127. http://dx.doi.org/10.2307/3348967

22. Tang CS, Wong CY. Factors influencing the wearing of facemasks to prevent the severe acute respiratory syndrome among adult Chinese in Hong Kong. Prev Med 2004; 39:1187-93. http://dx.doi.org/10.1016/j.ypmed.2004.04.032

23. Kuo PC, Huang JH, Liu MD. Avian influenza risk perception and preventive behaviour among traditional market workers and shoppers in Taiwan: practical implications for prevention. PLoS One 2011; 6:e24157. http://dx.doi.org/10.1371/journal.pone.0024157

24. Lau JT, Kim JH, Tsui HY, Griffiths S. Anticipated and current preventive behaviours in response to an anticipated human-to-human H5N1 epidemic in the Hong Kong Chinese general population. BMC Infect Dis 2007; 7:18. http://dx.doi.org/10.1186/1471-2334-7-18

25. Lau JT, Griffiths S, Choi KC, Lin C. Prevalence of preventive behaviours and associated factors during early phase of the H1N1 influenza epidemic. Am J Infect Control 2010; 38:374-80. http://dx.doi.org/10.1016/j.ajic.2010.03.002

26. Condon BJ, Sinha T. Who is that masked person: the use of face masks on Mexico City public transportation during the Influenza A (H1N1) outbreak. Health Policy 2010; 95:50-6. http://dx.doi.org/10.1016/j.healthpol.2009.11.009

27. Yap J, Lee VJ, Yau TY, Ng TP, Tor PC. Knowledge, attitudes and practices towards pandemic influenza among cases, close contacts, and healthcare workers in tropical Singapore: a cross-sectional survey. BMC Public Health 2010; 10:442. http://dx.doi.org/10.1186/1471-2458-10-442

28. Lau JT, Griffiths S, Au DW, Choi KC. Changes in knowledge, perceptions, preventive behaviours and psychological responses in the pre-community outbreak phase of the H1N1 epidemic. Epidemiol Infect 2011; 139:80-90. http://dx.doi.org/10.1017/S0950268810001925

29. Ferng YH, Wong-McLoughlin J, Barrett A, Currie L, Larson E. Barriers to mask wearing for influenza-like illnesses among urban Hispanic households. Public Health Nurs 2011; 28:13-23. http://dx.doi.org/10.1111/j.1525-1446.2010.00918.x

30. Chia SE, Koh D, Fones C, et al. Appropriate use of personal protective equipment among healthcare workers in public sector hospitals and primary healthcare polyclinics during the SARS outbreak in Singapore. Occup Environ Med 2005; 62:473-7. http://dx.doi.org/10.1136/oem.2004.015024

31. Lau JT, Griffiths S, Choi KC, Tsui HY. Widespread public misconception in the early phase of the H1N1 influenza epidemic. J Infect 2009; 59:122-7. http://dx.doi.org/10.1016/j.jinf.2009.06.004

32. Seale H, Mak JP, Razee H, Macintyre CR. Examining the knowledge, attitudes and practices of domestic and international university students towards seasonal and pandemic influenza. BMC Public Health 2012; 12:3 07. http://dx.doi.org/10.1186/1471-2458-12-307

33. Lau JT, Kim JH, Tsui HY, Griffiths S. Perceptions related to bird-to-human avian influenza, influenza vaccination, and use of face mask. Infection 2008; 36:434-43. http://dx.doi.org/10.1007/s15010-008-7277-y

34. Syed Q, Sopwith W, Regan M, Bellis M. Behind the mask. Journey through an epidemic: some observations of contrasting public health responses to SARS. J Epidemiol Community Health 2003; 57:855-6. http://dx.doi.org/10.1136/jech.57.11.855

35. World Health Organization. Severe acute respiratory syndrome (SARS): status of the outbreak and lessons for the immediate future [online]. Available at: http://www.who.int/csr/media/sars_wha.pdf. Accessed April 20, 2013.

36. Weiss MM, Weiss PD, Weiss DE, Weiss JB. Disrupting the transmission of influenza a: face masks and ultraviolet light as control measures. Am J Public Health 2007; 97 suppl 1:S32-7. http://dx.doi.org/10.2105/AJPH.2006.096214

37. Campbell JD, Allen-Ramey F, Sajjan SG, Maiese EM, Sullivan SD. Increasing pharmaceutical copayments: impact on asthma medication utilization and outcomes. Am J Manag Care 2011; 17:703-10.

38. McNeil D. Masks become a Taiwan must-have, with bootlegging and price gouging. New York Times 2003 May 22; A8.

39. Chor JS, Pada SK, Stephenson I, et al. Differences in the compliance with hospital infection control practices during the 2009 influenza H1N1 pandemic in three countries. J Hosp Infect 2012; 81:98-103. http://dx.doi.org/10.1016/j.jhin.2012.04.003

40. Leung GM, Lam TH, Ho LM, et al. The impact of community psychological responses on outbreak control for severe acute respiratory syndrome in Hong Kong. J Epidemiol Community Health 2003; 57:857-63. http://dx.doi.org/10.1136/jech.57.11.857

41. Di Giuseppe G, Abbate R, Albano L, Marinelli P, Angelillo IF. A survey of knowledge, attitudes and practices towards avian influenza in an adult population of Italy. BMC Infect Dis 2008; 8:36. http://dx.doi.org/10.1186/1471-2334-8-36

42. Pawlowski B, Atwal R, Dunbar R. Sex differences in everyday risk-taking behaviour in humans. Evol Psychol 2008; 6:29-42.

43. Archer J. Sex differences in aggression in real-world settings: a metaanalytic review. Rev Gen Psychol 2004; 8:291-322. http://dx.doi.org/10.1037/1089-2680.8.4.291

44. Eastwood K, Durrheim DN, Butler M, Jones A. Responses to pandemic (H1N1) 2009, Australia. Emerg Infect Dis 2010; 16:1211-6. http://dx.doi.org/10.3201/eid1608.100132