• Min Tan, Yingying Wang, Li Luo, and Jiale Hu.
• Institute of Hospital Management, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, Sichuan 610041, P.R. China; Department of Nursing, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, Sichuan 637000, P.R. China. Electronic address: mintan81@163.com.
• Int J Nurs Stud. 2021 Mar 1; 115: 103853.

BackgroundUniversal 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.ObjectiveTo evaluate the public's mask-wearing behaviours in the context of COVID-19.DesignCross-sectional study.SettingOnline survey from 6 April 2020 to 5 May 2020 in China.ParticipantsThis study included 10,165 persons who lived in China, understood Chinese, and were not health care providers.MethodsDescriptive 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.ResultsNearly 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.ConclusionsNearly 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.Copyright © 2020. Published by Elsevier Ltd.

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