Social and behavioral consequences of mask policies during the COVID-19 pandemic
Study population and setting
Between April 14 and May 26, 2020, the authors conducted approximately 6,973 online surveys (~1,000 per week) in Germany to assess changes in mask-wearing knowledge, behavior, and attitudes. On April 27, 2020, masks were required on public transport and in shops. Participants were recruited based on age and gender, and by state in Germany. In addition, during the May 26/27 survey (n=925), a vignette was presented where respondents were asked to imagine that mask policies were mandatory (or not) and their reaction to another person who is wearing a mask (or not) in a grocery store. Subsequent questions assessed how the respondent felt about the person wearing a mask or not, perceived “fairness” of mandatory mask policies, stigma associated with mask-wearing, and if the other person was perceived as prosocial (i.e. helpful, positive, concern for the welfare and rights of others).
Summary of Main Findings
The proportion of respondents reporting either often or always wearing masks increased dramatically April 14 and May 26. Those reporting wearing masks were more likely to also report other protective behaviors (avoiding handshakes, washing hands, and keeping physically distant) compared to those that did not wear a mask. The support for mandatory mask measures was stable over time at just under 60%. Respondents with more prosocial concerns (concerned about the welfare and rights of others), were more likely to report wearing masks. However, prosocial concerns were not associated with intent to wear a mask in the future. Mask wearers are likely to view other mask wearers more favorably regardless of whether mask-wearing is mandated or voluntary. Based on results from the vignette, when comparing voluntary versus mandated mask-wearing measures, voluntary policies suggested that less people would wear masks (77% versus 96%); respondents were more likely to judge other mask-wearers as being part of a group with higher risk of complications from COVID-19 (i.e. those over 50 years and/or those with pre-existing medical conditions) but not significantly more likely to have COVID-19; and voluntary policies were perceived as less “fair” especially among respondents that reported being part of a risk group.
Study Strengths
The study surveyed a large group (n=6,973) of participants weekly and stratified based on age and sex, and state in Germany. Their survey also used a variety of measures to assess attitudes towards masks allowing for more nuanced interpretation.
Limitations
It is unclear how or whether the results from Germany would apply to other contexts. Values and attitudes to mask-wearing policies will be influenced by country-specific cultures and broader perceptions of COVID-19. Views on mandatory versus voluntary mask-wearing policies and stigma associated with mask-wearing were based on a single and highly specific vignette, and it is unclear if results would vary if different vignettes were presented. Analysis of survey results also separated respondents into two groups: those that perceptive COVID-19 measures were exaggerated, and those that did not. Group membership was determined based on the median response at each survey time-point. Finally, data presented here is based on self-report rather than actual behaviors. As a result, respondents may be more likely to report behaviors that they believe are more socially desirable.
Value added
Based on the results presented, mask-wearing increased over time and was associated with other protective behaviors. Furthemore, mandatory mask policies are more likely to result in more people wearing masks, less likely to result in mask-associated stigma, and are more likely to be perceived as “fair” in Germany. It is unclear if these results can be applied to countries other than Germany.
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