Personal protective beliefs and behaviors during the COVID-19 pandemic at a large, multi-campus, public university in Pennsylvania: a cross-sectional survey

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Understanding the personal protective beliefs and behaviors surrounding public health measures such as face masking, social distancing, and handwashing helps to inform public health outreach measures. Objective This study evaluates the beliefs and occurrences of face masking, social distancing, and handwashing behaviors among people at a multi-campus, public university in Pennsylvania. Methods From October 5-November 30, 2021, a 10-minute REDCap survey was available to students, faculty, and staff 18 years of age and older at the Pennsylvania State University (PSU). Recruitment included targeted email, social media, digital advertisements, and university newspapers. 4,231 responses were received. Simple percentage associations between the selected factors and face masking behaviors as well as beliefs on the origin of the COVID-19 virus were made with IBM SPSS Statistics, version 29.0.2.0 (20). Results Of 3,662 completed surveys, 65.2% of respondents were positive that facemasks prevented the transmission of airborne disease, 49.9% of the respondents stated that they wore facemasks always (27.9%), almost always (26.9%), or often (11.1%). 65.3% believed social distancing prevented transmission of COVID-19, 57.5% reported social distancing while on-campus or out in public (always: 18.8%, almost always: 20.3%, often: 18.4%). The response rate for some level of conscientiously washing hands for the 20 second duration was 87.5% (always: 26.0%, almost always: 31.9%, sometimes: 19.9%, only after being out in public: 4.9%, and only when convenient: 4.8%). Conclusions Beliefs in public health and safety measures during the COVID-19 pandemic did not always match the behaviors of individuals surveyed. Understanding barriers to performing behaviors or public health safety may help inform future areas for targeted intervention. Introduction Face masks have been worn in healthcare settings for decades, especially during influenza season. 1 During the COVID-19 pandemic, the public was encouraged to wear face masks to reduce community spread and decrease hospitalizations. 2 , 3 Nevertheless, in the United States, face masking behaviors varied, and pandemonium surrounded face masks in public settings. 4 The leading theory was that face masks had become politicized, explaining the division and divisiveness between those who did not wear them compared to those who did wear them. 5 - 7 Studies have shown associations between face mask wearing and misinformation. 8 Social distancing behavior was also encouraged during the pandemic. 9 Early studies showed that it helped reduce transmission of the virus, especially at the beginning of the pandemic. 10 Again, however, the beliefs and behaviors surrounding social distancing became politicized and were subject to misinformation. 11 , 12 On the other hand, hand washing was less of a target for misinformation, most likely due to the established history of hand washing as preventing the transmission of disease for centuries. 13 Yet, to be effective, hand washing is supposed to be performed for a total of 20 seconds; this is less likely of a behavior than expected, handwashing studies have shown that people was for a shorter duration most of the time. 14 These behaviors and beliefs were popular topics of debate during the pandemic but were not explored in a large, public university setting in relation to age, gender, and political leaning. The present study evaluated demographic factors that may be associated with differences in mask wearing and different beliefs on the origin of the COVID-19 virus in the fall of 2021, a period when vaccines had become widely available. PSU is one of Pennsylvania’s largest employers, but still represents a higher education community, capturing an interesting subset of the United States population. Methods/Subjects This was a cross-sectional study that took place at all 23 PSU physical campuses, the World Campus, the Penn State Extension, and Penn State Health. Students, faculty, and staff 18 years of age and older were invited to take a REDCap survey between October 5 and November 30 of 2021. The Pennsylvania College of Technology was excluded, as it is only an affiliated institutional and not fully part of PSU. Survey questions were repeatedly tested by medical students, faculty, and staff prior to official launch to receive feedback about question clarity. Participants were recruited by randomly emailing 32,792 individuals with a PSU email address Additionally, digital and print marketing campaigns took place with campus websites, bulletins, and newspapers. This study was carried out in accordance with the institutional review board at the Penn State College of Medicine (reference number 00016908), which deemed this project exempt. Digital, written consent to participate was obtained from participants. They were provided with details and instructions about the research project and asked three qualifying questions. The survey only continued if participants answered “Yes” to all three qualifying questions, which were: consenting to the survey’s instructions, being 18 years of age or older, and being affiliated with the Pennsylvania State University during the study period. If a participant answered “No” to any of the criteria, the survey did not continue. The authors did not have access to information that could identify participants before, during or after data collection. The REDCap survey incorporated both original research questions and validated questions from previous studies. A simple percentage analysis was conducted using IBM SPSS Statistics, version 29.0.2.0 (20). Results 4,231 survey responses were received. 32,792 emails were randomly sent to those with a PSU email address, making the response rate 12.90%. After excluding participant responses that did not complete all questions of interest for this study, 3,662 cases were ultimately used for this analysis. From our prior analysis of vaccine hesitancy, most participants were between the ages of 26 and 35 (21.0%), women (57.2%), heterosexual (78.0%), and White (77.5%). Most respondents were employees (52.6%), and of the students who responded, most were undergraduates seeking a bachelor’s degree (63.3%). Additionally, most considered their political views to be liberal (32.9%). Regarding prior COVID-19 infection and vaccination status, most never tested positive for COVID-19 (80.3%), have been vaccinated or plan to get vaccinated (80.9%), and receive the seasonal influenza vaccine (61.4%). 15 For the second analysis of data, we focused on beliefs and behaviors of personal protection (face masking, social distancing, and handwashing) our survey respondents. Just 65.2% were positive that facemasks prevented the transmission of airborne disease, including COVID-19. ( Table 1 .) Conversely, only 49.9% of the respondents stated that they wore facemasks always (27.9%), almost always (26.9%), or often (11.1%). Furthermore, 19.0% answered that they wore facemasks only when required. ( Table 2 ). View this table: View inline View popup Download powerpoint Table 1. Do you feel that face masks safely prevent the transmission of airborne diseases, such as the COVID-19 virus? View this table: View inline View popup Download powerpoint Table 2. How often do you wear a face mask when indoors, on-campus, or out in public? Next, beliefs and behaviors related to social distancing were analyzed. Just 65.3% believed that social distancing prevented transmission of COVID-19. ( Table 3 ). 57.5% of the respondents reported that they commonly social distanced while on-campus or out in public (always:18.8%, almost always: 20.3%, often: 18.4%) ( Table 4 ). View this table: View inline View popup Download powerpoint Table 3. Do you feel that social distancing safely prevents the transmission of the COVID-19 virus? View this table: View inline View popup Download powerpoint Table 4. Do you attempt to social/physical distance when on-campus or out in public? The respondents were also asked if they washed their hands for at least 20 seconds. The response rate for some level of conscientiously washing hands for the 20 second duration was 87.5% (always: 26.0%, almost always: 31.9%, sometimes: 19.9%, only after being out in public: 4.9%, and only when convenient: 4.8%). 2.3% only used hand sanitizer. ( Table 5 ). Being that handwashing safety is a common part of early childhood education, in addition to keeping the survey length to a reasonable time to complete, no question was added regarding handwashing safety beliefs. View this table: View inline View popup Download powerpoint Table 5. Do you wash your hands for at least 20 seconds? Discussion The results indicate that in the case of COVID-19 protective measures, even when people believed in the correct information surrounding public health safety behaviors, or at least stated that they believe in them, they did not actually perform the behaviors. This was especially true in the cases of face masking and social distancing. 65% of respondents felt that face masking did prevent transmission of COVID-19, but yet only roughly 28% and 27% of respondents always or almost always wore them. Similarly, 65% of respondents felt that social distancing helped to reduce the spread of COVID-19 but only 19% and 20% of respondents almost or almost always social distanced themselves. It could be implied that individuals do believe in the power of handwashing, and this can be extrapolated to include the handwashing behaviors: if individuals do believe in the power of handwashing, there should be more “always” or “almost always” responses seen but only 26% and 32% do handwash for at least 20 seconds. The results indicated that there not only are there challenges to encouraging people to believe that certain public health measures are protective for their health, but also encouraging them to act in a manner consistent with those beliefs. During the COVID-19 pandemic, theories are that the politicization of behaviors and the spread of misinformation in the pandemic led to poor outcomes. 16 Yet, it is possible that beliefs were present, but the motivations of the behaviors were misaligned with a common goal of health and safety of the public. This study has several limitations, such as reliance on self-reporting for major endpoints of the study, including the personal protection specific questions. Participants may have had difficulty selecting survey responses if no clear definitions were provided, and respondents may have made some misinformed but well-meaning answers. Furthermore, the first study utilized a graduate level statistics student to conduct the analysis using R software (Murphy et al 2023). Such a student was not available for this study, thus the faculty advisor, a medical librarian, conducted the analysis using SPSS statistical software. Generalizability of the data is also a limitation. Further future analysis maybe be necessary to fully understand the implications of the survey results to the PSU community. Despite the limitations, this survey study showed that belief in public health and safety measures during the COVID-19 pandemic did not always match the behaviors of individuals. This has key implications for future public health information campaigns, where convincing individuals in the validity of the science and the behaviors may not be enough to get them to be invested in making a change for their own health and safety or the health and safety of society. An obvious next step would be to understand barriers to not performing the behaviors and the factors influencing the behaviors. Conclusion Beliefs in public health and safety measures during the COVID-19 pandemic did not always match the behaviors of individuals surveyed. Understanding barriers to performing behaviors or public health safety may help inform future areas for targeted intervention. Further future analysis may be required to determine why individual beliefs and behaviors did not necessarily match. Data Availability All personally non-identifiable data produced are available online at Mendeley Data. https://data.mendeley.com/datasets/vvnsj7n56t/2 Supporting Information Long B, Murphy R, Pomerantz L, Kuruppumullage Don P. Pennsylvania State University Fall 2021 COVID-19 Infodemic Survey. ver. 2. Mendeley Data. doi:10.17632/vvnsj7n56t.2 . Sep 27, 2023. References 1. ↵ Cowling BJ , Zhou Y , Ip DK , Leung GM , Aiello AE . Face masks to prevent transmission of influenza virus: a systematic review . Epidemiol Infect . Apr 2010 ; 138 ( 4 ): 449 – 56 . doi: 10.1017/s0950268809991658 OpenUrl CrossRef PubMed 2. ↵ Eikenberry SE , Mancuso M , Iboi E , et al. To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic . 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