Abstract

Wearing face masks were very much mandated during the pandemic peak period, and slowly the usage is getting reduced. Today, very few are using the face masks regularly, not only for COVID fear but also for some other reasons. This study is aimed to assess the reasons for mask-wearing intention even after COVID fear is reduced. In this study, a total of 653 mask wearers were interviewed about their continuous usage of masks even after the COVID pandemic was over. Out of 653 individuals wearing masks, 216 were males and 437 were females. While analyzing the age groups, predominantly 26 to 35 wear masks (36.7%), followed by 36 to 45 (19.4%) and 15 to 25 (17.3%). College-going students (9.5%) and health care professionals (9.5%) wear masks the most followed by college teachers (8.6%) and school teachers (8%). The mask types are varied among the users, with the majority using cotton masks (57%), followed by medical masks (36%). There are a variety of reasons given for wearing a mask even after COVID fear is over, including preventing pre-symptomatic spread, reducing direct transmission, good hygiene in general, public transportation like buses and trains, mask addiction, being free from dust, style, not showing identity, etc. Overall, we provide the novel findings of varied reasons for wearing face masks with the intention of health, hygiene, addiction, and other mask attractiveness beliefs. From this study, it is advised to wear a face mask in public settings when social distancing is difficult to maintain.

Keywords

Introduction

       
           
       
    Table 1: Survey description

The criteria for obtaining the answers are

       
           
       
    Table 2: Age and gender wise distribution of the study subjects

[Figure in parenthesis denoted percentages; percentages calculated for genders] The occupational status of the participants was also included in this study, so it is very useful to compare and assess the role of occupation and behavioral attitudes, especially wearing masks. More participants were on daily wages (17.6%), followed by teachers (16.5%) and students (15.8%) (Table 3).

       
           
       
    Table 3: Occupational description of the participants

The locality of the participants highlighted that urban participants were more prevalent (n=312; 47.2%), followed by semiurban residential participants. The type of mask used by the participants was also assessed, with the majority using cotton masks (56.4%), followed by medical masks (36.8%). Nearly 19 participants were classified as others indicated they were using their shawls, handkerchiefs, and other household materials as face masks.  Attitude is considered the major tool for assessing the individuals’ behavior; this attitude plays a vital role in the individuals wearing face masks. Various reasons for wearing face masks were recorded; thus, regular practice dominated with 83.2%, followed by good hygiene in general, fear of transmissible infections, getting rid of other infections, etc. The detailed description of behavioral and influencing factors in the public’s practice of wearing face masks is interpreted in Table 4.

       
           
       
    Table 4: Influencing and behavioural factors of public wearing face mask

[Figure in parenthesis denoted percentages] All the responses were further subjected to the factors that contribute to behavioral intention. Twenty one responses were correlated with the factor “attitudes towards the behavior”, five responses were correlated with “subjective norms” and seventeen responses were correlated with “perceived behavior control” (Table 5). This study highlighted that the behavior towards the practice (face masking) is good, but more people have perceived behavior control and thus follow the instructions without interest. The variations among the non-restricted and full-metric invariance were also analyzed, with the restriction that in the full-metric invariance model, factor loadings, factor variances, and path regression coefficients were equivalent. Thus, this study data confined the importance of having the personal attitudes and motivation from the peer teams for the continuous practice of any good and need-based activities like wearing a face mask. 

       
           
       
    Table 5: Analysis of responses towards behavioral intention

       
           
       
    Table 6: Qualitative validity

All the study participants knew that wearing a mask reduced the spread of various airborne and visceral infectious diseases, including COVID-19. The usage of masks among the public while traveling or attending the crowd was encouraged, but strict adherence to such practices was poorly recorded, even by the regulatory authorities. People who are not accepting the use of mask felt that the use of masks should not be forced because it interfered with breathing, speaking and caused overheating. (10,13) In this study, we are not concentrating on the negative effects of mask usage, and only the reasons for mask acceptance are included.  The attitudes towards the use of masks were also defined under perceived subjective norms, which are the perceived social pressures to wear a mask and the individual’s belief in wearing mask continually. (14) The face mask usage during the pandemic period is found effective to reduce the disease transmission and addressed to curtail the pandemic spread. (15) This study assessed mask usage as a personal protection technique even after COVID-19 fear reduced, and continuous usage of face masks is considered an attitude towards the behavior. Scientifically, it showed a noteworthy relationship between attitude and behavioral intention. Further, three more additional variables were also assessed with the inculcating aspects of perceived risk, social image, and its related pressure. (16)  Perceived usefulness is considered as one of the belief towards the usage or follows the technique or system. This may the first of its kind of investigating the perceived usefulness and its relativeness towards mask wearing among general public after COVID pandemic reduced. This phenomena has not much applicable to all and in all places, but some persons wearing masks in crowd, hospitals, malls etc. Comparatively, mild side effects and feels discomfort observed among the mask users. More studies relate the perceived usefulness of wearing face masks during pandemic period. (17) In general, there is a concept that increasing the age understands the adherence towards the preventable behaviors than the younger ones. Reversely, during the COVID pandemic and post pandemic periods, the older age groups are less likely to wear masks but likely to vaccinate. (18) From this study, we observed that the age groups between 15 and 45 wore masks more than the older age groups. While determining the gender and mask usage, comparably women are more fascinating than men in order to avoid the unwanted attention from men. During pandemic period, the attitude and perceptions towards wearing mask was common, no such gender variations, but post pandemic period, it becomes cosmetically and further the masks are blindly defined as an accessory item with different colors and designs. Most of the men having the negative perception that wearing mask are threat and fallacy to their masculine image. (19) In this study also, we observed 66.3% of females wearing masks continuously than males.  Mask wearing is predominantly an occupational behavior; thus, certain occupations and administration forced the employees to wear masks even after the COVID pandemic was reduced. Health care workers and sanitary workers are examples of occupational groups wearing masks. A study that compared the slum and non-slum groups who are wearing face masks revealed that there are no variations, while occupation is a major factor. (20)  In India, after COVID-19 cases were reduced, various states removed mask mandates; majority of the public informed that people in their area either don’t have a mask at all or are not wearing it properly. No such location discrepancy was found, but compared with urban areas, rural communities are very lethargic and not willing to wear masks even when they are coming out of their locality. (21) In this study, we noted 20.8% of rural community members wearing face masks while they are traveling or moving to other places for various reasons, including occupation.  During pandemic time, the use of face masks was predominantly propagated for medical and public health reasons. Google searches found that N95 was predominantly used in India, whereas surgical masks were used in Russia, FFP2 in Spain, and cloth masks in France and the United Kingdom during the pandemic and immediate post-pandemic periods. (22) In post-pandemic time, the usage of face masks is determined for various purposes, not only for medical and public health reasons, and quality and types of masks vary; thus, this study recorded that cotton masks (57%) followed by medial masks (36.1%) are predominantly used in India. The usage of N94 masks is reduced now a days, and very few, like health care workers use them.  Although the knowledge and attitude of using face masks were relatively good, practice and technique among the public were low, (23) and the same was found in India as well. While discussing with the mask users, 83.2% informed that wearing a mask is like a routine activity and has become one of the daily practices when coming out of the house.  The regular usage of a face mask during outside travel is good and hygienic, thereby reducing visceral infections and other related diseases. The same was expressed by 79% of the participants in this study. The primary non-pharmaceutical interventions followed by the individuals, like wearing a face mask, improved personal hygiene and were also considered as the strong and positive predictors. (24)  In this initial period of the pandemic, people are more lethargic to wear face masks; later, as per government instructions and awareness, people used the face mask. Further, the fear decreased with knowledge about the pandemic, education level, and age. (25) Still, some of the people have fear of such infections; in this study, 55.4% people have fear of such infections and wear mask continuously.  Wearing masks plays a pivotal role in the prevention and control of infectious respiratory disease transmission; 49.9% of individuals also adhere to the same reason for wearing masks. (26) In general, mask usage is closely associated with low adherence, but adherent mask users are significantly protected against seasonal disease and also avoid spread their diseases to others; 47.8% of individuals are accepting the same. (27) Regular mask-wearing habits are considered commuting protection against dust, pollen and traffic particles, especially when traveling by motorbike. (28) In this study, 36.1% of people like to wear masks to get rid of dust; while traveling, most of the roadside dead animals were thrown as it without any covering, and the decay smell disturbed them; in such situations, wearing masks helps us to avoid external bad smell. Our observation emphasizes that limited social distancing and living along with pre-symptomatic or suspected patients will render a high risk for disease transmission. The individuals informed that they lived along with their COVID-19 infected parents in the same house by wearing face masks, no disease spread; thus, masks prevent the presymptomatic spread. Nearly 23% of the individuals informed that murmuring (in a low quiet voice) or scolding in low voice when using mask, helps them escape from the situation. After wearing the mask, hot and humid raise, mean skin temperature and the heart rate increase; conversely, blood oxygen saturation level decreases, leading to a decline in health and comfort levels. (29) Even though a lot of discomfort was observed, 18.2% of people defined their comfort zone as well. During the pandemic, all the companies and institutions insisted their employees wear face masks. Academic institutions mandated their members of faculty, staff, and students to wear face masks. The CDC also recommended that anyone who is deemed to be an “essential employee” should wear face coverings in the workplace. (30) While speaking with a mask, some information are not clearly communicated to the listener. This may be good or bad for the speakers in certain situations. Studies highlighted that impairing speech recognition, radio communication and eliminating visual speech information affect the acoustic signal thereby mask speech are not much recognized. (31,32) Some of the interviewees (17.2%) informed that they have a mask addiction or dependence and cannot come out from the house without a mask. They also highlighted that if anybody comes close for communication; they automatically wear a mask or close their mouth and nose with a handkerchief. Some have studies highlighted that the mask-wearing behavior may have some adverse effects, including mask dependence and addiction. (33) Around 15% of the mask users felt that masking gave them a self protection, same was considered by a study that defined it as a collective offsetting effect. (34) Some of the mask users informed that they are using designed, ornamental, and dress-matched color masks (13 to 14%). Studies on using disposable masks create environmental pollution; thus, the usage of designed and color-matched masks that are reusable is suggested. (35) Hospital code is one of the major reasons for wearing masks in the working environment in order to avoid cross-contamination and nosocomial and iatragenic infections. Although mask wearing alone is not enough to provide safety and prevention control, there is a possibility of microbial particles not entering in the layers of the mask. (36) Nearly 11% of the participants felt that it was part of their professional lives. Girls in the age groups of 20 and 30 years felt that the use of a face mask hindered their identity, but the mask also saved them in most situations. No male participants were informed about the face-hindering and safety measures. A study revealed that donning face coverings has profound implications for face recognition in everyday situations. (37) Passive smoking causes more ill effects in smoke inhalers and is more serious and at risk for diseased patients. (38) Though the Government of India banned smoking in public places in 2008, the implementation of the rule is being smoked into thin air. In this study, 9.8% of participants expressed that wearing masks reduces inhalation of smoking and air pollutants.  Onychophagia, nail biting, is a chronic condition that happens in repetitive and compulsive ways among all age groups, with multiple factors ranging from genetic to psychiatric. (39) More than 60 participants informed that their nail biting habit and other foreign materials like pens, pencils etc, get reduced after wearing the face masks. The flu-like illnesses are easily spread where people gather (in a crowd environment) in a places like schools, colleges, family functions and funerals, public functions like temples, competitions, and celebrations, (40,41) and public transportation. (42) People thought it was very tough to reduce the crowd on various occasions, but 8.6% of mask wearers felt that it may reduce some sort of infection. Some participants (8.1%) felt that they should not spread their respiratory infections to others. Respiratory droplets are exhaled from infected patients when they breathe, talk, cough, sneeze, or sing; thereby, masks prevent infected persons from exposing others by stopping the exhalation of virus-containing droplets into the air. (43) Interestingly, some participants (n=50; 7.7%) expressed that they are looking good in appearance while wearing masks. Studies revealed some research outcomes, including that medical face masks reduced attractiveness because they were associated with disease or illness; (44) wearing a cloth mask was significantly more attractive; (3) and images of men wearing a blue medical face mask were perceived as being the most attractive. (45)  Some of the student participants (7%) informed that they were singing and scolding in the classroom (if they felt bore) in a very mild voice, for that face mask helps them to protect themselves from the teachers. Around 6% revealed that the mask usage helps them to cover their tooth clips, wounds, and scars on the face. Conversely, various side effects regarding oral health were recorded, including sour breath, dry mouth due to mouth breathing, bleeding gums, receding gums, and tooth decay. (46) A few participants informed that wearing a mask is reducing some social stigmas like salivary splash (6.3%), yawning (5.5%), bad smell in the mouth (2.3%), drooling, and opening (1.7%) of the mouth while traveling on the public transport.

CONCLUSION

Through this study, we can understand the importance of wearing a mask when exposed to crowds, suspicious infectious groups, and confirmed patients. Looks and thoughts are deceptive; based on this line, our study also exhibited the different reasons for using masks even in pandemic cases and reduced fear. This study also determined the analysis of perceived social pressures to wear a mask and the individual’s belief in wearing a mask continually, and which was considered an attitude towards the behavior. Further, perceived usefulness and its relativeness towards mask wearing are reduced. This study further recommends to all wearing face masks of their interest whenever they are coming out of the house, exposed to air currents and crowds.

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