Observational Study

. 2021 Oct 5;21(1):1791.

doi: 10.1186/s12889-021-11822-5.

The trajectory of COVID-19 pandemic and handwashing adherence: findings from 14 countries

Zofia Szczuka¹, Charles Abraham², Adriana Baban³, Sydney Brooks⁴, Sabrina Cipolletta⁵, Ebrima Danso⁶, Stephan U Dombrowski⁴, Yiqun Gan⁷, Tania Gaspar⁸, Margarida Gaspar de Matos⁸, Konstadina Griva⁹, Michelle Jongenelis¹⁰, Jan Keller¹¹, Nina Knoll¹¹, Jinjin Ma⁷, Mohammad Abdul Awal Miah¹², Karen Morgan¹², William Peraud¹³, Bruno Quintard¹³, Vishna Shah¹⁴, Konstantin Schenkel¹⁵, Urte Scholz¹⁵, Ralf Schwarzer¹¹, Maria Siwa¹, Kamil Szymanski¹, Diana Taut³, Silvia C M Tomaino⁵, Noa Vilchinsky¹⁶, Hodaya Wolf¹⁶, Aleksandra Luszczynska^{17

18}

Affiliations

¹ Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities, 30b Ostrowskiego Street, PL-53-238, Wroclaw, Poland.
² School of Psychology, Deakin University, Melbourne, Australia.
³ Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania.
⁴ Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada.
⁵ Department of General Psychology, University of Padova, Padova, Italy.
⁶ Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, Gambia.
⁷ School of Psychological and Cognitive Sciences, Peking University, Beijing, China.
⁸ Institute of Environmental Health, Medical School, University of Lisbon, Lisbon, Portugal.
⁹ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
¹⁰ Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.
¹¹ Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
¹² Perdana University-Royal College of Surgeons in Ireland School of Medicine, Kuala Lumpur, Malaysia.
¹³ Department of Psychology, INSERM 1219, University of Bordeaux, Bordeaux, France.
¹⁴ Environmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.
¹⁵ Applied Social and Health Psychology, University Research Priority Program "Dynamics of Healthy Ageing", Department of Psychology, University of Zurich, Zurich, Switzerland.
¹⁶ Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel.
¹⁷ Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities, 30b Ostrowskiego Street, PL-53-238, Wroclaw, Poland. aluszczy@uccs.edu.
¹⁸ Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia. aluszczy@uccs.edu.

PMID: 34610808
PMCID: PMC8492037
DOI: 10.1186/s12889-021-11822-5

Observational Study

The trajectory of COVID-19 pandemic and handwashing adherence: findings from 14 countries

Zofia Szczuka et al. BMC Public Health. 2021.

. 2021 Oct 5;21(1):1791.

doi: 10.1186/s12889-021-11822-5.

Authors

Affiliations

¹ Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities, 30b Ostrowskiego Street, PL-53-238, Wroclaw, Poland.
² School of Psychology, Deakin University, Melbourne, Australia.
³ Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania.
⁴ Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada.
⁵ Department of General Psychology, University of Padova, Padova, Italy.
⁶ Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, Gambia.
⁷ School of Psychological and Cognitive Sciences, Peking University, Beijing, China.
⁸ Institute of Environmental Health, Medical School, University of Lisbon, Lisbon, Portugal.
⁹ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
¹⁰ Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.
¹¹ Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
¹² Perdana University-Royal College of Surgeons in Ireland School of Medicine, Kuala Lumpur, Malaysia.
¹³ Department of Psychology, INSERM 1219, University of Bordeaux, Bordeaux, France.
¹⁴ Environmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.
¹⁵ Applied Social and Health Psychology, University Research Priority Program "Dynamics of Healthy Ageing", Department of Psychology, University of Zurich, Zurich, Switzerland.
¹⁶ Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel.
¹⁷ Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities, 30b Ostrowskiego Street, PL-53-238, Wroclaw, Poland. aluszczy@uccs.edu.
¹⁸ Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia. aluszczy@uccs.edu.

PMID: 34610808
PMCID: PMC8492037
DOI: 10.1186/s12889-021-11822-5

Abstract

Background: The COVID-19 pandemic has affected people's engagement in health behaviors, especially those that protect individuals from SARS-CoV-2 transmission, such as handwashing/sanitizing. This study investigated whether adherence to the World Health Organization's (WHO) handwashing guidelines (the outcome variable) was associated with the trajectory of the COVID-19 pandemic, as measured by the following 6 indicators: (i) the number of new cases of COVID-19 morbidity/mortality (a country-level mean calculated for the 14 days prior to data collection), (ii) total cases of COVID-19 morbidity/mortality accumulated since the onset of the pandemic, and (iii) changes in recent cases of COVID-19 morbidity/mortality (a difference between country-level COVID-19 morbidity/mortality in the previous 14 days compared to cases recorded 14-28 days earlier).

Methods: The observational study (#NCT04367337) enrolled 6064 adults residing in Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland. Data on handwashing adherence across 8 situations (indicated in the WHO guidelines) were collected via an online survey (March-July 2020). Individual-level handwashing data were matched with the date- and country-specific values of the 6 indices of the trajectory of COVID-19 pandemic, obtained from the WHO daily reports.

Results: Multilevel regression models indicated a negative association between both accumulation of the total cases of COVID-19 morbidity (B = -.041, SE = .013, p = .013) and mortality (B = -.036, SE = .014 p = .002) and handwashing. Higher levels of total COVID-related morbidity and mortality were related to lower handwashing adherence. However, increases in recent cases of COVID-19 morbidity (B = .014, SE = .007, p = .035) and mortality (B = .022, SE = .009, p = .015) were associated with higher levels of handwashing adherence. Analyses controlled for participants' COVID-19-related situation (their exposure to information about handwashing, being a healthcare professional), sociodemographic characteristics (gender, age, marital status), and country-level variables (strictness of containment and health policies, human development index). The models explained 14-20% of the variance in handwashing adherence.

Conclusions: To better explain levels of protective behaviors such as handwashing, future research should account for indicators of the trajectory of the COVID-19 pandemic.

Trial registration: Clinical Trials.Gov, # NCT04367337.

Keywords: COVID-19; Cross-country; Hand hygiene; Morbidity; Mortality; Pandemic.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest with regard to this study. This study was approved by the Ethics Committee at SWPS University, Poland; University of Melbourne’s Psychology Health and Applied Sciences Human Ethics Sub-Committee, Australia; University of New Brunswick Ethics Board, Canada; Internal Review Board at Peking University, China; Data Protection Officer of University of Bordeaux, France; The Gambia Government/MRC Joint Ethics Committee and London School of Hygiene and Tropical Medicine Ethics Committee, the Gambia; Ethics Committee of the Freie Universität Berlin, Germany; Ethics Committee of the Department of Psychology of Bar-Ilan University, Israel; Perdana University-Institutional Review Board, Malaysia; Internal Review Board of Nanyang Technological University, Singapore. In case of Switzerland, the study was carried out in accordance with the ethics regulations of the Faculty of Arts and Social Sciences at the University of Zurich. Portugal, Italy, and Romania: the approval obtained at another European Union country (i.e., issued by the Ethics Committee at SWPS University, Poland) is deemed sufficient, assuming observational and anonymous data collection, following European Union regulations of data protection (GDPR). All study procedures were carried out in accordance with the 1964 Helsinki declaration and its later amendments. Written informed consents were obtained from all participants.

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Situational handwashing adherence following the WHO (2020) guidelines across the study countries. *Figure Note.* Participants were asked to indicate if during the previous week they have usually washed their hands (for at least 20 s, all surfaces of the hands) in the respective situation (with responses ranging from 1 = *strongly disagree* to 4 = *strongly agree*). Participants who indicated that they did not care for someone at home who is sick were excluded when calculating mean item response calculated for the respective situation

See this image and copyright information in PMC

References

1. World Health Organization . WHO save lives: clean your hands in the context of COVID-19. 2020.
1. Hirose R, Ikegaya H, Naito Y, Watanabe N, Yoshida T, Bandou R, et al. Survival of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) and influenza virus on human skin: importance of hand hygiene in coronavirus disease 2019 (COVID-19). Clin Infect Dis. 2020:ciaa1517. 10.1093/cid/ciaa1517. - PMC - PubMed
1. Lima-Costa MF, de Melomambrini JV, de Andrade FB, Peixoto SWV, Macinko J. Social distancing, use of face masks and hand washing among participants in the Brazilian longitudinal study of aging: the ELSI-COVID-19 initiative. Cad Saúde Pública. 2020;36(suppl 3):e00193920. doi: 10.1590/0102-311X00193920. - DOI - PubMed
1. Nivette A, Ribeaud D, Murray A, Steinhoff A, Bechtiger L, Hepp U, Shanahan L, Eisner M. Non-compliance with COVID-19-related public health measures among young adults in Switzerland: insights from a longitudinal cohort study. Soc Sci Med. 2021;268:113370. doi: 10.1016/j.socscimed.2020.113370. - DOI - PMC - PubMed
1. Toussaint LL, Cheadle AD, Fox J, Williams DR. Clean and contain: initial development of a measure of infection prevention behaviors during the COVID-19 pandemic. Ann Behav Med. 2020;54(9):619–625. doi: 10.1093/abm/kaaa064. - DOI - PMC - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions

Associated data

Actions
- Search in PubMed
- Search in ClinicalTrials.gov

LinkOut - more resources

Full Text Sources
Medical
- ClinicalTrials.gov
- MedlinePlus Health Information
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

The trajectory of COVID-19 pandemic and handwashing adherence: findings from 14 countries

Affiliations

The trajectory of COVID-19 pandemic and handwashing adherence: findings from 14 countries

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous