Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2023 Oct 16;57(11):921-928.
doi: 10.1093/abm/kaad039.

Theory-based Trial to Promote Uptake and Sustained Use of Face Coverings During the COVID-19 Pandemic

Christopher J Armitage  1   2   3 , Chris Keyworth  4 , Nicola Gartland  5   6 , Anna Coleman  5   6 , David Fishwick  5 , Sheena Johnson  7 , Martie van Tongeren  5   6
Affiliations
Randomized Controlled Trial

Theory-based Trial to Promote Uptake and Sustained Use of Face Coverings During the COVID-19 Pandemic

Christopher J Armitage et al. Ann Behav Med. .

Abstract

Background: Transmission of airborne viruses can be mitigated by wearing face coverings but evidence suggests that face covering declines with the removal of relevant legislation, partly due to low automatic motivation.

Purpose: Test whether an intervention based on implementation intentions could support people's automatic motivation and promote face covering during the COVID-19 pandemic.

Methods: Randomized controlled design. At baseline (May 20 to June 6, 2022), 7,835 UK adults reported how much time they spent wearing face coverings in work, public transport, and indoor leisure settings as well as their capabilities, opportunities, and motivations. 3,871 participants were randomized to form implementation intentions; 3,964 control participants completed questionnaires only. Measures were repeated 6 months postbaseline (November 1 to November 14, 2022). Data were analyzed using mixed measures ANOVAs and Bayes Factors to examine whether the observed data supported the experimental hypothesis.

Results: The proportion of time spend wearing face coverings declined substantially across the 6-month study period, from 15.28% to 9.87% in work settings, 38.31% to 24.55% on public transport, and 9.58% to 7.85% in leisure settings. Bayes Factors indicated moderate relative evidence of no effect of implementation intentions on behavior in work and leisure settings, and inconclusive evidence of a positive effect on public transport.

Conclusions: In the context of declining COVID-19 rates and removal of legal mandates, implementation intentions were not effective in sustaining face covering. Further research is required to ensure that evidence-based interventions are prepared and deployed in the event of future pandemics.

Trial registration: ClinicalTrials.gov NCT05377814.

Keywords: Adherence; COM-B; COVID-19; Face covering; Face mask; Intervention; SARS-CoV-2.

Plain language summary

The spread of viruses through the air can be reduced by people wearing face coverings. The evidence suggests that face covering reduces with the removal of relevant legislation, partly due to habits not being formed. The aim of the present study was to test whether an intervention designed to help people to form new habits could support people’s face covering during the COVID-19 pandemic. We asked 7,835 UK adults how much time they spent wearing face coverings in work, public transport, and indoor leisure settings. We chose 3,871 participants at random to form new habits; 3,964 participants completed questionnaires only. Measures were repeated 6 months later. The proportion of time spend wearing face coverings declined sharply across the 6-month study period, from 15.28% to 9.87% in work settings, 38.31% to 24.55% on public transport, and 9.58% to 7.85% in leisure settings. Our analyses showed a small positive effect of forming new habits on wearing face coverings in public transport settings. In the context of declining COVID-19 rates and the removal of legal mandates, our intervention was not effective in sustaining face covering. Further research is required to ensure that evidence-based interventions are prepared and deployed in the event of future pandemics.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Flow of participants through the trial.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Greenhalgh T, Schmid MB, Czypionka T, Bassler D, Gruer L.. Face masks for the public during the covid-19 crisis. Br Med J. 2020; 2020(8242):m1435. - PubMed
    1. Howard J, Huang A, Li Z, et al. . Face masks against COVID-19: an evidence review. Proc Natl Acad Sci USA. 2021; 118:e2014564118. doi:10.1073/pnas.2014564118. - DOI - PMC - PubMed
    1. UK Department of Health and Social Care. (2022). Face coverings: when to wear one, exemptions and what makes a good one. Available at https://www.gov.uk/government/publications/face-coverings-when-to-wear-o.... Accessibility verified November 4, 2022.
    1. Michie S, Atkins L, West R.. The Behaviour Change Wheel: A Guide to Designing Interventions. London: Silverback Publishing; 2014.
    1. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991; 50:179–211.

Publication types

Associated data