In a bid to ease lockdown restrictions in England, the government has advised that people should wear face coverings when in enclosed public spaces, such as supermarkets and when on public transport. Although the evidence to support the effectiveness of face coverings is mixed (see the arguments for and against), more people have decided to wear face coverings when out in public, with 15% of people in the UK currently wearing them as a preventative measure, and 74% agreeing that they would be likely to wear one if advised by the government. In the coming weeks we can expect to see an increase in the number of people wearing face coverings outside of their homes. Government guidance is available online regarding how to make face coverings at home; but this also needs to be made available to those that do not have access to the internet or clear advice on what is suitable to use as a face covering (e.g. scarves).
On the face of it, wearing a face covering might seem easy and risk-free, but one of the downsides of wearing a face covering is that they can make things worse if they are used incorrectly. Assuming that you have a suitable face covering (e.g. scarf or bandana) in the first place, there are then five inter-related behaviours (Figure 1.):
- Putting on the face covering while avoiding virus entering via the eyes, nose or mouth by making sure one’s hands are clean to start with
- Wearing the face covering correctly by ensuring it is covering the nose and the mouth
- Avoiding touching the face covering while it is in use
- Removing the face covering safely while avoiding virus entering via the eyes, nose or mouth by making sure one’s hands are clean to start with
- Disposing of, or cleaning the face covering effectively after use
According to the COM-B model, a person must have sufficient Capability, Opportunity, and Motivation for behaviours to occur. Likely barriers and facilitators include:
In order to maximise the safe use of face coverings, we need to use strategies that address these barriers and facilitators. Below are our recommendations as to how to promote effective and safe use of face coverings:
- Clear messages are needed to outline what the behaviour is (e.g. wearing a face covering), what is suitable (e.g. scarf, homemade covering), as well as when they should be worn (e.g. whilst queueing for supermarkets as well as inside supermarkets) and why. This will provide people with the knowledge and understanding of what they are being advised to do, limiting room for interpretation that could lead to potential errors.
- People’s risk perceptions need to be addressed, ensuring that people are aware that face coverings are a risk-reduction strategy for others, not themselves, and that they need to be used alongside other preventative behaviours (e.g. handwashing and physical distancing).
- Overcoming communication difficulties by talking slowly, not shouting and consider using hearing aid apps that can provide amplification or translate speech into text in real time.
- Practical guidance is needed to help people overcome habits, by practising wearing face coverings in the home before going out for the first time and prompts such as having a box or plastic bag by the front door to act as a reminder to people that they need to put on their face covering before leaving the house and remove it when entering their home.
- Social norms around wearing face coverings should be promoted through images and videos of people wearing face coverings in different settings, as people are more likely to perform behaviours if they feel it is the norm. Videos and images could also be used to provide examples of how people are correctly wearing, disposing, and cleaning face coverings.
- Guidance around the use of face coverings needs to come from credible sources. People need to trust where the information is coming from, as well as understand that these messages are applicable to them.
There is no simple answer to the effectiveness of public face covering use as a preventive measure, especially as not all people will choose to use a face covering. It is important to consider that some people may not choose to wear face coverings as it could lead to communication difficulties if people need to lip read. Nevertheless guidance needs to be provided to those that do choose to wear them to ensure that they are worn safely and effectively. Researchers at the Behavioural Science Consortium have begun to develop materials to promote the effective use of face coverings by the public.