Knowledge, Attitude and Practices on the Use of Face Mask in the City of Jeddah
Aim: To evaluate the knowledge, attitudes, and practices of using face masks to limit the spread of COVID-19 among citizens
and residents in Jeddah.
Methodology: A cross-sectional analytical study was conducted in Jeddah. Electronic questionnaire survey was used
to collect data. A total of 18 questions on demographic data, knowledge, attitude, practices and barriers related to the
use of masks were framed. The questionnaire was pilot tested.
Results: A total of 460 citizens and residents from the city of Jeddah participated in the study. Highest number of
participants believed that vaccinated (1/2 doses) or previously infected individuals must still wear a mask (84.1%) and that
mask wearing by infected individuals reduces its spread (90.9%). Participants strongly believed that even those without
COVID-19 must wear a mask (93.9%). The hijab/scarf was believed to be a replacement for mask by some (35.2%) or not by
others (48.7%), with 16.5% unsure. Majority of the participants (83.5%) believed that they are wearing the mask correctly
at all times and that wearing a mask is an important method of preventing spread of corona (95.4%). The duration of mask
wearing generally ranged from 1-4 hours, and difficulty in breathing was the most commonly reported barrier to mask
Conclusion: The knowledge score on mask usage was high. Practices were satisfactory but certain aspects needed further
reinforcement to optimize mask usage.
KeywordsFace mask, COVID-19, Knowledge and Practices
COVID-19 is a respiratory infection caused by the SARS-CoV-2 virus. The infection in majority cases causes mild to moderate illness. The symptoms reported have been wide ranging including but not limited to high fever, cough, dyspnoea, headache, loss of smell and diarrhea.1 Reported in Wuhan, China in December 2019 2 it was designated a pandemic by the World Health Organization 3 on March 11, 2020. As of July 5, 2020, there were 11,125,245 cases of COVID-19 recorded worldwide, with 528,204 fatalities .
The spread of coronavirus occurs either through; (a) droplet transmission of small or large respiratory droplets loaded with virus in close proximity to infected person or airborne transmission over longer distances and time . Increased stress has therefore been put on improved personal hygiene such as: using the soap to wash hands after touching any hard surfaces or using another alternative which is alcohol-based sanitizers, nail neatness and environmental hygiene .
Since the beginning of the pandemic, several prevention and control measures have been implemented in most of the countries. The Saudi government has also implemented several public health measures including: restrictions on flights, temporary closure of establishments including malls, shops, schools, universities and curfew to restrict movement of people as deemed necessary .
To reduce the spread of COVID-19 , on April 3, 2020 the Centres for Disease Control and Prevention (CDC) in the United States advised that people should wear a face mask in public if they can't keep a distance of at least six feet from others . Additionally, a recent animal model study showed that when surgical masks are used, non-contact transmission of SARS-CoV-2 may be decreased from 67% (without masks) to 17% . According to the World Health Organization, improper usage and disposal of face masks might raise the risk of transmission . Moreover, a nonlinear link has been reported between knowledge and practice of using face masks to prevent the spread of COVID-19 across different types of participants . Since the beginning of the pandemic, arguments have been made both: for and against the need for the general population to wear the masks . Nevertheless, in both clinical and laboratory conditions, evidence seems to suggest that transmission of the virus can be reduced significantly, and public spread can be reduced effectively by compliance in wearing mask .
Evaluating the various aspects of face mask usage can provide an insight into the current status and make recommendations on public health measures to use the mask optimally. Thus, the aim of this study is to evaluate the knowledge, attitudes, and practices of using face masks to limit the spread of COVID-19 among citizens and residents in Jeddah.
The study was approved by the institutional review board. A cross-sectional survey was conducted in city of Jeddah, Saudi Arabia for a period of 6 weeks in the months of May and June, 2021.
A total of 18 questions were framed in the questionnaire. These included 5 on demographic data, 5 on knowledge, 3 on attitude, 4 on practices and 1 on barriers related to the use of masks.
The questionnaire was pilot tested with 37 respondents. The face validity was assessed based on the responses and the content validity was assessed by feedback from healthcare practitioners.
According to the General authority for statistics of Saudi Arabia the population of Jeddah as of 2019 was estimated to be 4,522,000 and reach 4,697,000 by 2021 .
All Jeddah residents located in the city of Jeddah above 18 years of age irrespective of religion, gender, education level, marital status, and occupation were considered eligible for the study.
Assuming that at least 50% of the respondents would have adequate knowledge and satisfactory practices, the sample size was calculated to be 384 using the Open-Source Epidemiologic Statistics for Public Health (Open Epi), v.3.01 at 95% confidence interval. By adding approximately 25 percent contingence for non-compliance to the data collection tool, a total sample size of 500 participants was targeted. The city of Jeddah was divided into 5 zones and the survey was electronically distributed evenly between males and females with 100 people targeted in each zone.
A covering letter was enclosed with the questionnaire stating that the responses would be kept confidential and that response to the survey will be considered as implicit consent.
Statistical analysis: The statistical analysis was done using IBM SPSS version 23. The data was expressed in number of responses and percentages. Analytical statistics was done using chi square test with p<0.05 considered statistically significant.
A total of 460 citizens and residents from the city of Jeddah participated in the study. Most participants were females (n=336,73.04%) in the age group of 51 and above (n=162,35.22%) and married (n=299,65%). In terms of education, highest number were with bachelor’s degree (n=296,64.35%) with unemployed (n=191,41.52%) forming the largest subgroup (Table 1).
|Table on demographic data for masks|
|51 and above||162||35.22%|
|**Percentages may not be 100% in all cases due to rounding.|
Table 1: The demographic data: gender, marital status, age, education level, and occupation (designation), expressed in terms of numbers and percentages.
As seen in Table 2, highest number of participants believed that vaccinated (1/2 doses) or previously infected individuals must still wear a mask (84.1%) and that mask wearing by infected individuals reduces its spread (90.9%). Participants strongly believed that even those without COVID must wear a mask (93.9%). The hijab/scarf was believed to be a replacement for mask by some (35.2%) or not by others (48.7%), with 16.5% unsure. The overall knowledge score was 83.94%, calculated as the number of respondents with score higher than the average score.
|Marital status (total)||387||41||32||0.429||432||10||18||.477||428||17||15||0.008||394||41||25||0.819||162||224||74||0.003|
|51 and above||139||12||11||154||4||4||155||3||4||141||13||8||47||37||78|
|Education level (total)||387||41||32||0.94||432||10||18||0.203||428||17||15||0.751||394||41||25||0.154||162||224||74||0.013|
|Q1: Do vaccinated (1 or 2 doses of Pfizer or Astrazeneca) OR previously infected individuals, need to wear a face mask?
Q2: Do infected individuals decrease the risk of spreading COVID to others by wearing a mask?
Q3: Is it essential to wear a mask if you don’t have COVID?
Q4: Do you need to maintain social distancing after wearing a mask?
Q5: Is covering your face with scarf or hijab a replacement for the use of mask?
Table 2: Socio demographic factors and their influence on knowledge of Jeddah residents and citizens towards use of masks for prevention of COVID spread. (Y=yes, N=no, NS=not sure).
#Overall score was calculated to be 5. Scores above mean score were considered satisfactory while those below were considered unsatisfactory
On a routine basis a surgical mask was the most frequently used mask (80.4%) while the N95 was the least (2.8%). Under conditions perceived as high risk, while surgical mask was still most preferred (61.9%), the use of N95 increased (22.6%). Washing hands or using sanitizer before wearing a mask was performed by 61.5% but 32.6% was not sure (Table 3).
|51 and above||9||17||132||4||31||15||102||14||110||10||42|
|Education level (total)||13||71||370||6||104||53||285||18||280||27||150|
|Q1: Which of the following masks do you use routinely?
Q2: Which of the following do you prefer most when you are in high-risk conditions such as flight travel, being in enclosed spaces such as restaurants, cafe’s?
Q3: I wash my hands or use hand sanitizer before putting on a mask or after removing it or if I touch the mask.
Q4: When no one is near you, do you put the mask in any of the different positions shown below
Table 3: Socio demographic factors and their influence on practices of Jeddah residents and citizens towards use of masks for prevention of covid spread. Q1 and Q2(K=N95/KN95, C =cloth, S=surgical, F=Face shield) and for Q3 (Y=yes, N=no, NS=not sure).
#Overall score was calculated to be 4. Scores above mean score were considered satisfactory while those below were considered unsatisfactory
A majority of the participants (83.5%) believed that they are wearing the mask correctly at all times and that wearing a mask is an important method of preventing spread of corona (95.4%). Nevertheless, 29.3% felt the need for more knowledge on how to wear the mask correctly (Table 4).
|Marital status (total)||439||10||11||0.216||384||39||37||0.01||135||272||53||0.374|
|51 and above||160||2||0||141||10||11||53||92||17|
|Education level (total)||439||10||11||0.568||384||39||37||0.54||49||94||21||0.195|
|Q1. Is Wearing a face mask an important method of reducing transmission of COVID?
Q2. Do you believe that you are wearing the mask correctly at all times?
Q3. Do you believe you need more knowledge on how to wear¬† the mask correctly ?
Table 4: Socio demographic factors and their influence on attitudes of Jeddah residents and citizens towards use of masks for prevention of COVID spread.
The duration of mask usage was: 2-4 hours (n=160,34.8%), 1-2 hours (n=159,34.3%), 4-6 hours (n=84,18.3%) followed by more than 6 hours (n=49,10.7%). The most commonly reported barrier to the use of a mask was difficulty in breathing (n=269,58.5%) followed by itching around the nose/skin (n=129,28%).
The current study was conducted in the city of Jeddah with the objective of recording responses from a diverse cross section of the population. Probability sampling was not feasible in this study because a sampling frame was unavailable. Despite using a nonprobability sampling method, quota sampling was adopted to improve representation in the sample.
Respondents overall knowledge score in the current study was similar to those reported previously within the kingdom . Nevertheless, the scores on mask usage in the current study are comparatively higher. The earlier study was conducted in the initial stages of the pandemic and some of the factors that may have contributed to the widespread increase in knowledge on the use of mask may include: the measures adopted by the ministry of health to spread awareness through social media and educational platforms and regulatory conditions established early in the COVID spread . The results are also comparable to studies in other countries conducted in the later stages of the pandemic [6,15,16,17].
In the current study, respondent’s belief that they are wearing the mask correctly differed according to the age groups, gender and marital status. The odds of wearing a mask increased significantly with age in a previous report , a finding that can be corroborated from the current study. Females above 51 and married individuals displayed a significantly higher score compared to other groups. Research into perceptions regarding pandemic across several countries suggests that women tend to perceive the pandemic to be a serious threat and are more likely to comply with precautionary measures [18,19]. Unsurprisingly, the above mentioned subgroup was also open to suggestion and felt the need for more knowledge on the correct use of mask.
The use of surgical mask was by far most preferred for routine use. Cloth mask was the next preferred method, though the use was significantly less. The results from previous studies are mixed. While in China, 16 the use of medical masks was highest, a study in Poland 20 reported that cloth masks were used more. However, in situations where social distancing was perceived to be a challenge, the use of KN95 masks was preferred by almost one fourth of the population, though the use of surgical mask continued to be the most preferred. The CDC7 recommends use of N95 masks subject to availability after prioritization for healthcare workers. The increased use of KN95 indicates that (a) individuals exhibited a heightened sense of precautionary measures being adopted in challenging situations and (b) the availability of KN95 masks was not a hinderance.
As significant number of individuals are getting vaccinated, regulatory bodies are contemplating removal of mask as a mandatory practice. Nevertheless, in the latest guidelines, the CDC recommends that even fully vaccinated individuals should wear a mask in an area of “substantial or high transmission” .
In day to day situations, individuals do not wear the mask continuously in a fixed position covering the nose. While half of the respondents followed the CDC guidelines, nevertheless a large number of respondents (almost 1/3rd) were not sure if they washed their hands or used sanitizer every time they touched the mask to wear or remove it. The improper storage, disposal and practices regarding use of mask has been consistently noted in previous studies as well [15,16]. Future strategies to educate public on mask usage may need reinforcement on the methods to wear and dispose mask correctly.
The traditional use of niqab (females) or shmaagh (males), which are face coverings, warranted a clarification if they may be used as a substitute for face mask. The ministry in Saudi Arabia has clarified that these may be “deemed an alternative for the cloth face mask, provided it is made of several layers of fabric. Furthermore, it should fit tightly when worn, specifically at the nose and mouth areas” . In the current study, respondents were divided on their opinions, with majority still believing that scarf or hijab is not a substitute for mask. Moreover, further research is needed to confirm if the population that believes the traditional covering to be a substitute is actually following the ministry specifications.
The duration of mask use was investigated with majority of respondents using the mask from 1 to 4 hours. Increased duration of usage has been linked to increase itching of the skin . This duration may decrease further if the individual works in a hot atmosphere, needs to talk a lot or any such activity that makes the mask wet . Though not included in the current study, headaches associated with prolonged mask use may also discourage individuals from compliance . Thus public awareness needs to be enhanced on the amount of time a mask may be used to avoid complications and make its use more acceptable.
The knowledge score on mask usage was high. Practices were satisfactory but certain aspects needed further reinforcement to optimize mask usage.
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2Intern, IBN Sina National College for Medical Studies, Jeddah, Makkah, Saudi Arabia
Received: 09-May-2022, Manuscript No. JRMDS-22-50038; , Pre QC No. JRMDS-22-50038; Editor assigned: 11-May-2022, Pre QC No. JRMDS-22-50038; Reviewed: 25-May-2022, QC No. JRMDS-22-50038; Revised: 09-Jul-2022, Manuscript No. JRMDS-22-50038; Published: 20-Jul-2022