How to make COVID-19 mask-wearing a habit: Social scientists offer some suggestions

Mandating, not just recommending, the use of non-medical masks will help convince more Canadians to wear them as the economy reopens, just as wearing seatbelts is now the norm, some social scientists and physicians say.

In Canada's largest city, wearing non-medical masks is now mandatory for people riding with the Toronto Transit Commission, with certain exemptions, to prevent the spread of the novel coronavirus. A bylaw extending the rule to indoor public spaces goes into effect on July 7. Similarly, mayors in Peel Region, which includes Mississauga and Brampton, west of Toronto, and York Region to the north also plan to introduce such bylaws.

In Quebec, Premier François Legault announced that public transit users in the province will be required to wear masks starting on July 13.

Many health authorities now consider face coverings a necessity, and governments are passing laws that require them, but those laws are difficult to enforce. That's why behavioural scientists say it's so important for the public to get on board if the rules are going to stick.

Virus not more powerful than collective will to fight it, says expert

Kim Lavoie, a professor of psychology in behavioural medicine at the University of Quebec at Montreal, is among the experts calling for governments in Canada to consult social scientists on preventive measures like wearing masks as lockdowns lift in the absence of vaccines or effective treatments for COVID-19.

"Wearing a mask is something we control. Washing our hands, staying home, skipping that party are all things we control," Lavoie said.

"People forget that the virus isn't more powerful than our collective will to get rid of it, and there are things we can do. But right now, they're behavioural."

Dr. David Fisman, an epidemiologist at the University of Toronto's Dalla Lana School of Public Health, said masks could help more people get back to business and "regular life."

"We think it's sort of low-hanging fruit and a no-brainer," Fisman said.

Why? Layering on masks on top of hand hygiene, avoiding touching your face and physical distancing helps reduce transmission in small case reports, observational studies and a preliminary model.

"Me wearing a mask protects you. If I have COVID, you wearing a mask also protects you from breathing in my virus," Fisman said.

While Fisman called Canada "a country of rule followers," there are people who oppose mandating masks, saying it impinges on individual rights and freedoms.

But with COVID-19, one person's behaviour affects the next person — the basis for secondhand smoke laws.

"It's no more [an infringement] than asking you to wear a seatbelt," Lavoie said. "You're not free to drink yourself under the table and then get behind the wheel. If you don't have a PCR test at your house to test yourself negative, then you have to consider the possibility that you might be infected and not know it and be putting us all at risk."

Protecting yourself a major motivator

Lavoie is one of the researchers behind a large study called iCARE (International assessment of COVID-19-related attitudes, concerns, responses and impacts). Together with collaborators from Johns Hopkins University's project on cases and Oxford's policy tracker, they're regularly surveying Canadians and people around the world on how they feel about and adhere to policies.

The goal of the research is to disentangle what motivates people of different ages and socioeconomic backgrounds to change their behaviour to inform health-care policy and messaging.

Based on 50,000 responses since the end of March, Lavoie said the findings to this point suggest that concern about getting infected with the virus is a major motivator.

"One thing people don't realize is how contagious it is," she said.

Most people recover at home, but people of all ages have also been severely sickened, some for months, says the Public Health Agency of Canada. Patients say long-term symptoms and consequences such as heart damage are coming to the fore.

An urgent need

While making mask wearing the norm would help prevent transmission, Fisman said mixed messaging and "dithering" by Ontario's government have hindered mask use from becoming commonplace.

"Once the signal comes from our public health leaders that this is the expectation and this is how we're going to move forward, I think people will fall in line pretty fast," he said.

Wearing masks could be considered a behaviour that needs to be adopted urgently and collectively, Lavoie said.

She pointed to how behavioural change boils down to three factors:

• Awareness of the need to wear masks.

• Motivation, such as protecting yourself, loved ones or neighbours who may be vulnerable to serious complications.

• Confidence in the ability to execute the behaviour.

Cost can be a barrier. That's why Alberta's government is distributing 20 million non-medical masks at drive-thru restaurants.

Shift from self-consciousness to the norm

Mitsutoshi Horii, a professor of sociology at Chaucer College in Canterbury, England, studied the uptake of masks in Japan during the 1918 flu pandemic. The practice continues in Japan during flu and hay fever season, as well as during COVID-19.

Horii said when the 1918 flu pandemic hit, the Japanese government prohibited traditional folk rituals around health as part of its efforts to promote modernization and to avoid colonization.

"Then the mask came in and that gave people a sense of direction. When you're facing uncertainty, you want to do something. By doing something, we establish a sense of control," he said.

WATCH | Canada's patchwork of mask measures:

Horii contrasts that with his experience in the U.K. now, where wearing masks is not common.

"Personally, I still feel embarrassed to wear a mask" in the U.K., Horii said, even though they're now compulsory on public transit in England and will soon be required in stores in Scotland.

He said he thinks changing the rules would encourage him and others to overcome self-consciousness.

"At the same time, I bought some masks and we're ready to wear [them] at any time. We just need a bit of a push to do it."