Document Type : Original Article


Epidemiology Unit , Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand


BACKGROUND: Use of face covering may help prevent COVID‑19 transmission. However, there
is a lack of data on behavioral drivers of face covering use and compliance to mandatory face
covering policy at health facilities. This study aimed to describe behavioral drivers and observed
face covering use among outpatients and visitors at a tertiary hospital in Southern Thailand during
the COVID‑19 pandemic.
MATERIALS AND METHODS: We conducted a hospital‑based, cross‑sectional study in June 2020.
We developed, pilot‑tested and finalized an interview questionnaire in Thai. We also developed a
structured observation questionnaire. Two trained enumerators recruited outpatients and visitors at
the hospital’s internal medicine outpatient department (OPD), surgery OPD, and the pharmacy using
the convenience sampling. Another enumerator conducted structured observation of face covering
use among outpatients and visitors when interviews were not taking place. We analyzed the data
using the descriptive statistics.
RESULTS: A total of 206 persons that our interview enumerators approached agreed to
participate (n = 206; response rate = 62.4%). Nearly all participants stated that the use of face
covering was beneficial in preventing COVID‑19 infection from others and preventing others from being
infected (94.0% and 98.0%, respectively). Common barriers included inconvenience in breathing and
speaking (19.7%) and pain at the ears (9.6%). Structured observation of 408 outpatients and visitors
showed that nearly everyone (>99%) had a face covering on their person, most of whom (94.6%)
covered both their nose and mouth.
CONCLUSION: We found near‑universal perceived benefits and compliance, but variations in
perceived barriers, cues, and social norms for the use of face coverings. The findings of this study
can inform future intervention programs on face covering use promotion.


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