Factors associated with willingness to wear a mask to prevent the spread of COVID-19 in a Midwestern Community

OBJECTIVE: To identify motivators and barriers to wearing a mask to prevent COVID-19. PARTICIPANTS AND METHODS: An anonymous, online survey of adults from Southeastern Minnesota conducted August 2020. We assessed willingness to wear a mask and its associations with socio-demographics, COVID-19-related factors and prevention behaviors using multivariable ordinal logistic regression. RESULTS: Of 7,786 respondents (78% women, 51% rural), 9% reported ‘not at all willing’, 27% ‘willing’, and 64% ‘very willing’ to wear a mask. Factors independently associated with willingness to wear a mask were: urban residence (OR = 1.23, 95% CI 1.05–1.44, p = 0.009); college degree or greater (OR 1.42, CI 1.05–1.93, p = 0.025); age (18–29 years OR 1.29, CI 01.02–1.64, p = 0.038; 30–39 OR = 1.37, CI 1.12–1.69, p = 0.003; 60–69 OR = 1.44, CI 1.09–1.91, p = 0.011; 70–89 OR 2.09, CI 1.32–3.37, p = 0.002; 40–49 reference group); and (all p < 0.001) democratic party affiliation (OR 1.79, CI 1.40–2.29), correct COVID-19 knowledge (OR 1.50, CI 1.28–1.75), 5 + COVID-19 prevention behaviors (OR 2.74, CI 1.98–3.81), positive perceived impacts for wearing a mask (OR 1.55, 1.52–1.59), perceived COVID-19 severity (OR 2.1, CI 1.44–3.1), and greater stress (OR 1.03, CI 1.02–1.04), and trust in the Centers for Disease Control (CDC) (OR 1.78, CI 1.45 –2.19). CONCLUSION: Results from this sample of SEMN residents suggest interventions to enhance COVID-19 knowledge, positive expectations for mask wearing, and trust in the CDC are warranted. Research is needed to understand cultural and other barriers and facilitators among sub-populations, e.g., rural residents less willing to wear a mask.