Behavioral drivers and observation of face covering use during the COVID-19 pandemic among outpatients and visitors at a tertiary hospital in 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.