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The trajectory of COVID-19 pandemic and handwashing adherence: findings from 14 countries

Szczuka Z 1 , Abraham C 2 , Baban A 3 , Brooks S 4 , Cipolletta S 5 , Danso E 6 Show all authors , Dombrowski SU 4 , Gan Y 7 , Gaspar T 8 , de Matos MG 8 , Griva K 9 , Jongenelis M 10 , Keller J 11 , Knoll N 11 , Ma J 7 , Miah MAA 12 , Morgan K 12 , Peraud W 13 , Quintard B 13 , Shah V 14 , Schenkel K 15 , Scholz U 15 , Schwarzer R 11 , Siwa M 1 , Szymanski K 1 , Taut D 3 , Tomaino SCM 5 , Vilchinsky N 16 , Wolf H 16 , Luszczynska A 17

Affiliations 

  • 1 Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities, 30b Ostrowskiego Street, PL-53-238, Wroclaw, Poland
  • 2 School of Psychology, Deakin University, Melbourne, Australia
  • 3 Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
  • 4 Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
  • 5 Department of General Psychology, University of Padova, Padova, Italy
  • 6 Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, Gambia
  • 7 School of Psychological and Cognitive Sciences, Peking University, Beijing, China
  • 8 Institute of Environmental Health, Medical School, University of Lisbon, Lisbon, Portugal
  • 9 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
  • 10 Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
  • 11 Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
  • 12 Perdana University-Royal College of Surgeons in Ireland School of Medicine, Kuala Lumpur, Malaysia
  • 13 Department of Psychology, INSERM 1219, University of Bordeaux, Bordeaux, France
  • 14 Environmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
  • 15 Applied Social and Health Psychology, University Research Priority Program "Dynamics of Healthy Ageing", Department of Psychology, University of Zurich, Zurich, Switzerland
  • 16 Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
  • 17 Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities, 30b Ostrowskiego Street, PL-53-238, Wroclaw, Poland. aluszczy@uccs.edu
BMC Public Health, 2021 10 05;21(1):1791.
PMID: 34610808 DOI: 10.1186/s12889-021-11822-5

Abstract

BACKGROUND: The COVID-19 pandemic has affected people's engagement in health behaviors, especially those that protect individuals from SARS-CoV-2 transmission, such as handwashing/sanitizing. This study investigated whether adherence to the World Health Organization's (WHO) handwashing guidelines (the outcome variable) was associated with the trajectory of the COVID-19 pandemic, as measured by the following 6 indicators: (i) the number of new cases of COVID-19 morbidity/mortality (a country-level mean calculated for the 14 days prior to data collection), (ii) total cases of COVID-19 morbidity/mortality accumulated since the onset of the pandemic, and (iii) changes in recent cases of COVID-19 morbidity/mortality (a difference between country-level COVID-19 morbidity/mortality in the previous 14 days compared to cases recorded 14-28 days earlier).

METHODS: The observational study (#NCT04367337) enrolled 6064 adults residing in Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland. Data on handwashing adherence across 8 situations (indicated in the WHO guidelines) were collected via an online survey (March-July 2020). Individual-level handwashing data were matched with the date- and country-specific values of the 6 indices of the trajectory of COVID-19 pandemic, obtained from the WHO daily reports.

RESULTS: Multilevel regression models indicated a negative association between both accumulation of the total cases of COVID-19 morbidity (B = -.041, SE = .013, p = .013) and mortality (B = -.036, SE = .014 p = .002) and handwashing. Higher levels of total COVID-related morbidity and mortality were related to lower handwashing adherence. However, increases in recent cases of COVID-19 morbidity (B = .014, SE = .007, p = .035) and mortality (B = .022, SE = .009, p = .015) were associated with higher levels of handwashing adherence. Analyses controlled for participants' COVID-19-related situation (their exposure to information about handwashing, being a healthcare professional), sociodemographic characteristics (gender, age, marital status), and country-level variables (strictness of containment and health policies, human development index). The models explained 14-20% of the variance in handwashing adherence.

CONCLUSIONS: To better explain levels of protective behaviors such as handwashing, future research should account for indicators of the trajectory of the COVID-19 pandemic.

TRIAL REGISTRATION: Clinical Trials.Gov, # NCT04367337.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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