Factors influencing mask use and physical distancing for COVID-19: A qualitative evidence synthesis

Background: The World Health Organization (WHO) recommends a bundle of precautions to reduce community transmission of COVID-19, including mask use and physical distancing. However, there is evidence that suggests poor adherence to these health measures community settings. Aim: To summarise qualitative research evidence on the perceptions and factors influencing masks use and physical distancing in the context of the COVID-19 pandemic. Setting: We included studies conducted in community settings. Method: An electronic database search was conducted using search terms derived from the inclusion criteria and combined in a peer-reviewed search strategy. Thirty studies were sampled. Qualitative data analysis was performed using the thematic synthesis approach. The confidence in each review finding was ascertained using the Grading of Recommendations, Assessment, Development and Evaluations - Confidence in the evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. Results: Ten analytical themes of low to high confidence were identified. Values, belief systems and cultural norms shaped the perception and uptake of mask use and physical distancing. Key barriers included the cost of masks, limited infrastructure for spatial separation and inconsistent political or government messaging, while visual cues and social responsibility facilitated adherence. Conclusion: Personal values and preferences influenced individuals' adherence to these public health measures. Political or government messaging is important to aid understanding and adherence. Contribution: Insights provided by this synthesis can support future emergency preparedness and response to outbreaks of acute respiratory infections by providing policy makers with information needed to make contextually relevant recommendations to enhance adherence.