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

Zofia Szczuka; Charles Abraham; Adriana Baban; Sydney Brooks; Sabrina Cipolletta; Ebrima Danso; Stephan U Dombrowski; Yiqun Gan; Tania Gaspar; Margarida Gaspar de Matos; Konstadina Griva; Michelle Jongenelis; Jan Keller; Nina Knoll; Jinjin Ma; Mohammad Abdul Awal Miah; Karen Morgan; William Peraud; Bruno Quintard; Vishna Shah; Konstantin Schenkel; Urte Scholz; Ralf Schwarzer; Maria Siwa; Kamil Szymanski; Diana Taut; Silvia C M Tomaino; Noa Vilchinsky; Hodaya Wolf; Aleksandra Luszczynska

doi:10.1186/s12889-021-11822-5

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

BMC Public Health. 2021 Oct 5;21(1):1791. doi: 10.1186/s12889-021-11822-5.

Authors

Zofia Szczuka¹, Charles Abraham², Adriana Baban³, Sydney Brooks⁴, Sabrina Cipolletta⁵, Ebrima Danso⁶, Stephan U Dombrowski⁴, Yiqun Gan⁷, Tania Gaspar⁸, Margarida Gaspar de Matos⁸, Konstadina Griva⁹, Michelle Jongenelis¹⁰, Jan Keller¹¹, Nina Knoll¹¹, Jinjin Ma⁷, Mohammad Abdul Awal Miah¹², Karen Morgan¹², William Peraud¹³, Bruno Quintard¹³, Vishna Shah¹⁴, Konstantin Schenkel¹⁵, Urte Scholz¹⁵, Ralf Schwarzer¹¹, Maria Siwa¹, Kamil Szymanski¹, Diana Taut³, Silvia C M Tomaino⁵, Noa Vilchinsky¹⁶, Hodaya Wolf¹⁶, Aleksandra Luszczynska^{17

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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.
¹⁸ Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia. aluszczy@uccs.edu.

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.

Keywords: COVID-19; Cross-country; Hand hygiene; Morbidity; Mortality; Pandemic.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Germany
Hand Disinfection
Humans
Pandemics*
SARS-CoV-2

Associated data

ClinicalTrials.gov/NCT04367337