Boundaries of solidarity: a meta-ethnography of mask use during past epidemics to inform SARS-CoV-2 suppression.
health policy
public health
qualitative study
respiratory infections
Journal
BMJ global health
ISSN: 2059-7908
Titre abrégé: BMJ Glob Health
Pays: England
ID NLM: 101685275
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
28
09
2020
revised:
04
12
2020
accepted:
09
12
2020
entrez:
7
1
2021
pubmed:
8
1
2021
medline:
14
1
2021
Statut:
ppublish
Résumé
Many countries aiming to suppress SARS-CoV-2 recommend the use of face masks by the general public. The social meanings attached to masks may influence their use, but remain underinvestigated. We systematically searched eight databases for studies containing qualitative data on public mask use during past epidemics, and used meta-ethnography to explore their social meanings. We compared key concepts within and across studies, then jointly wrote a critical synthesis. We found nine studies from China (n=5), Japan (n=1), Mexico (n=1), South Africa (n=1) and the USA (n=1). All studies describing routine mask use during epidemics were from East Asia. Participants identified masks as symbols of solidarity, civic responsibility and an allegiance to science. This effect was amplified by heightened risk perception (eg, during SARS in 2003), and by seeing masks on political leaders and in outdoor public spaces. Masks also acted as containment devices to manage threats to identity at personal and collective levels. In China and Japan, public and corporate campaigns framed routine mask use as individual responsibility for disease prevention in return for state- or corporate-sponsored healthcare access. In most studies, mask use waned as risk perception fell. In contexts where masks were mostly worn by patients with specific diseases (eg, for patients with tuberculosis in South Africa), or when trust in government was low (eg, during H1N1 in Mexico), participants described masks as stigmatising, uncomfortable or oppressive. Face masks can take on positive social meanings linked to solidarity and altruism during epidemics. Unfortunately, these positive meanings can fail to take hold when risk perception falls, rules are seen as complex or unfair, and trust in government is low. At such times, ensuring continued use is likely to require additional efforts to promote locally appropriate positive social meanings, simplifying rules for use and ensuring fair enforcement.
Sections du résumé
BACKGROUND
Many countries aiming to suppress SARS-CoV-2 recommend the use of face masks by the general public. The social meanings attached to masks may influence their use, but remain underinvestigated.
METHODS
We systematically searched eight databases for studies containing qualitative data on public mask use during past epidemics, and used meta-ethnography to explore their social meanings. We compared key concepts within and across studies, then jointly wrote a critical synthesis.
RESULTS
We found nine studies from China (n=5), Japan (n=1), Mexico (n=1), South Africa (n=1) and the USA (n=1). All studies describing routine mask use during epidemics were from East Asia. Participants identified masks as symbols of solidarity, civic responsibility and an allegiance to science. This effect was amplified by heightened risk perception (eg, during SARS in 2003), and by seeing masks on political leaders and in outdoor public spaces. Masks also acted as containment devices to manage threats to identity at personal and collective levels. In China and Japan, public and corporate campaigns framed routine mask use as individual responsibility for disease prevention in return for state- or corporate-sponsored healthcare access. In most studies, mask use waned as risk perception fell. In contexts where masks were mostly worn by patients with specific diseases (eg, for patients with tuberculosis in South Africa), or when trust in government was low (eg, during H1N1 in Mexico), participants described masks as stigmatising, uncomfortable or oppressive.
CONCLUSION
Face masks can take on positive social meanings linked to solidarity and altruism during epidemics. Unfortunately, these positive meanings can fail to take hold when risk perception falls, rules are seen as complex or unfair, and trust in government is low. At such times, ensuring continued use is likely to require additional efforts to promote locally appropriate positive social meanings, simplifying rules for use and ensuring fair enforcement.
Identifiants
pubmed: 33408191
pii: bmjgh-2020-004068
doi: 10.1136/bmjgh-2020-004068
pmc: PMC7789204
pii:
doi:
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Int J Equity Health. 2016 May 04;15:73
pubmed: 27145823
Lancet Respir Med. 2020 May;8(5):434-436
pubmed: 32203710
BMJ. 2020 Apr 9;369:m1435
pubmed: 32273267
Public Health Nurs. 2011 Jan-Feb;28(1):13-23
pubmed: 21198810
BMC Med Res Methodol. 2019 Jan 31;19(1):25
pubmed: 30709371
Health Policy. 2010 Apr;95(1):50-6
pubmed: 19962777
Med Anthropol. 2018 Aug-Sep;37(6):472-485
pubmed: 29648893
Sociol Health Illn. 2012 Nov;34(8):1184-98
pubmed: 22443378
Am J Hum Biol. 2020 Sep;32(5):e23485
pubmed: 32830396
Psychiatry. 1955 Aug;18(3):213-31
pubmed: 13254953
Eur J Med Res. 2020 Jun 23;25(1):23
pubmed: 32576263
Asia Pac J Public Health. 2019 Apr;31(3):246-256
pubmed: 31007032
BMJ. 2020 Aug 19;370:m3021
pubmed: 32816815
Med Anthropol. 2019 Jul;38(5):440-454
pubmed: 31107603
BMC Public Health. 2014 Jun 11;14:589
pubmed: 24920395
Lancet. 2020 Jun 27;395(10242):1973-1987
pubmed: 32497510
Implement Sci. 2011 Apr 23;6:42
pubmed: 21513547