Decline Of Handwashing And Masking Among The General Population In Post COVID-19 Pandemic: Insights From A Mixed Methods Study In Ghana

COVID-19 has now entered the endemic stage where the virus is widespread with less fatality than it was in 2020. Restrictions and mandates such as handwashing and masking are eased although the pandemic is not yet over. Many have concluded that we have reached a point that marks the end of the pandemic spurring changes in public behavior. However, SARS-CoV-2 is still causing deaths every day and cases have not plateaued at low level. Better knowledge on why people have relented in handwashing and masking is needed to guide the development of effective interventions against future waves of the infection. In this study, we explored factors contributing to this pattern of behavior in Ghana. Questionnaires were administered to 350 respondents, via social media (WhatsApp, LinkedIn, Twitter, Facebook, reedit,) and these were used to determine the level of handwashing and masking at the first stage of study. Screening and scoring of the questionnaires were used to estimate the level of these activities at the second stage. Among all respondents, we identified and selected 279 participants at the second stage: 95 as decliners, 120 non-regulars, and 64 maintainers according to their level of these activities and adapted scoring criteria. For each category, a group of 5 participants were randomly selected to take part in an in-depth interview. The theory of planned behavior guided our analysis. Six themes emerged from the analysis with the acronym, IMPASE; inconvenience and contamination, Mass population, pandemic patterns and regulations, Availability, Safety and infection prevention, environment and activity. These themes appeared to have elements relating to another component of the theory of planned behavior. Collectively, the environment (Subjective norms) and pattern of pandemic and regulation (Perceived behavioral control) interact with each other to ultimately influence handwashing and masking. Declining and non-regularity were associated with inconvenience and contamination. Maintenance is associated with the environment and activity. Thus, public educational campaigns must be intensified to highlight and address these themes. The public health authorities, employers and, essential services could play an important role in enforcing and disseminating such information.