Much has been said about the political divide over the willingness to wear a face mask in order to reduce the spread of the virus that causes COVID-19 (SARS-CoV-2). According to some surveys, more conservative people are less likely to wear them, often on the grounds that it violates their civil rights. That research seems solid to us, but we are not political experts and wondered if there are psychological reasons that influence some people to refrain from face mask-wearing.
Psychological Factors with Some Empirical Support
A psychological reason was revealed by a recent New York Times map of who is wearing masks in the U.S. By obtaining 250,000 responses, the study is able to give a more detailed geographical picture than just at the state level. What the Times found is that there are clear clusters of people who do and do not wear face masks. The basis for this, according to Elizabeth Dorrance Hall, a professor at Michigan State University, who is quoted in the Times article about its study, is “peer pressure.”
An effect closely related to social pressure is culture. Although as we mentioned earlier, most Americans now say they accept that wearing face masks is important, that majority hovers around 80 percent, significantly less than the universal adoption of face masks for which public health officials and scientists are looking. Many have noted that people in some Asian countries have a long tradition of wearing face masks to control the spread of infectious disease and some of these countries, like Taiwan and Vietnam, had much lower rates of COVID-19 than were seen in the U.S. and some European countries. Thus, a culture of face mask-wearing may provide an enduring psychological motivation.
Another psychological factor is likely to be how one judges risk. Face mask use is highest among people who know others who have been infected and/or live in communities with higher rates of COVID-19. This is an example of the availability bias—we act on things that are most easily called to mind. Reading about COVID-19 in another part of the country or about CDC guidelines for wearing face masks in the newspaper or social media may seem removed from a person’s own experiences and therefore they will minimize the risk to themselves and their families. On the other hand, there is a more immediate effect when one knows specific individuals who have been infected or hear about people living nearby who have succumbed to SARS-CoV-2. That raises the risk assessment the individual makes, which in turn motivates a change in behavior toward wearing a mask.
Another important psychological factor may be the feeling of confusion that was exacerbated by early CDC and WHO advice. As the pandemic unfolded in February, the CDC first insisted that face masks were unnecessary for healthy people. Then in early April, CDC issued new recommendations that called for wearing face masks in certain crowded public situations. It was not until June that CDC issued guidelines calling for everyone to wear cloth face masks in public. WHO was also criticized for not recommending that everyone wear face masks until June. Confusion about something is often dealt with by ignoring it; that is, if people cannot be sure what is the right thing to do with respect to face masks, they may default to a position of just not thinking about the issue and therefore not wearing them.
Yet another psychological factor to consider is a sense of control. One thing we can certainly say about COVID-19 is that it makes us feel we are out of control. Although experts rightly tell us there are things we can do to control the pandemic (i.e. social distancing, wearing face masks, frequent handwashing, and getting tested), there is little we can do personally to affect businesses closed all around us, children not able to go to school, and people dying. Refusing to wear a mask may seem, paradoxically, like taking control of the situation. No, it is not a rational step because doing so will only make things worse. But to some, refusing the mask may seem like a major personal statement that re-establishes a sense of control.
Overcoming the Psychological Factors
While it is beyond our expertise to recommend how to convince people who refuse to wear face masks for purely ideological reasons (e.g. “It is a violation of my First Amendment rights”), there may be some things we can do to overcome the more psychological factors that determine face mask-wearing.
Let’s start with a thought experiment. Ask a person who is uncertain about wearing a mask whether they would want surgeons who aren’t wearing surgical masks to operate on them or a member of their family. Most people will likely think that idea is dangerous and even absurd. In fact, there is something we regard as almost heroic in the image of the surgeon in her surgical gown and mask. Then remind the person that the reason why surgeons wear masks, even though they themselves feel perfectly healthy, is that it cuts down on the risk of passing off an infection to the patient undergoing surgery. This creates a positive role model for wearing face masks to prevent the spread of COVID-19.
To combat social pressure against wearing a mask, we need to make sure that everyone everywhere sees people they trust and respect wearing masks. Let’s go to communities where mask-wearing rates are low and find out what public officials, celebrities, actors, and sports figures the people there respect. Then let’s ensure that people in these communities see plenty of their heroes, be they surgeons or basketball players, wearing masks. Finally, we need everyone in responsible public health positions to stop equivocating about face masks and to make definitive and clear statements. We may have trouble changing fixed political convictions about face masks, but perhaps we have a chance to change the psychological barriers to wearing them.