https://doi.org/10.15218/ejnm.2023.08 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article Motivations of Wearing Face Mask: A Cross-sectional Study ABSTRACT Background and Objectives: Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by the SARS-CoV-2 coronavirus, which initially appeared in China in December 2019 and has since spread to most countries in the global. Initial preventive recommenda- tions called for the use of masks for protection against infection. To reduce COVID-19 transmission in the community. The purpose of this study was to assess motivation factors for wearing surgical face masks and investigate reasons for not wearing face coverings, and gain insights from our study population about messaging strategies. Methods: A cross-sectional Descriptive study of 297 administrative staff of Hawler Medical University was conducted from February to October 2022. The data was gathered through direct interviews using a questionnaire that had been modified, include socio- demographic information and fifteen questions about the reason participants want to use face covering. The data were analyzed by Statistical Package for Social Science (SPSS ver- sion 25). Chi-square and Fisher's Exact tests were used to determine the study's result. The P-value was considered significant at ≤ 0.05. Results: The result revealed the highest percentage of the administrative staff was 34-46 years old (54.3%). Most of the participants in this study were female (55.6 %). Half of the participants demonstrated a high level of motivation (51.9 %). The highest level of motiva- tion was related to "I want to protect people who are vulnerable (85.7%) and "I feel a re- sponsibility to wear a facemask (81.9%) and wearing a facemask could prevent me from giving COVID-19 to the family (80.9%). Conclusion: The studied sample had a high motivational level for wearing a face mask; the desire to protect people who are vulnerable and the feeling of responsibility to wear a face mask and oneself are often the driving motivation for using face coverings. It is nec- essary to implement massive education campaigns at the level of Hawler Medical Univer- sity for administrative staff to increase motivation toward using a facemask to stop the separation of viruses COVID-19. Keywords: Motivation; Facemasks; COVID-19. Burhan Izzaddin Sabir; Department of Nursing, College of Nursing, Hawler Medical University, Kurdistan Region- Iraq. (Correspondence: burhan.sabir@hmu.edu.krd ). Dara Abdulla Al-Banna; Department of Nursing, Faculty of Nursing, Tishk International University and Hawler Medical University, Erbil, Kurdistan Region, Iraq . 65 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Received: 05/01/2023 Accepted: 02/04/2023 Published: 30/5/2023 mailto:burhan.sabir@hmu.edu.krd https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.08 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by the SARS-CoV- 2 coronavirus, which first appeared in Chi- na in December 2019 and has since spread to most countries around the world, result- ed in a coronavirus pandemic in 2019- 2020. The virus is primarily transmitted through respiratory droplets, Released when an infected person coughs or sneezes or through touching contaminated surfaces or objects and then touching their mouth, nose, or eyes [1]. In Wuhan, Hubei Prov- ince, China, the coronavirus (2019-nCoV) was discovered for the first time [2]. The full clinical picture is still unknown, but the most commonly described symptoms are fever, cough, myalgia or tiredness, pneu- monia, and complex dyspnea. SARS-CoV-2 nucleic acid is detected using real-time flu- orescence (RT-PCR) [3]. COVID-19 is the third emerging coronavirus to pose a global public health threat, following the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) in 2002 [4]. Due to the similari- ty in COVID-19 and previous coronaviruses, initial preventive recommendations called for the use of masks for protection against infection. Social distancing and hand hy- giene were initially implemented to reduce COVID-19 transmission in the community [5]. On March 11, 2020, the World Health Organization (WHO) proclaimed the SARS- CoV-2 coronavirus disease 2019 (COVID- 19) outbreak to be a pandemic [6]. Face masks quickly rose to the top of the pan- demic's most recognizable symbols. The general agreement is that using a mask lowers the risk of contracting and trans- mitting the virus, protecting both the per- son wearing it and those nearby [7]. But how well masks function is largely depend- ent on human behavior. Studies on the effectiveness of mask use make the as- sumption that people wear masks and do so correctly [8]. While older persons have a significantly higher mortality risk from disease complications than younger people, COVID-19 offers varied intrinsic motives for mask wear for different age groups. Therefore, it is possible that there would be a generational conflict in the reasons people follow the pandemic limitations, such as wearing masks. We, therefore, postulate that specific methods for conveying public health advice on mask use to the older and younger age groups are required [9]. The lack of evidence regarding the virus's mode of transmission at the beginning of the pandemic caused conflicting public health recommendations from health organizations and political leaders. For instance, the WHO initially held off on endorsing mask use, partly because of the dearth of data and partially out of concern for the depletion of supplies for frontline workers. The WHO even stated in March 2020 that wearing a mask when "not ill or caring for someone who is ill" would constitute "wasting a mask " [10]. Understanding how to encourage people of various ages to wear masks in public is crucial, especially when doing so is up to them. People may choose to wear masks for either to protect themselves from contracting the illness (risk preferences) or to prevent spreading it to others. This study aims to investigate the driving forces of face coverings. This cross-sectional study was onducted between February to October 2022 among administrative staff at Hawler Medical University (Colleges of Medicine 67, Dentistry 49, Pharmacy 73, Nursing 59, and Health Sciences 45) both genders (male and female) during the Corona Virus pandemic in Erbil City, Kurdistan Region of Iraq. The sample of the study was estimated according to the total number of 66 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. INTRODUCTION METHODS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.08 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article Table 1 shows that the highest proportion of the study sample was between ages 34 to 46 years, followed by 31.4% in ages 21 to 33 years and female groups of gender (55.6%). The highest percentage of the cur- rent study samples graduated from univer- sities (40.6%). The table shows the number of married in the study sample exceeds two third (67.9%). Close to half (49.8%) of the study sample got COVID-19, and 51.9% of the sample wore masks. administrative staff. Among 1300 staff, 297 of them were selected as the study sample. The estimated sample size of the study was determined by using a sample size calculation formula known as Power analysis with a 95% confidence interval (CI) and a 5% margin of error for the re- quired sample size [11]. the tool and method of data collection include a ques- tionnaire consisting of two parts. The first part includes the sociodemographic char- acteristics of respondents, including age, gender, educational level, marital status, and religion. The second part consisted of the statements to identify why partici- pants want to use face covering (motivation). The data were collected through direct face-to-face interview tech- niques with the participants. After describ- ing the contents of all parts of the ques- tionnaire, the responses to the partici- pants about motivational levels of wearing face mask items included two answers 0 = not motivated (no) and 1= motivated (yes). The calculation of the overall moti- vational levels of wearing face masks (15 items) was categorized into three groups highly motivated (1-5), moderately moti- vated (6-10), and low motivated (11-15). This study was submitted to the Ethical Committee at the College of Nursing, Hawler Medical University, in order to get an approval letter for conducting it. Then, getting the informal oral approval from each participant after clarification of the purpose of the study. The data were en- tered into the computer by using a Statis- tical Package for Social Science (SPSS ver- sion 25). The quantitative data were de- scribed by frequency and percentage. The inferential statistical analysis was assessed by using Chi-square and Fisher's Exact tests. The P-value was considered signifi- cant at ≤ 0.05. 67 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium RESULTS Table 1: Socio demographic Characteristics of the study sample Sociodemographic Characteristics (n=293) n. (%) Age Group (years) 21-33 92 (31.4) 34-46 159 (54.3) 47-59 42 (14.3) Gender Male 130 (44.4) Female 163 (55.6) Level of education Basic 32 (10.9) Secondary 51 (17.4) Institute 65 (22.2) University 119 (40.6) Higher education 26 (8.9) Marital status Single 94 (32.1) Married 199 (67.9) Religion Muslim 272 (92.8) Christian 18 (6.1) Others 3 (1) Had COVID-19 Definitely No 68 (23.2) Not sure 79 (27) Definitely Yes 146 (49.8) Face covering use (mask) Never 29 (9.9) Some of the time 152 (51.9) Most of the time 112 (38.2) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.08 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article Other responses included "I feel a respon- sibility to wear a face mask" at 81.9%, "wearing a face mask could prevent me from giving COVID-19 to the family" at 80.9%, "will allow the school to open" at 74.4%, and "allow me to see family and friends" at 72%. of the sample is highly motivated for wear- ing masks. 68 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 2 shows that 77.8% of the sample was widely motivated by using face masks to protect themselves and others from COVID-19. 85.7% wanted to protect vul- nerable people to wear facemasks. Partici- pants were motivated by a desire to exert control and typically agreed that covering one's face will protect the community from risk , with a 74.1% response rate. Table 3 is concerning the motivation of the overall sample; the table shows that 51.9% Table 2: Motivations for face mask used by the study sample Motivations for Face Mask Use (n=293) Correct Incorrect n. (%) n. (%) I don't want to give COVID-19 to anyone 228 (77.8) 65 (22.2) I want to protect people who are vulnerable 251 (85.7) 42 (14.3) Wearing a face covering will prevent my community (e.g., members from my neighborhood, work, university, and church) from being at risk. 217 (74.1) 76 (25.9) I feel a responsibility to wear a face covering 240 (81.9) 53 (18.1) Wearing a face covering could prevent me from giving COVID-19 to my family 237 (80.9) 56 (19.1) Wearing a face covering helps keep our hospitals from getting too full 210 (71.7) 83 (28.3) I want to follow the experts' advice. 194 (66.2) 99 (33.8) Wearing a face covering could prevent me from getting COVID-19. 191 (65.2) 102 (34.8) Wearing a face covering is something I can control in an uncontrollable situation. 193 (65.9) 100 (34.1) Wearing a face mask will allow the government to ease restrictions. 201 (68.6) 92 (31.4) Wearing a face mask will allow schools to open. 211 (72) 82 (28) Wearing a facemask allows me to see my friends and family. 218 (74.4) 75 (25.6) I would be embarrassed if people saw me not wearing a face covering. 102 (34.8) 191 (65.2) I am afraid of getting in trouble if I don't wear a face mask 146 (49.8) 147 (50.2) I feel pressure from friends and family 107 (36.5) 186 (63.5) Table 3: Overall motivational levels of wearing face masks Motivational Levels n. (%) High 152 (51.9) Moderate 103 (35.1) Low 38 (13) Total 293 (100) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.08 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article 69 between the motivation level of wearing a face mask and the use of face masks, and significance with genders having high mo- tivation (P-values of 0.001 and 0.009, re- spectively). Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 4 illustrates the association be- tween sociodemographic characteristics and the level of motivation for wearing a face mask. The result shows a very highly statistically significant association Table 4: Association between Sociodemographic characteristics with motivation the level wearing a face mask Sociodemographic Characteristics Motivational Levels (n=293) P-Value High Moderate Low n. (%) n. (%) n. (%) Age Group (years) 21-33 45 (48.9) 28 (30.4) 19 (20.7) 0.126 NS 34-46 85 (53.5) 59 (37.1) 15 (9.4) 47-59 22 (52.4) 16 (38.1) 4 (9.5) Gender Male 67 (51.5) 38 (29.2) 25 (19.2) 0.009 NS Female 85 (52.1) 65 (39.9) 13 (8) Level of educa- tion Basic 14 (43.8) 14 (43.8) 4 (12.5) 0.286 NS Secondary 28 (54.9) 14 (27.5) 9 (17.6) Institute 34 (52.3) 22 (33.8) 9 (13.8) University 58 (48.7) 49 (41.2) 12 (10.1) Higher educa- tion 18 (69.2) 4 (15.4) 4 (15.4) Marital status Single 44 (46.8) 34 (36.2) 16 (17) 0.290 NS Married 108 (54.3) 69 (34.7) 22 (11.1) Religion Muslim 138 (50.7) 96 (35.3) 38 (14) 0.217 NS Christian 11 (61.1) 7 (38.9) 0 (0) Others 3 (100) 0 (0) 0 (0) Had COVID-19 Definitely No 37 (54.4) 25 (36.8) 6 (8.8) 0.835 NS Not sure 40 (50.6) 27 (34.2) 12 (15.2) Definitely Yes 75 (51.4) 51 (34.9) 20 (13.7) Face covering use (mask) Never 6 (20.7) 5 (17.2) 18 (62.1) < 0.001 VHS Some of the time 73 (48) 65 (42.8) 14 (9.2) Most of the time 73 (65.2) 33 (29.5) 6 (5.4) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.08 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article 70 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Knowing when and why people are cover- ing their faces is crucial because the COVID -19 pandemic is still affecting all communi- ties in the world. There are opportunities to increase compliance even among peo- ple who frequently cover their faces, espe- cially in social settings. The result of the present study shows that more than half of the study sample occurred in middle age between 34-46 years old and were female. This finding agrees with study conducted by Vereen et al., 2021 among 448 partici- pants on motivation, barriers, and commu- nication for promoting face covering dur- ing the Covid-19 pandemic, in which more than half of the participants are females [12]. Another study conducted by Shelus et al. in 2020 about perceptions of wearing face masks among 34 focus groups showed 82% of them were female. [13]. Regarding educational level, the present study shows that a considerable proportioof both gen- ders had university degrees. This finding is consistent with previous research, which found that the majority of the study sam- ple, 46% had a bachelor's degree [12]. In terms of the marital status of the study sample, the findings revealed that the highest percentage of the study sample was married. This finding is similar Inter- net-Based Cross-Sectional Study conducted in 2022 by Xu Y. et al. on Factors Associat- ed with Protective Mask-Wearing Behavior to Avoid COVID-19 Infection in China, which included 10,304 survey respondents. Over half of the study participants (n = 5302, 51.46%) were married. [26]. About half of the participants reported having had covid-19. This result contrasts with the result of a study done by Vereen et al. in 2021, which reported among 448 partici- pants, few (just 6%) reported having had covid-19 [12]. Regarding motivational fac- tors for facemask use, many participants were motivated by statements about DISCUSSION wearing face coverings because they don't want to give COVID-19 to anyone majority of the study sample wearing the facemask to protect vulnerable people, wearing a face covering will prevent the community and some participants were motivated by statements that face coverings could pre- vent themselves from getting COVID-19. This finding is similar to a previous study that reported that the most (77%) fre- quently endorsed motivations were, "I don't want to give COVID-19 to anyone, and 76% wear a face covering to protect old people [12]. The current study's find- ings are consisten with a previous study on data on illness complications and mortali- ty, which found that older people are more likely to fall into the COVID-19 risk group. Furthermore, the median cutoff for both the younger and older subgroups falls within the age range with a COVID-19 death rate of 1% or higher [10]. The promi- nence of risk as the primary motivator for mask use can be due to significant age- related changes. While reducing the risk of infection may serve as the primary reason for older individuals, who are more likely to develop significant symptoms. The re- sults are consistent with earlier research suggesting that people may be more altru- istic when faced with uncertainty [14] and with newer research showing links be- tween the intention to cover one's face and the desire to protect one's community [15]. Messages encouraging the safety of loved ones are therefore encouraged. Most of the study participants like to fol- low the expert's advice regarding the im- portance of wearing facemasks. This result is supported by a previous study about the perception of face covering that reported The majority of participants expressed a desire to follow the rules of face covering based on health experts' recommenda- tions and data supporting their efficacy [16]. About one-third of the participants in https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.08 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article 71 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. this study responded that "Wearing a face covering is something I can control in an uncontrollable situation" (65.9%). The face coverings were frequently worn out of a sense of duty or because it was thought to be morally correct. The choice to cover one's face must not be influenced by the actions of those around one; some people choose to cover their faces in an effort to "keep the peace" by adhering to social norms [16]. On the other hand, the least endorsed statement is that half of the par- ticipants feel pressure, get into trouble, Feel embarrassed if one is observed with- out a facial covering. According to the sup- porting research, messages evoking emo- tions reduced the intention to cover one's face more than messages evoking reason- ing. [17]. while the use of fear in health communication campaigns is supported by some literature [18]. According to our find- ings, it may not be appropriate to promote COVID-19 prevention behaviors by using messages that incite fear or call for harsh punishment. Social norms are a well- documented prerequisite for both the in- tention to perform and subsequent partici- pation in a behavior [19,20]. The present study shows association between gender and motivational level to wearing face- masks. This result disagrees with the study conducted by Howard in 2021 regarding gender, face mask perceptions, and face mask wearing among 698 participants showed that gender did haven't relation- ship with face mask wearing [21]. Both men and women are known to engage in comparable amounts of passive health be- haviors, such as vaccination and pre- sentism, but men are less likely to wear face masks than women. according to nu- merous authors of popular press in terms of risky active health behaviors, men are known to use drugs, drink alcohol, and smoke more than women [22]. While there is a non-significant relationship between educational level and motivational level, this finding contradicts a previous cross- sectional study regarding knowledge, atti- tude, and practice of wearing a facemask in the population presenting to tertiary hospitals in a developing country, where a statistically significant relationship was noted between education levels and the practice of wearing a facemask (P = 0.01) [23]. Many previous studies have clearly proven this concept [24,25]. According to the findings, there is a non-statistically sig- nificant relationship between marital sta- tus and motivation to wear face masks. This finding concurs with the findings of the study about Factors Associated with Protective Mask-Wearing Behavior to Avoid COVID-19, whereas the marital sta- tus of family members did not show a sig- nificant relationship with the wearing of the facemask [26]. Understanding the motivations behind us- ing ace masks by administrative staff members is essential for influencing health behavior and informing health communi- cation. The participant in the study was very motivated to don a facemask. In our study sample, the desire to protect the weak and the feeling of responsibility to wear a face mask and provide protection for both oneself and others.At the level of Hawler Medical University, massive educa- tion campaigns must be launched to spread the word about the advantages of wearing a facemask to prevent the trans- mission of viruses. COVID-19. The author reports no conflict of interest. CONCLUSIONS CONFLICT OF INTEREST https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.08 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article 72 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. difference of susceptibility by age. Scien tific reports. 2020 Oct 6;10(1):16642. [11] Ho, H. S. W. (2012). Use of face masks in a primary care outpatient setting in Hong Kong: knowledge, attitudes and practic- es. Public health, 126(12), 1001-1006. [12] Vereen RN, Lazard AJ, Frank SC, Pulido M, Richter AP, Higgins IC, Shelus VS, Vandegrift SM, Hall MG, Ribisl KM. Motiva- tions, barriers, and communication recom- mendations for promoting face coverings during the COVID-19 pandemic: Survey findings from a diverse sample. PLoS One. 2021 May 7;16(5):e0251169. [13] Shelus VS, Frank SC, Lazard AJ, Higgins IC, Pulido M, Richter AP, Vandegrift SM, Ve- reen RN, Ribisl KM, Hall MG. Motivations and barriers for the use of face coverings during the COVID-19 pandemic: messaging insights from focus groups. International journal of environmental research and public health. 2020 Dec;17(24):9298. [14] Kappes A, Nussberger AM, Faber NS, Ka- hane G, Savulescu J, Crockett MJ. Uncer- tainty about the impact of social decisions increases prosocial behaviour. Nature hu- man behaviour. 2018 Aug;2(8):573-80.. [15] Capraro V, Barcelo H. The effect of messag- ing and gender on intentions to wear a face covering to slow down COVID-19 transmis- sion. arXiv preprint arXiv:2005.05467. 2020 May 11. [16] Fisher KA, Barile JP, Guerin RJ, Esschert KL, Jeffers A, Tian LH, Garcia-Williams A, Gurbaxani B, Thompson WW, Prue CE. Fac- tors associated with cloth face covering use among adults during the COVID-19 pan- demic—United States, April and May 2020.. [17] Capraro V, Barcelo H. Telling people to "rely on their reasoning" increases inten- tions to wear a face covering to slow down COVID‐19 transmission. Applied Cognitive Psychology. 2021 May;35(3):693-9. [18] Simpson, J.K., 2017. Appeal to fear in health care: appropriate or inappropri- ate?. Chiropractic & Manual Therapies, 25 (1), pp.1-10. [19] McEachan R, Taylor N, Harrison R, Lawton R, Gardner P, Conner M. Meta-analysis of the reasoned action approach (RAA) to understanding health behaviors. Annals of Behavioral Medicine. 2016 Aug 1;50(4):592 -612. [1] Sohrabi C, Alsafi Z, O'neill N, Khan M, Kerwan A, Al-Jabir A, Iosifidis C, Agha R. World Health Organization declares global emer- gency: A review of the 2019 novel corona- virus (COVID-19). International journal of surgery. 2020 Apr 1;76:71-6. [2] Feng S, Shen C, Xia N, Song W, Fan M, Cowl- ing BJ. Rational use of face masks in the COVID-19 pandemic. The Lancet Respiratory Medicine. 2020 May 1;8(5):434-6. [3] WHO Statement Regarding Cluster of Pneu- monia Cases in Wuhan, China. Access date: [April 27 2020]. Available at: https:// www.who.int/china/news/detail/09-01- 2020. [4] Mersha A, Shibiru S, Girma M, Ayele G, Ban- te A, Kassa M, Abebe S, Shewangizaw M. Perceived barriers to the practice of preven- tive measures for COVID-19 pandemic among health professionals in public health facilities of the Gamo zone, southern Ethio- pia: a phenomenological study. BMC Public Health. 2021 Dec;21:1-0. [5] Munster VJ, Koopmans M, Van Doremalen N, Van Riel D, de Wit E. A novel coronavirus emerging in China—key questions for impact assessment. New England Journal of Medi- cine. 2020 Feb 20;382(8):692-4. [6] Al Naam YA, Elsafi SH, Alkharraz ZS, Alfahad OA, Al-Jubran KM, Al Zahrani EM. Communi- ty practice of using face masks for the pre- vention of COVID-19 in Saudi Arabia. PLoS One. 2021 Feb 19;16(2):e0247313. [7] Mahase E. Covid-19: WHO declares pandem- ic because of "alarming levels" of spread, severity, and inaction. Bmj. 2020 Mar 12;368 (March):m1036. https://doi.org/10.1136/ bmj.m1036. [8] Asri A, Asri V, Renerte B, Föllmi-Heusi F, Leuppi JD, Muser J, Nüesch R, Schuler D, Fischbacher U. Wearing a mask—For your- self or for others? Behavioral correlates of mask wearing among COVID-19 frontline workers. Plos one. 2021 Jul 19;16 (7):e0253621. [9] Betsch C, Wieler LH, Habersaat K. Monitoring behavioural insights related to COVID-19. The Lancet. 2020 Apr 18;395(10232):1255-6. https://doi.org/10.1016/S0140-6736(20) 30729-7 . [10] Omori R, Matsuyama R, Nakata Y. The age distribution of mortality from novel corona- virus disease (COVID-19) suggests no large REFERENCES https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.08 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article 73 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. [20] Sheeran P, Maki A, Montanaro E, Avishai- Yitshak A, Bryan A, Klein WM, Miles E, Roth- man AJ. The impact of changing attitudes, norms, and self-efficacy on health-related intentions and behavior: A meta-analysis. Health psychology. 2016 Nov;35(11):1178. https://doi.org/10.1037/hea0000387. [21] Howard MC. Gender, face mask perceptions, and face mask wearing: Are men being dan- gerous during the COVID-19 pandemic?. Personality and individual differences. 2021 February 15;170:110417. [22] Haischer MH, Beilfuss R, Hart MR, Opielinski L, Wrucke D, Zirgaitis G, Uhrich TD, Hunter SK. Who is wearing a mask? Gender-, age-, and location-related differences during the COVID-19 pandemic. PloS one. 2020 Oct 15;15(10):e0240785. [23] Furnaz S, Baig N, Ali S, Rizwan S, Khawaja UA, Usman MA, Haque MT, Rizwan A, Ali F, Karim M. Knowledge, attitude and practice of wearing mask in the population pre- senting to tertiary hospitals in a developing country. Plos one. 2022 Mar 10;17 (3):e0265328. [24] Hayat K, Rosenthal M, Xu S, Arshed M, Li P, Zhai P, Desalegn GK, Fang Y. View of Paki- stani residents toward coronavirus disease (COVID-19) during a rapid outbreak: a rapid online survey. International journal of envi- ronmental research and public health. 2020 May;17(10):3347. [25] Iqbal MA, Younas MZ. Public knowledge, attitudes, and practices towards COVID-19 in Pakistan: A cross-sectional study. Children and Youth Services Review. 2021 Jan 1;120:105784. [26] Xu Y, Wu Q, Xu S, Zhao Y, Zhang X. Factors Associated With Protective Mask-Wearing Behavior to Avoid COVID-19 Infection in Chi- na: Internet-Based Cross-sectional Study. Journal of Medical Internet Research, Public Health and Surveillance. 2022 May 26;8 (5):e32278. https://creativecommons.org/licenses/by-nc-sa/4.0/