Health Behavior Change During COVID-19 Pandemic

Health Behavior Change During COVID-19 Pandemic: the Focus on Handwashing

This study aims at investigating handwashing behavior during COVID-19 pandemic. It was hypothesized that social-cognitive and emotional predictors as well as COVID-19 morbidity and mortality rates within the country would be associated with handwashing behavior in the general population of adults in 14 countries.

Study Overview

• Status: Completed
• Conditions: Health Behavior
• Intervention / Treatment: Other: No intervention

Detailed Description

This observational study aims at testing the adherence to handwashing guidelines (the World Health Organization, WHO, 2020) at two measurement points, spanning 1 month. Adults from the general population in 14 countries (Poland, Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Portugal, Romania, Singapore, Switzerland) will provide self-report data on handwashing behavior and its social-cognitive predictors (perceived effectiveness of handwashing, risk perception, outcome expectancy, self-efficacy, intention, planning, and action control), anxiety, as well as COVID-19 morbidity and mortality rates within the country.

• Study Type: Observational
• Enrollment (Actual): 6079

Contacts and Locations

Study Locations

• Australia
  • Melbourne, Australia
    • The University of Melbourne
• Canada
  • Fredericton, Canada
    • University of New Brunswick
• China
  • Beijing, China
    • Peking University
• France
  • Bordeaux, France
    • University of Bordeaux
• Gambia
  • Fajara, Gambia
    • London School of Hygiene and Tropical Medicine (in collaboration with MRC Unit The Gambia at LSHTM)
• Germany
  • Berlin, Germany
    • Freie Universität Berlin
• Israel
  • Ramat Gan, Israel
    • Bar-Ilan University
• Italy
  • Padova, Italy
    • University of Padova
• Malaysia
  • Serdang, Malaysia
    • Perdana University
• Poland
  • Lower Silezia
    • Wroclaw, Lower Silezia, Poland, 53-328
      • SWPS University of Social Sciences and Humanities
• Portugal
  • Lisbon, Portugal
    • University of Lisbon
• Romania
  • Cluj-Napoca, Romania
    • Babes-Bolyai Unversity
• Singapore
  • Singapore, Singapore
    • Nanyang Technological University
• Switzerland
  • Zürich, Switzerland
    • University of Zurich

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Adults in 14 countries are recruited using the snowballing method. Data are collected using an online platform (software: Qualtricts).

Description

Inclusion Criteria:

• adults (from general population) who provided informed consent to participate

Exclusion Criteria:

• younger than <18 years old

Study Plan

How is the study designed?

Number of groups / cohorts

14

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Poland; Adults, general population, N = 400	Other: No intervention; Observational data collection only, accounting for COVID-19 morbidity and mortality levels within each country
Australia; Adults, general population, N = 400	Other: No intervention; Observational data collection only, accounting for COVID-19 morbidity and mortality levels within each country
Canada; Adults, general population, N = 400	Other: No intervention; Observational data collection only, accounting for COVID-19 morbidity and mortality levels within each country
China; Adults, general population, N = 400	Other: No intervention; Observational data collection only, accounting for COVID-19 morbidity and mortality levels within each country
France; Adults, general population, N = 400	Other: No intervention; Observational data collection only, accounting for COVID-19 morbidity and mortality levels within each country
Gambia; Adults, general population, N = 400	Other: No intervention; Observational data collection only, accounting for COVID-19 morbidity and mortality levels within each country
Germany; Adults, general population, N = 400	Other: No intervention; Observational data collection only, accounting for COVID-19 morbidity and mortality levels within each country
Israel; Adults, general population, N = 400	Other: No intervention; Observational data collection only, accounting for COVID-19 morbidity and mortality levels within each country
Italy; Adults, general population, N = 400	Other: No intervention; Observational data collection only, accounting for COVID-19 morbidity and mortality levels within each country
Malaysia; Adults, general population, N = 400	Other: No intervention; Observational data collection only, accounting for COVID-19 morbidity and mortality levels within each country
Portugal; Adults, general population, N = 400	Other: No intervention; Observational data collection only, accounting for COVID-19 morbidity and mortality levels within each country
Romania; Adults, general population, N = 400	Other: No intervention; Observational data collection only, accounting for COVID-19 morbidity and mortality levels within each country
Singapore; Adults, general population, N = 400	Other: No intervention; Observational data collection only, accounting for COVID-19 morbidity and mortality levels within each country
Switzerland; Adults, general population, N = 400	Other: No intervention; Observational data collection only, accounting for COVID-19 morbidity and mortality levels within each country

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Handwashing adherence	The 12-item self-report measure of adherence to handwashing guidelines across situations (e.g., after visiting public spaces, after touching garbage, etc.) based on the guidelines issued by the World Health Organization and the Centers for Disease Control and Prevention. The responses are provided on a 4-point scale, ranging from 1 (strongly disagree) to 4 (strongly agree). Higher scores indicate better outcomes (the higher level of adherence to handwashing guidelines).	1 month
Frequency of handwashing	The 1-item self-report measure of the frequency of handwashing (for at least 20 seconds, all surfaces of the hands) daily. The responses are provided on a 4-point scale, ranging from 1 (less than once) to 5 (more than 10 times). Higher scores indicate better outcomes (the higher frequency of handwashing).	1 month

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Self-efficacy	4 self-efficacy questionnaire items; mean item score ranging from 1 to 4, higher scores indicate stronger self-efficacy	1 month
Risk perception	3 questionnaire items to assess risk perception; mean item score ranging from 1 to 5, higher scores indicate higher risk perception	1 month
Outcome expectancy	4 items assessing positive (1 item) and negative (1 items) outcome expectancies; mean item scores ranging from 1 to 4, higher scores indicate more positive outcome expectancies	1 month
Intention	2 questionnaire items assessing intention to adhere to handwashing recommendations; mean item scores ranging from 1 to 4, higher scores indicate stronger intention to wash hands (for at least 20 seconds, all surfaces of the hands)	1 month
Planning	2 questionnaire items assessing action planning (1 item) and coping planning (1 item); mean item scores ranging from 1 to 4, higher scores indicate a higher level of self-reported planning	1 month
Action control	3 questionnaire items assessing a facet of action control, namely self-monitoring; mean item scores ranging from 1 to 4, higher scores indicate a higher level of self-reported monitoring of handwashing behavior	1 month
Perceived effectiveness of hand hygiene	1 questionnaire item assessing perceptions of handwashing as an effective means of preventing coronavirus SARS-CoV-2 infection; item scores ranging from 1 to 4, higher scores indicate a higher level of perceived effectiveness of hand hygiene	1 month
Anxiety	7-item self-report scale (Generalized Anxiety Disorder, GAD-7) scale to assess anxiety symptoms; mean item scores ranging from 1 to 4, higher scores indicate a higher level of generalized anxiety	1 month
Country-level COVID-19 morbidity and mortality rates	The daily cumulative numbers for COVID-19 morbidity and mortality in the study countries. Published daily as the Situation Report by World Health Organization, starting on 21 January 2020. Higher numbers indicate the higher cumulative COVID-19 morbidity and mortality rates in the country.	60 days

Collaborators and Investigators

• Sponsor: University of Social Sciences and Humanities, Warsaw
• Investigators: Principal Investigator: Aleksandra Luszczynska, PhD, SWPS University of Social Sciences and Humanities

Publications and helpful links

General Publications

• Schwarzer R, Lippke S, Luszczynska A. Mechanisms of health behavior change in persons with chronic illness or disability: the Health Action Process Approach (HAPA). Rehabil Psychol. 2011 Aug;56(3):161-70. doi: 10.1037/a0024509.
• World Health Organization. Coronavirus disease (COVID-19) advice for the public. 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
• Centers for Disease Control and Prevention. When and how to wash your hands. 2020. https://www.cdc.gov/handwashing/when-how-handwashing.html
• Reyes Fernandez B, Knoll N, Hamilton K, Schwarzer R. Social-cognitive antecedents of hand washing: Action control bridges the planning-behaviour gap. Psychol Health. 2016 Aug;31(8):993-1004. doi: 10.1080/08870446.2016.1174236. Epub 2016 Apr 26.
• Ruiter RAC, Abraham C, Kok G. Scary warnings and rational precautions: A review of the psychology of fear appeals. Psychol Health. 2011;11(1): 613-630. doi: 10.1080/08870440108405863
• Luszczynska A, Szczuka Z, Abraham C, Baban A, Brooks S, Cipolletta S, Danso E, Dombrowski SU, Gan Y, Gaspar T, de Matos MG, Griva K, Jongenelis MI, Keller J, Knoll N, Ma J, Miah MAA, Morgan K, Peraud W, Quintard B, Shah V, Schenkel K, Scholz U, Schwarzer R, Siwa M, Taut D, Tomaino SCM, Vilchinsky N, Wolf H. The Interplay Between Strictness of Policies and Individuals' Self-Regulatory Efforts: Associations with Handwashing During the COVID-19 Pandemic. Ann Behav Med. 2022 Apr 2;56(4):368-380. doi: 10.1093/abm/kaab102.
• Szczuka Z, Abraham C, Baban A, Brooks S, Cipolletta S, Danso E, Dombrowski SU, Gan Y, Gaspar T, de Matos MG, Griva K, Jongenelis M, Keller J, Knoll N, Ma J, Miah MAA, Morgan K, Peraud W, Quintard B, Shah V, Schenkel K, Scholz U, Schwarzer R, Siwa M, Szymanski K, Taut D, Tomaino SCM, Vilchinsky N, Wolf H, Luszczynska A. 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.

Study record dates

Study Major Dates

• Study Start (Actual): March 25, 2020
• Primary Completion (Actual): September 24, 2020
• Study Completion (Actual): September 24, 2020

Study Registration Dates

• First Submitted: April 28, 2020
• First Submitted That Met QC Criteria: April 28, 2020
• First Posted (Actual): April 29, 2020

Study Record Updates

• Last Update Posted (Actual): August 10, 2021
• Last Update Submitted That Met QC Criteria: August 8, 2021
• Last Verified: August 1, 2020

More Information

Terms related to this study

• Keywords: Anxiety; COVID-19; Adult; Handwashing; General population; Social cognition
• Additional Relevant MeSH Terms: Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Pneumonia, Viral; Pneumonia; Lung Diseases; COVID-19
• Other Study ID Numbers: 3228-1BPSYPSBEH-30

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

IPD Plan Description

The lead researchers in 14 countries will have full access to data collected across the countries.

In line with the Consortium Agreement (v2, 16th Jul 2020) data will be openly available under following conditions:

De-identified individual participant data that underline the results reported in publications; individual-level aggregated data (e.g., sum scores for scales) used for main analyses in respective publications; available following the publication, no end date of availability; available for analyses that are conducted to achieve aims in the approved proposal.

Due to local regulations, there are exceptions in terms of data sharing rules (stated above):

• AUSTRALIA: Data from Australia will be available for 5 years after collection.
• GERMANY, SWITZERLAND: Instead of individual-level sum scores, variance-covariance matrices will be shared.
• MALAYSIA: Data will not be shared.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No