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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of Ghana Health Service gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript