What are the main motivating factors for wearing a face mask?

It’s social pressure, rather than the fear of getting sick or the severity of COVID-19, that seems to make the difference.

That’s according to a national study recently published in the Annals of Behavioral Medicine. Jack Barile, interim director of the Social Science Research Institute at the University of Hawaii at Manoa’s College of Social Sciences, was lead author of the study examining the motivators behind an individual’s choice to wear or not wear a face covering in public.

The study found the motivation for wearing a mask is a combination of whether others around you are wearing one and whether others think you should be wearing one.

More than 1,000 adults across the nation, including Hawaii, representative of the U.S. population by gender, age, region, ethnicity and education were surveyed online in May and June for the study.

Barile, who works with the Centers for Disease Control and Prevention in Atlanta, said most of the study’s findings did not surprise him.

“The strong role of social norms we thought would be present, particularly because it’s such a novel behavior to people,” said Barile. “Typically, things like severity and susceptibility and those sort of predictors can come into play, but oftentimes not to the extent people expect that they do.”

In fact, no evidence was found that a perceived susceptibility to becoming ill and a perceived severity of COVID-19 correlated with an increase in the intent to use a face covering in public. There was no noticeable association, either, between knowing someone who had been hospitalized due to COVID-19 and mask-wearing.

While mask mandates can help, a more effective messaging strategy might be to make wearing a face mask not only socially acceptable, but commonplace — and cool.

“Because face coverings is such a new behavior to people, they look around and see what other people are doing,” he said. “If they don’t feel like it’s a socially acceptable behavior, they won’t do it.”

The study found that the “perceived importance of others wanting the respondent to wear a face covering” was an important motivator for mask-wearing, as well as confidence in wearing one.

It also found that women were more likely to wear a face covering than men, which follows general trends of the former being less likely to take risks in general.

Although COVID-19 vaccines are being distributed in the U.S., health officials predict it will be months before the vaccine is readily available to all individuals who seek it.

Understanding the motivators behind an individual’s choice to wear a face mask is critical to developing successful messaging strategies, Barile said, and to encourage acceptance and use of face coverings to prevent the transmission of SARS-CoV-2, the virus that causes COVID-19.

The CDC also recommends that people age 2 and up continue wearing a mask that covers their nose and mouth when in contact with others outside their household, even if one has received the vaccine.

In Hawaii, COVID infection rates have been on the rise since Christmas. The Aloha State’s compliance with mask-wearing, however, has been above average, at 89% statewide as of Dec. 27, according to the state Health Department’s COVID-19 dashboard. This is up from mid-November, when 85% of people in Hawaii were wearing a mask correctly.

In the most populated county of Honolulu, 90% are wearing a face mask correctly, 7% wearing masks incorrectly and 3% not wearing a mask.

The state has launched several public service announcements, including “I Wear a Mask.”

Barile said it is important for leadership to set examples by wearing masks in public and as part of public campaigns.

Local celebrities — particularly ones people can relate to — can also be effective in spreading a message, along with tips and reminders. The celebrities should be relatable to the target demographic.

In New York, Gov. Andrew Cuomo recruited Marvel star Paul Rudd to deliver a public serv­ice announcement urging millennials to wear face coverings as part of a nationwide “Mask Up America” campaign. Although Rudd is not actually a millennial, his humorous PSA was viewed by millions.

In Hawaii, one effective message might be that 90% of people are wearing a face mask in public and that you would not want to be part of the 10% that does not, Barile said.

“You want people to believe they’re on the outside if they’re not wearing one and that most people are doing it and so should you,” he said.