Institute for Global Health, University College London, London, UK
Institute for Global Health, University College London, London, UK.
BMJ Glob Health. 2021 Jan;6(1). doi: 10.1136/bmjgh-2020-004068.
Many countries aiming to suppress SARS-CoV-2 recommend the use of face masks by the general public. The social meanings attached to masks may influence their use, but remain underinvestigated.
We systematically searched eight databases for studies containing qualitative data on public mask use during past epidemics, and used meta-ethnography to explore their social meanings. We compared key concepts within and across studies, then jointly wrote a critical synthesis.
We found nine studies from China (n=5), Japan (n=1), Mexico (n=1), South Africa (n=1) and the USA (n=1). All studies describing routine mask use during epidemics were from East Asia. Participants identified masks as symbols of solidarity, civic responsibility and an allegiance to science. This effect was amplified by heightened risk perception (eg, during SARS in 2003), and by seeing masks on political leaders and in outdoor public spaces. Masks also acted as containment devices to manage threats to identity at personal and collective levels. In China and Japan, public and corporate campaigns framed routine mask use as individual responsibility for disease prevention in return for state- or corporate-sponsored healthcare access. In most studies, mask use waned as risk perception fell. In contexts where masks were mostly worn by patients with specific diseases (eg, for patients with tuberculosis in South Africa), or when trust in government was low (eg, during H1N1 in Mexico), participants described masks as stigmatising, uncomfortable or oppressive.
Face masks can take on positive social meanings linked to solidarity and altruism during epidemics. Unfortunately, these positive meanings can fail to take hold when risk perception falls, rules are seen as complex or unfair, and trust in government is low. At such times, ensuring continued use is likely to require additional efforts to promote locally appropriate positive social meanings, simplifying rules for use and ensuring fair enforcement.
许多旨在抑制 SARS-CoV-2 的国家建议公众使用口罩。口罩所具有的社会意义可能会影响其使用，但这方面的研究仍不够充分。
我们系统地在八个数据库中搜索了包含过去流行期间公众口罩使用的定性数据的研究，并使用元民族志方法来探索其社会意义。我们比较了研究内和研究间的关键概念，然后共同撰写了批判性综合报告。
我们从中国（n=5）、日本（n=1）、墨西哥（n=1）、南非（n=1）和美国（n=1）的九项研究中发现。所有描述流行期间常规使用口罩的研究均来自东亚。参与者将口罩视为团结、公民责任和对科学的忠诚的象征。这种效果因风险感知的提高而放大（例如，在 2003 年 SARS 期间），并因在政治领导人身上和在户外公共场所看到口罩而放大。口罩还充当了控制装置，以管理个人和集体层面的身份威胁。在中国和日本，公共和企业宣传将常规口罩使用作为个人预防疾病的责任，以换取国家或企业赞助的医疗保健机会。在大多数研究中，随着风险感知的下降，口罩的使用减少。在口罩主要由特定疾病患者佩戴的情况下（例如，南非结核病患者），或在对政府信任度低的情况下（例如，墨西哥 H1N1 期间），参与者将口罩描述为具有污名化、不舒适或压迫性。
在流行期间，口罩可以具有与团结和利他主义相关的积极社会意义。不幸的是，当风险感知下降、规则被认为复杂或不公平以及对政府的信任度降低时，这些积极意义可能无法得到落实。在这种情况下，确保口罩的持续使用可能需要做出额外的努力，以促进具有当地适应性的积极社会意义，简化使用规则并确保公平执行。
