Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
J Eval Clin Pract. 2024 Jun;30(4):585-621. doi: 10.1111/jep.13982. Epub 2024 Mar 27.
Masks have been widely used as a preventative tool during the COVID-19 pandemic. However, the use of masks by children has been controversial, with international guidelines recommending a risk-based approach to national policymakers.
We aimed to conduct a systematic review that explores children's experiences of mask-wearing, drawing on an evidence base that describes mask-wearing in different contexts including air pollution, and to prevent the spread of infectious disease.
We searched MEDLINE, Embase and PsycINFO in June 2021, with repeat searches in August 2022 and January 2024, for primary research studies exploring children's experiences of masks. Included studies reported on participants between 4 and 14 years (inclusive), with no restrictions on language where an English translation was available. Two reviewers independently screened titles and abstracts and reviewed full texts, with discrepancies resolved by a third reviewer. We used the Mixed Methods Appraisal Tool for quality appraisal and narrative synthesis to identify key findings. We also conducted stakeholder consultation (Patient and Public Involvement (PPI)) with nine children, where they submitted annotated drawings of their preferred masks to complement our review findings.
We screened 982 titles and abstracts and reviewed 94 full texts. 45 studies were included in the synthesis. Children's experiences of mask-wearing were influenced by their perceived necessity, social norms around their use and parental attitudes. Challenges related to mask-wearing were described, including difficulty reading facial expressions and physical discomfort. Children found it easier to wear masks when sitting and in cooler environments, and they benefited from unmasking during outdoor break time at school. As part of the PPI consultation, children highlighted the importance of mask design and the environmental impact of masks.
Children's experiences of mask-wearing were varied and context-dependent, with several mask-design challenges raised. Future policy on mask-wearing needs to consider the context in which mask-wearing would be most beneficial, and how local adaptations to policy can respond to children's needs.
在 COVID-19 大流行期间，口罩已被广泛用作预防工具。然而，儿童使用口罩一直存在争议，国际指南建议国家政策制定者采取基于风险的方法。
我们旨在进行一项系统评价，探讨儿童戴口罩的经验，借鉴描述在不同背景下戴口罩的证据基础，包括空气污染和预防传染病传播。
我们于 2021 年 6 月在 MEDLINE、Embase 和 PsycINFO 中进行了搜索，并于 2022 年 8 月和 2024 年 1 月进行了重复搜索，以寻找探索儿童戴口罩经验的原始研究。纳入的研究报告了 4 至 14 岁（含）之间的参与者，在有英文翻译的情况下，对语言没有限制。两名评审员独立筛选标题和摘要，并审查全文，有分歧的地方由第三名评审员解决。我们使用混合方法评估工具进行质量评估和叙述性综合，以确定关键发现。我们还与 9 名儿童进行了利益相关者磋商（患者和公众参与（PPI）），他们提交了他们喜欢的口罩的注释性图纸，以补充我们的审查结果。
我们筛选了 982 个标题和摘要，并审查了 94 篇全文。45 项研究纳入综合分析。儿童戴口罩的经验受到他们对口罩必要性的看法、社会对口罩使用的规范和父母态度的影响。描述了与戴口罩相关的挑战，包括阅读面部表情困难和身体不适。儿童发现坐着和在较凉爽的环境中戴口罩更容易，在学校户外休息时间摘口罩对他们有好处。作为 PPI 磋商的一部分，儿童强调了口罩设计的重要性和口罩的环境影响。
儿童戴口罩的经验因情况而异，存在一些口罩设计挑战。未来的口罩佩戴政策需要考虑到最能受益于口罩佩戴的环境，以及如何对政策进行本地调整以满足儿童的需求。
