Why are people not wearing COVID 19 masks

By James Achanyi Fontem, camlinknews

How the Covid-19 pandemic unfolds in the coming months in Cameroon is our focus in this article. It has been noted that the behaviour of Cameroonians and not medicines or ventilators, that will determine the severity of its impact. This is the repeated message from public health experts, Cameroon’s Minister of public health and the Prime Minister, Chief Professor John Ngute. Cameroon as a country and particularly the Ministry of Public Health, have done the important work of disseminating accurate information in the early stages of the pandemic. However, people are now at a point where they need a more complex approach if any hope of achieving the deeper and more sustained behaviour changes are required. Cameroonians know what they need to do. Wear a mask in public, wash hands frequently and keep their distance. Getting people to adopt these behaviours seems as if it should be simple. Cameroon Link thinks that spending millions on catchy slogans and beautiful billboards, pamphlets, and public service announcements will work. If this is done frequently enough people will change their behaviour. But Unfortunately, the evidence shows that this is not the case. If it did, many would smoke, abuse alcohol or contract HIV/Aids. Changing behaviours Fortunately, there is a wealth of evidence gleaned from both local and international experience for what constitutes best practice in behaviour change campaigns. There are two major learnings from these experiences. First, Cameroon Link cannot assume to know why people do or do not act in a certain way. It is necessary to find out through a research process that asks them. For example, Cameroon Link is developing a campaign called Fathers’ Issues to promote the active positive presence of men in the lives of children, something that research has proven to have a significant impact on children's wellbeing. There is a common assumption that many men aren't involved in their children's lives simply because they are dead dads who are uncaring and unconcerned. Cameroon Link investigators painted a different picture which shows that many men were not involved because there is a pervasive attitude out there that if the government can't provide financially, they are not seen as proper fathers. This has affected substantially the messages that underpin ministry of public health campaigns. By rooting our messaging in what we have learnt, and are addressing the real barriers to change, we ensure a greater probability of positive behaviour change. Cameroon Link founded in 1991, became globally acknowledged for changing the health behaviour of thousands of Cameroonian mothers through exclusive breastfeeding campaigns and radio dramas as well as print and other resources and interventions. One Cameroon Link intervention was developed to promote breastfeeding, as it has been shown to be a key intervention in the promotion of child health. In the development of this series, research showed that women knew this was best for their baby. However, there were several obstacles at community and social level that prevented them from doing so. The young mother newly arrived in an urban area often had no one to support her as they reported that breastfeeding is not easy and as such gave up. The working mother had to give up breastfeeding when she went back to work because there was nowhere for her to express or store her milk. So instead of Cameroon Link trying to persuade women that breastfeeding was the right thing to do, it focused on overcoming these barriers. Cameroon Link encouraged older mothers to support younger ones in their communities, and employers to support mothers on their return to work.

It is important to note, that human behaviour is seldom linear, where message plus person equals behaviour. Humans are complex and thus theories that help us to understand these complexities can give actors a framework to direct their research into why we do or do not behave in a certain way. The findings then become the basis for messaging and interventions. Individuals are not islands There is a range of such theories - one that is particularly useful is the socio-ecological model which illustrates the interplay between the different factors that encourage or impede our behaviour. The socio-ecological model The basis for this theory is the understanding that as individuals we are not islands. Rather, we are social beings who are deeply influenced by the beliefs and actions of the people who make up our relationships and the broader community. What we do, we perceive as being "normal" behaviour. For example, if your friends and community believe it is 'normal' to beat a woman to discipline her, you will grow up believing the same thing. But not all these relationships have an equal influence on us. There are some people who can have an outside influence on our behaviour, such as a reverend priest, bishop, pastor, a cool kid or even a gang leader. So, we may know that it is the right thing to wear a mask, but if it does not seem like the "normal" or "cool" thing to do, then we will be unlikely to do it. Some people like to be "abnormal" or "uncool". But there is another layer of influence that is particularly important to consider. Our behaviour is not just influenced by the people around us - we are often more influenced by those that make up our 'virtual' community. These are the people we have never met who flicker across our screens and whose voices we hear on radio, such as sports personalities and political and religious leaders. Included in this group would be so-called social media influencers such as actresses and sports’ team captains. These people have a massive influence on the norms and values of our societies. Did the United States of America, President Donald Trump not wearing a mask send an extraordinarily strong message to Americans that masks are not normal or necessary? This message was received around the world, though it was a negative message. Even fictional characters can influence us. In the TV series we watch. How we behave is also influenced by societal factors like laws, infrastructure, economics, availability of supplies and so on, that either enable or act as an obstacle to the adoption of a behaviour. For instance, we may want to wash our hands often, but if we have no running water in my community or we can't afford sanitiser, then we can't do it. Not having running water is like promoting immunization against measles, but having no measles vaccine in the local clinic is also a problem. Therefore, as we seek for instances to promote the wearing of masks, we should aim to find out why people are not wearing them. At an individual level, is it because of lack of knowledge? At a relational and community level, is it because people we look up to are not wearing them and they don't want to be "abnormal" or "uncool", or are there myths that make people scared to wear them? At a societal level, could it be that they cannot afford them? We would also seek to find out who their influencers are so that in programming we could seek to use them.

We need to know this to design campaigns that have any hope of success. It is not one size fits all. We also need to understand that enablers and barriers may vary. The reasons people in rural parts of Cameroon are not wearing masks may be quite different from urban Yaounde or Douala. The only factor that will determine the future of this epidemic's impact on our lives and livelihoods will not be more intensive care unit beds, nurses, and doctors, but our behaviours. In the early stages of the epidemic, we did not need to consult with people; we simply needed to quickly get information to them and this seems to have been well done. But now, despite this information, many of us are not wearing masks and adopting the other preventive behaviours we need. The result is that infections are skyrocketing. We need to urgently set up an ongoing research process that is underpinned by theory, that gives us insight into why we behave the way we do. This can be done quickly. This information should be the source of all of our messaging and programming. This does not need to delay our efforts, but merely strengthen them.