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Are evidence-based public health campaigns, aiming to contain the coronavirus disease 2019 pandemic and using digital news media and social media, associated with improvements in personal hygiene?
In this survey study of hygiene awareness and behavior in the context of the coronavirus disease 2019 pandemic, exposure to a targeted campaign video and news article was associated with an approximately 2-fold increase in the odds of washing of all required hand areas and longer duration of handwashing.
These findings suggest that evidence-based campaigns using existing digital news and social media platforms may be an effective means to help combat critical health issues, such as the coronavirus disease 2019 pandemic.
In the absence of a vaccine and therapeutic agent, personal hygiene and physical distancing are essential measures to contain the coronavirus disease 2019 pandemic.
To determine whether a social media campaign, targeted at the gaps in behavior on personal hygiene and physical distancing and distributed nationwide via digital news media, may be an effective method to improve behavior and help to inhibit person-to-person transmission of severe acute respiratory syndrome coronavirus 2.
Design, Setting, and Participants
This survey study was designed to uncover self-reported gaps in behavior regarding personal hygiene and physical distancing in the Netherlands. A diagnostic survey was distributed by a large national newspaper (De Telegraaf) and a popular social influencer (Govert Sweep) on March 17, 2020, and was completed by 16 072 participants. Analysis of these outcomes showed that coughing and sneezing in the elbow was done well, but that handwashing, face touching, and physical distancing showed serious gaps compared with advised behavior. This diagnostic information was used to design infographics and a video targeted at repairing these gaps in behavior. The video and infographics were distributed on a national level on March 21, 2020, followed by a postcampaign survey to measure the results on March 24, 2020. Data analysis was performed from March to April 2020.
Exposed participants were those who viewed the infographics and/or video.
Main Outcomes and Measures
Improvement on the extent of handwashing in all areas, handwashing duration of 20 seconds or longer, awareness on face touching, and physical distancing were measured according to responses on the postcampaign survey.
A total of 17 189 participants (mean [SD] age, 47.61 [13.57] years; 9100 women [52.9%]) responded to the postcampaign survey. The news article in De Telegraaf was read more than 2 million times, and the influencer video was watched more than 80 000 times. Cross-sectional analysis of the postcampaign survey using logistic regression correcting for age, gender, and educational level showed that exposure to the video plus infographics (827 participants) (adjusted odds ratio [OR], 2.14; 95% CI, 1.83-2.50; P < .001) and to the infographics alone (11 348 participants) (adjusted OR, 1.31; 95% CI, 1.22-1.40; P < .001) were positively associated with washing hands in all areas compared with the unexposed group (4751 participants). In addition, exposure to the video plus infographics (adjusted OR, 1.86; 95% CI, 1.59-2.16; P < .001) and to the infographics alone (adjusted OR, 1.27; 95% CI, 1.19-1.36; P < .001) were positively associated with washing hands long enough compared with the unexposed group. Exposure to the video alone was not associated with improved handwashing. Compared with the unexposed group, exposure to the infographics alone and video plus infographics were associated with improvements in physical distancing when the participant had COVID-19 syptoms (infographics alone, adjusted OR, 1.10; 95% CI, 1.03-1.17; P = .006; video plus infographics, adjusted OR, 0.79; 95% CI, 0.69-0.91; P = .001) and face touching (infographics alone, adjusted OR, 1.29; 95% CI, 1.22-1.38; P < .001; infographics and video, adjusted OR, 1.49, 95% CI, 1.30-1.71; P < .001).
Conclusions and Relevance
These findings suggest that a targeted behavioral change campaign, promoted by a news platform and social media, was associated with self-reported improvement in personal hygiene with the aim to prevent person-to-person transmission of severe acute respiratory syndrome coronavirus 2. This method of evidence-based campaigning may be an effective way to improve critical public health issues, such as the coronavirus disease 2019 pandemic.
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Accepted for Publication: June 4, 2020.
Published: July 8, 2020. doi:10.1001/jamanetworkopen.2020.14323
Open Access: This is an open access article distributed under the terms of the CC-BY-NC-ND License. © 2020 Yousuf H et al. JAMA Network Open.
Corresponding Authors: Leonard Hofstra, MD, PhD, Department of Cardiology, Amsterdam University Medical Center, VUMC De Boelelaan 1117, 1118, 1081 HV, Room ZH 5 F 013, Amsterdam, the Netherlands (firstname.lastname@example.org); Jan-Willem Lindemans, PhD, Center for Advanced Hindsight, Duke University, 334 Blackwell St, Ste 320, Durham, NC 27701 (email@example.com).
Author Contributions: Dr L. Hofstra had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Yousuf, Corbin, Sweep, van Gorp, Zhao, van Rossum, Jiang, Lindemans, Narula, L. Hofstra.
Acquisition, analysis, or interpretation of data: Yousuf, M. Hofstra, Scherder, van Gorp, Zwetsloot, Lindemans, L. Hofstra.
Drafting of the manuscript: Yousuf, M. Hofstra, Narula, L. Hofstra.
Critical revision of the manuscript for important intellectual content: Yousuf, Corbin, Sweep, M. Hofstra, Scherder, van Gorp, Zwetsloot, Zhao, van Rossum, Jiang, Lindemans, L. Hofstra.
Statistical analysis: Yousuf, M. Hofstra, Zwetsloot, L. Hofstra.
Obtained funding: Yousuf, van Rossum, Lindemans, L. Hofstra.
Administrative, technical, or material support: Yousuf, Sweep, Scherder, Zhao, van Rossum, Lindemans, L. Hofstra.
Supervision: Yousuf, Corbin, van Gorp, Jiang, Lindemans, L. Hofstra.
Conflict of Interest Disclosures: Dr Lindemans reported receiving grants from Centene Corporation during the conduct of the study. No other disclosures were reported.
Funding/Support: This study was supported by grants from the Fred Foundation, Noaber Foundation, and HAPPY Foundation.
Role of the Funder/Sponsor: The Fred Foundation, the Noaber Foundation, and HAPPY Foundation approved the design and conduct of the study; the funders had no involvement in the collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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