To Wear or Not to Wear, That Is the Question*

This variation on one of the most famous lines in English literature serves as a reminder of the dystopia present in the USA today. People have a choice about wearing a mask, and the choice they make has consequences for themselves and society. Most people who wear masks focus their energy on keeping themselves and their loved ones safe and protected from the coronavirus. Many wear masks and also wonder how to interact with friends, relatives and strangers who do not to wear them. Should they ignore and avoid them? Should they try to “persuade” them to follow the recommended health guidelines? It seems to us that somewhere in the middle of this spectrum exists the possibility of having a constructive conversation.

Psychological research has shown that many people choosing not to use protective masks and maintain physical distance do not respond favorably to the use of strong argumentative messages, financial or behavioral consequences, or shaming and other devaluing messages. These efforts to overpower a perceived resistance to wear masks are not only ineffective, but can backfire and have the opposite effects of contributing to stronger resistance, or what psychologists call “reactance” and “hardening of the person’s categories.”

The stakes are incredibly high, and stopping the spread of COVID-19 requires that we engage those choosing not to follow preventive measures. We need to understand their reasons for not adhering to these measures and to motivate them to see that wearing a mask and ensure physical distance are ways for all of us to get back to life as we knew it before this pandemic. A key question is, how can we accomplish this without entering into confrontational debates and being harshly dismissed? We believe that insights from research on motivational interviewing and public health can help us here. There is a need to understand people’s perception of risk and safety, both physical and psychological, and how these beliefs guide their behavior.

There is substantial literature about motivational interviewing to help individuals engage in health-promoting behaviors. Motivational Interviewing uses open-ended questions to help individuals express their thoughts about making decisions, especially when they are ambivalent and have mixed feelings. Such questioning helps individuals put into words their reasons “to wear or not to wear a mask.” Experts in this area highlight the need to:

• Express empathy.
• Avoid being argumentative.
• Help individuals articulate the discrepancy between the way things are and the way they would like them to be.
• Address ambivalence about the desired behavior.
• Support the individual’s self-efficacy and their ability to change.

How a conversation is initiated determines whether individuals will feel comfortable talking about an issue that is infused with so many negative emotions. Start by asking for permission to talk. Then ask follow-up, open-ended questions. The questions should be based on a curiosity about what the person sees as the best reasons to wear or not wear a mask. It is vitally important to understand the reasons offered for not wearing protective masks, keeping the physical distance and participating in preventive measures.

Understanding and respecting the reasons that individuals offer for their decisions, rather than trying to correct, argue with and challenge them, will open opportunities for engagement and connection to occur. Expressing empathy is critical to having individuals consider doing things differently. It is crucial to resist the temptation to forcefully persuade. Instead, one must listen with a goal of understanding.

You may start by saying something like this:

• “Is it OK if I ask you a question?”
• “I am curious to understand how people decide to wear or not wear a mask in public.”
• “How often do you decide whether or not to wear a mask?”

These questions can be followed up with the following type of questions:

• “What do you most look forward to doing once the pandemic is over?”
• “What do you miss most about your life during this pandemic?”
• “What do you think is the best way for people to deal with the decision about whether or not to wear a mask?”
• "What advice, if any, would you give others concerning using a mask?”

Reasons to Wear a Mask

As we see it, there are three main reasons for wearing a mask.

1. Wearing a mask decreases the risk of becoming infected with the COVID-19 (See video below). You would not want someone blowing cigarette smoke in your face. In the same way, you would not want someone to cough or sneeze in your face during the pandemic. They don’t want you to do that to them, either.
   • “I could be a carrier and not know it. I am not as invincible as I’d like to believe.”
   • “Can I put public health ahead of my impulse to have a good time?”
2. Wearing a mask decreases the likelihood that you can infect a loved one. Wearing a mask is considerate in helping protect others. Perhaps one can view wearing a mask and keeping social distancing as a kind of “patriotic act.” You want others to “watch your back” and not infect you. The least you can do is “protect their back.”
   • “Americans are smart, tough and patriotic. Look at all the things we have gone through in the past. We are all in this together. A person can be a team player.”
3. Wearing a mask will help us get back to the intimate lifestyle and activities that we all so desperately desire.
   • “Wearing a mask and keeping social distancing are annoying, inconvenient and difficult, but they are the only ways of getting our lives back to normal.”
   • “I don’t want to be the one who is responsible for sending everyone home from school.”

Reasons Not to Wear a Mask

Reasons for choosing not to wear a mask and follow other recommended COVID-19 public health guidelines also fall into three categories. You should anticipate these reasons with a curious mindset and be ready to inquire about the perceived risk to themselves and to those whom they interact with.

1. Some people choosing not to wear a mask question the science behind public health recommendations.
   • “I am not at risk for getting the coronavirus.”
   • “I maintain my distance from others. I don’t need to wear a mask.”
   • “If I get COVID-19, at my age I would recover quickly.”
   • ”If wearing a mask is necessary, then politicians like the president and governors would wear a mask all the time and they would mandate wearing a mask, which they don’t.”
   • “It boils down to my doubting all those scientists. One day they say one thing and another day they take it back or say the opposite.”
   • “I heard that wearing a mask could actually cause you to get the virus.”
   • “I have been around folks who had the virus and I didn’t get it. I must be protected in some way.”
   • “I have gone to the grocery store multiple times and nothing happened. It must be safe now.”
2. People may choose not to wear a mask because of perceived barriers to do so.
   • “I can’t stand wearing a mask. They are very uncomfortable.”
   • “I feel claustrophobic when I wear a mask. I feel like I can’t breathe and that I might have a panic attack.”
   • “My glasses steam up. I can’t see and get anything done. It’s just not practical for me.”
   • “I don’t have a good mask. The one I own does little good.”
   • “I forget to carry a mask with me all the time.”
   • “I have a hard time understanding people when they talk.”
3. Others may have personal preferences and beliefs for choosing not to wear a mask.
   • “It is my prerogative. I know what is best for me.”
   • “I don’t like anyone telling me how to live my life or bossing me around.”
   • “Life is filled with risks. I am not afraid. The good Lord takes care of me.”
   • “You cannot let fear dictate your life.”
   • “I have a constitutional right not to wear a mask if I don’t want to.”
   • “There is no COVID. It is a fake pandemic created to destroy the United States of America.”
   • “If I die, I die. We got to get this country moving. What are we going to do, wear a mask and stay inside for another year?”
   • “We’re all going to die anyway, so I’d rather choose my own poison.”
   • “If I wear a mask with my friends who don’t wear masks, it will make them feel uncomfortable and they won’t want to hang out with me.”
   • “If I wear a mask in the presence of my family and co-workers, they will think of me just as a follower.”
   • “I know what is best for me. I am a very stubborn person.”
   • “Wearing a mask is unmanly and not cool."

Adopting Health-Promoting Behaviors

Now let’s consider insights from the public health literature on adopting health-promoting behaviors with implications for how to facilitate the use of masks. Three things that work to encourage desired health behaviors are:

1. Changing the group’s social norms and expectations about the desired behavior.
2. Having individuals offer self-generated reasons for engaging in desired behavior.
3. Having people make a public commitment to engage in the desired behavior.

What would happen if experts and people with authority all gave the same clear and consistent message about wearing masks? Consider how this could help to change the social norm and expectations?

For instance, imagine university officials requiring students who do not wear a mask and who violate physical distance guidelines to read this statement, watch the video below and email two of their noncompliant friends the following message? In the email, students would be asked to include the reasons why they are now going to wear a mask and how they are going to try to convince others to do the same. The student would say: “This is my public commitment to help stop COVID-19 and my considerate, patriotic duty. It is the only way we can get life back to normal.”

When trying to encourage those who resist or oppose the use of masks to consider changing their ways, we should engage them in a conversation at a proper social distance and while wearing a mask, using the science and art of questioning and persuasion. Remember that the “name of the game” is to encourage others to offer self-generated reasons why wearing a mask is a safety issue and a “patriotic duty” to themselves and others. The only way they will get their life back to the way they want it to be is by wearing a mask and following social distancing guidelines.

Doing so works. In Taiwan they are now allowing fans into ballparks. Many countries are letting students back into school. Recently, Thailand, a country of 70 million people, went 100 days without a local coronavirus transmission and have experienced 58 deaths.

There is a clear discrepancy between the way those who choose not to use masks and social distance are now living and how they want to live. (“What are they missing in their lives right now?”) The goal is to engage and motivate as many people as possible to wear masks and keep the appropriate social distance so that we can all go on living how we want to live.

To watch the mask video, visit https://www.youtube.com/watch?v=930glgrxMsM

In summary, the decision “to wear or not to wear a mask” comes down to how you balance a 3 x 3 BOX of reasons:

*Revised version of Meichenbaum D. & Aldarondo, E. (2020, August 1). How to Engage and Motivate People to Wear Masks and Social Distance. https://melissainstitute.org/how-to-engage-and-motivate-people-to-wear-masks-and-maintain-social-distance/. Thanks to all readers who took the time to share their thoughtful feedback on the original blog with us.
**Learn more about TMI at https://melissainstitute.org/.