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      Self-Reported Compliance With Personal Preventive Measures Among Chinese Factory Workers at the Beginning of Work Resumption Following the COVID-19 Outbreak: Cross-Sectional Survey Study

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          Abstract

          Background

          Maintaining compliance with personal preventive measures is important to achieve a balance of COVID-19 pandemic control and work resumption.

          Objective

          The aim of this study was to investigate self-reported compliance with four personal measures to prevent COVID-19 among a sample of factory workers in Shenzhen, China, at the beginning of work resumption in China following the COVID-19 outbreak. These preventive measures included consistent wearing of face masks in public spaces (the workplace and other public settings); sanitizing hands using soap, liquid soap, or alcohol-based hand sanitizer after returning from public spaces or touching public installations and equipment; avoiding social and meal gatherings; and avoiding crowded places.

          Methods

          The participants were adult factory workers who had resumed work in Shenzhen, China. A stratified two-stage cluster sampling design was used. We randomly selected 14 factories that had resumed work. All full-time employees aged ≥18 years who had resumed work in these factories were invited to complete a web-based survey. Out of 4158 workers who had resumed work in these factories, 3035 (73.0%) completed the web-based survey from March 1 to 14, 2020. Multilevel logistic regression models were fitted.

          Results

          Among the 3035 participants, 2938 (96.8%) and 2996 (98.7%) reported always wearing a face mask in the workplace and in other public settings, respectively, in the past month. However, frequencies of self-reported sanitizing hands (2152/3035, 70.9%), avoiding social and meal gatherings (2225/3035, 73.3%), and avoiding crowded places (1997/3035, 65.8%) were relatively low. At the individual level, knowledge about COVID-19 (adjusted odds ratios [AORs] from 1.16, CI 1.10-1.24, to 1.29, CI 1.21-1.37), perceived risk (AORs from 0.58, CI 0.50-0.68, to 0.85, CI 0.72-0.99) and severity (AOR 1.05, CI 1.01-1.09, and AOR 1.07, CI 1.03-1.11) of COVID-19, perceived effectiveness of preventive measures by the individual (AORs from 1.05, CI 1.00-1.10, to 1.09, CI 1.04-1.13), organization (AOR 1.30, CI 1.20-1.41), and government (AORs from 1.14, CI 1.04-1.25, to 1.21, CI 1.02-1.42), perceived preparedness for a potential outbreak after work resumption (AORs from 1.10, CI 1.00-1.21, to 1.50, CI 1.36-1.64), and depressive symptoms (AORs from 0.93, CI 0.91-0.94, to 0.96, CI 0.92-0.99) were associated with self-reported compliance with at least one personal preventive measure. At the interpersonal level, exposure to COVID-19–specific information through official media channels (AOR 1.08, CI 1.04-1.11) and face-to-face communication (AOR 0.90, CI 0.83-0.98) were associated with self-reported sanitizing of hands. The number of preventive measures implemented in the workplace was positively associated with self-reported compliance with all four preventive measures (AORs from 1.30, CI 1.08-1.57, to 1.63, CI 1.45-1.84).

          Conclusions

          Measures are needed to strengthen hand hygiene and physical distancing among factory workers to reduce transmission following work resumption. Future programs in workplaces should address these factors at multiple levels.

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          Most cited references30

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          Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

          Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.
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            A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations

            The Coronavirus Disease 2019 (COVID-19) epidemic emerged in Wuhan, China, spread nationwide and then onto half a dozen other countries between December 2019 and early 2020. The implementation of unprecedented strict quarantine measures in China has kept a large number of people in isolation and affected many aspects of people’s lives. It has also triggered a wide variety of psychological problems, such as panic disorder, anxiety and depression. This study is the first nationwide large-scale survey of psychological distress in the general population of China during the COVID-19 epidemic.
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              An Ecological Perspective on Health Promotion Programs

              During the past 20 years there has been a dramatic increase in societal interest in preventing disability and death in the United States by changing individual behaviors linked to the risk of contracting chronic diseases. This renewed interest in health promotion and disease prevention has not been without its critics. Some critics have accused proponents of life-style interventions of promoting a victim-blaming ideology by neglecting the importance of social influences on health and disease. This article proposes an ecological model for health promotion which focuses attention on both individual and social environmental factors as targets for health promotion interventions. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individuals in the population is essential for implementing environmental changes.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J. Med. Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications (Toronto, Canada )
                1439-4456
                1438-8871
                September 2020
                29 September 2020
                29 September 2020
                : 22
                : 9
                : e22457
                Affiliations
                [1 ] Big Data Center The Seventh Affiliated Hospital Sun Yat-sen University Shenzhen China
                [2 ] Precision Medicine Center, Scientific Research Center The Seventh Affiliated Hospital Sun Yat-sen University Shenzhen China
                [3 ] Department of Early Childhood Education The Education University of Hong Kong Hong Kong China (Hong Kong)
                [4 ] JC School of Public Health and Primary Care Chinese University of Hong Kong Hong Kong China (Hong Kong)
                [5 ] Department of Health Behavior Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill, NC United States
                [6 ] Department of Neurology The Seventh Affiliated Hospital Sun Yat-sen University Shenzhen China
                [7 ] Department of Endocrinology The Seventh Affiliated Hospital Sun Yat-sen University Shenzhen China
                [8 ] Department of Clinical Nutrition The Seventh Affiliated Hospital Sun Yat-sen University Shenzhen China
                [9 ] Clinical Research Center The Seventh Affiliated Hospital Sun Yat-sen University Shenzhen China
                [10 ] Center for Digestive Disease The Seventh Affiliated Hospital Sun Yat-sen University Shenzhen China
                Author notes
                Corresponding Author: Yulong He heyulong@ 123456mail.sysu.edu.cn
                Author information
                https://orcid.org/0000-0002-6278-7051
                https://orcid.org/0000-0003-1154-5076
                https://orcid.org/0000-0002-8636-4918
                https://orcid.org/0000-0001-5614-6293
                https://orcid.org/0000-0002-1103-7293
                https://orcid.org/0000-0003-0678-1840
                https://orcid.org/0000-0002-6642-4258
                https://orcid.org/0000-0003-3854-1227
                https://orcid.org/0000-0003-4862-7200
                https://orcid.org/0000-0003-0016-776X
                https://orcid.org/0000-0002-1158-2304
                https://orcid.org/0000-0002-1902-0963
                Article
                v22i9e22457
                10.2196/22457
                7527164
                32924947
                f97981ca-3fa2-434c-a0ae-a7ce38944208
                ©Yihang Pan, Yuan Fang, Meiqi Xin, Willa Dong, Liemin Zhou, Qinghua Hou, Fanping Li, Gang Sun, Zilong Zheng, Jinqiu Yuan, Zixin Wang, Yulong He. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 29.09.2020.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 12 July 2020
                : 15 August 2020
                : 28 August 2020
                : 3 September 2020
                Categories
                Original Paper
                Original Paper

                Medicine
                covid-19,work resumption, factory workers,facemask wearing,hand hygiene,physical distancing,prevention,cross-sectional,online,survey,compliance

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