Journal Information
Vol. 35. Issue S2.
The 3rd International Nursing and Health Sciences Students and Health Care Professionals Conference (INHSP)
Pages S546-S548 (January 2021)
Not available
Vol. 35. Issue S2.
The 3rd International Nursing and Health Sciences Students and Health Care Professionals Conference (INHSP)
Pages S546-S548 (January 2021)
Open Access
Why not wearing mask during Covid-19 outbreak: Big question mark
Sri Martinia, Ira Kusumawatya,
Corresponding author
, Yunikeb, Detianac, Jumiaty Nurungd
a Mental Health Nursing Department, Politeknik Kesehatan Kemenkes Palembang, Indonesia
b Pediatric Nursing Department, Politeknik Kesehatan Kemenkes Palembang, Indonesia
c Medical Surgical Nursing Department, Politeknik Kesehatan Kemenkes Palembang, Indonesia
d Graduate School, Hasanuddin University, Indonesia
This item has received

Under a Creative Commons license
Article information
Full Text
Download PDF
Special issue
This article is part of special issue:
Vol. 35. Issue S2

The 3rd International Nursing and Health Sciences Students and Health Care Professionals Conference (INHSP)

More info

The qualitative research participants were 15 mothers, had children, and did not work.


Collecting data through in-depth interviews, observations, and field notes. The data were arranged into transcripts, analyzed through the process of data reduction, triangulation and conclusions.


The resulting themes include: inner family conflicts, the mother of a central family figure, increased family burdens, lack of awareness, fluctuations in family income which are internal causes, while external causes are inconsistencies in implementing regulations, the uncertainty of information validity, lack of role models, restrictions in cultivating culture.


It is necessary to strengthen multisectoral coordination continuously in fostering a culture of awareness of using masks during the Covid-19 period.

Big question
Wearing mask
Full Text

Novel coronavirus or nCoV became a trending topic at the end of 2019; this outbreak of cases with pneumonia symptoms first appeared in Wuhan, China, spreading suddenly and quickly, causing international concern. The number of cases is increasing intensively, and the risk of occurrence worldwide is very high. A total of 486,648 cases with 22,030 deaths have been confirmed globally as of March 25, 2020, and the World Health Organization has declared this condition a global health emergency.1 According to the WHO Situation Report 113 published on May 12, 2020, coronavirus now affects 210 countries and has affected more than 4,100,000 people, with more than 283,000 people dying.2

SARS-CoV-2 occurs mainly through droplets and close contact with people who have symptoms or have been infected with Covid-19.3 The medium of transmission is through secretions such as saliva and respiratory tract secretions or respiratory droplets that come out when an infected person coughs, sneezes, talks, or sings.4 The use of personal protective equipment at the beginning is a must. This is in accordance with the government decree No. Presidential Instruction. 6 of 2020 concerning Discipline Improvement and Law Enforcement of Health Protocols in the Prevention and Control of Covid-19.5

One of the health protocols, especially masks, can prevent transmission; stated in research6 the use of masks by the community is an effort to reduce the risk of infection caused by pathogens that stick to the hands and face and fly in the air.7 This is also in line with the statement8 that the use of face masks is designated as a non-pharmaceutical intervention that has the potential to be very effective in inhibiting the spread of COVID-19.

Face masks have played an important role in protecting health workers and the general public by reducing the incidence of infection through airborne transmission.4 Face masks worn by patients can reduce the release of virus-carrying droplets into the open air and the inhalation of virus-carrying droplets from the open air.9

Compliance with the use of masks is highly dependent on public awareness to protect themselves and others. Public awareness of using masks in public is still very lacking, this is due to the general perception that evidence to support the use of masks still lacks, especially for the general public in the community.9 Many factors, including unfamiliarity, impracticality cause of non-compliance with the use of masks, must be purchased.10

MethodResearch location

This research was carried out in schools that have implemented offline learning in small groups three times a week while still implementing health protocols during the learning process.

Types and sources of data

This qualitative research with a descriptive phenomenological approach aims to explore non-compliance with masks in public places. Fifteen mothers who do not work and have children in schools that apply offline learning during the Covid-19 outbreak are determined based on the purposive sampling method.

Data collection techniques

Data collection through in-depth interviews and observations. The data were compiled into transcripts, analyzed through the process of data reduction, triangulation and conclusions. This research was conducted for three months. The research instrument was the researcher himself, who gave open-ended questions using the in-depth interview method. During the interview, a recording device was used with the consent of the informant. Researchers observed the behavior of informants in carrying out Health protocols, especially the use of masks during interactions. Questions were developed to obtain information about:

  • 1.

    How do masks work so that they can protect someone from contracting and transmitting the COVID-19 virus?

  • 2.

    How do you feel when you always have to wear a mask out of the house?

  • 3.

    What is the mother's responsibility to provide education to family members about the use of masks?

  • 4.

    How do you assess that family member are aware of the use of masks?

  • 5.

    Are there government regulations that support the obligation to use masks in the community?

  • 6.

    Have the government and health workers set an example to the community about the use of masks?

Stages of collection/research

Data collection begins with giving research approval and is then signed by the participants after they are willing to join the research. This study used 15 mothers as informants who were determined based on saturation data obtained during in-depth interviews. Informants were given different codes, namely P1 to P15, sequentially. In-depth interviews were conducted at the informant's house or an agreed place, such as in the school waiting room when the informant was going to pick up his child from school. In addition to the meeting, face-to-face interviews were also conducted via telephone. Interviews were conducted repeatedly for each respondent between two and three times until data saturation was reached. In addition, researchers conducted data validation to ensure the validity of the data by mapping the behavior of informants through field notes about the use of masks by mothers and family members during interactions.


The participants in this study were 15 mothers with an age range of 23–48 years and residing in Palembang. The education level of the participants varied from general high school to undergraduate. Two participants are widowed, and the others are married. All participants have a routine of dropping off and picking up their children in school activities during the Covid-19 outbreak.

This study resulted in nine themes according to specific objectives, namely the themes generated include: problems that arise when always have to use a mask in public places are depicted in three themes, namely family inner conflict, and increasing family burden and family income fluctuations; mothers provide education on the use of masks indicated in two themes, namely mothers are the central figure of education in the family and the lack of awareness of family members on the importance of using masks; External causes are described in 4 themes, namely inconsistency in applying regulations, uncertainty in the validity of information, lack of role models and restrictions in growing culture.


Problems that arise When having to always use a mask in public places creates inner conflicts for family members, this was revealed by participant no. P3, P5, P9, and P10. An uncomfortable mental state, when faced with two different beliefs or values, is called inner conflict.11 Participants believed that using masks during the Covid-19 outbreak was important, but the uncomfortable feeling of wearing masks continuously and looking strange caused a conflict of its own. This is in line with research,12 which states that wearing a mask looks strange and raises suspicion. Another statement supports that the use of masks by the public creates a false sense of security that can reduce social distancing, thus making the situation worse.13

Not only does it cause inner conflict, the use of masks for family members causes an increase in the family's burden because they have to provide a separate budget, while there are also problems with decreasing income triggered by the Covid-19 outbreak.14 The problem of uncertainty and a decrease in income is felt by the community, especially those with irregular jobs. This is in line with the statement that an uncontrolled pandemic and social distancing, and regional lockdown policies have severe consequences on the economy.15

Government policies related to regulations significantly affect the condition of the community not only from the economic sector but also the community's defense sector against the transmission of Covid-19. People must be aware of health together by implementing health protocol regulations, one of which is the use of masks, this awareness is influenced by how they are given education in the family. This is in line with the motivational crowding theory, which states that a person can believe in something very much depending on how education is in the family.13 Mother as the central figure in the family, has a very dominant role in introducing the importance of using masks, this is expected to change the behavioral response of other family members to use masks when outside the home.

Several external factors are indicated to affect public compliance in implementing health protocols during the Covid-19 outbreak. Inconsistency in the application of regulations by the government has led to global non-compliance. People are confused about which regulations to apply; for example, changes to regulations on the use of masks that were initially only for paramedics then changed to masks.

Regulations play an important role in improving the orderly use of masks by the community, and this is in line with the results of a government survey where almost all participants stated that they would use masks if legally required.11 However, the phenomenon of information changing quickly creates uncertainty in the validity of information and creates confusion in public understanding of the applicable regulations.16

Stipulation of regulations must be accompanied by the provision of concrete examples that the community can adopt. The government as the central figure becomes a benchmark for people's behavior in carrying out the rules for using masks. However, in reality, the public still has not seen the regulation being implemented in real terms, and there are still many government officials using masks that do not comply with the rules.17

Regulations that are applied correctly will change people's behavior, and in the end, it will become entrenched. The culture of using masks is important to grow in society, but various conflicts that arise due to masks are an obstacle.18 Conflicts that arise include people's perceptions that the use of masks limits interaction and limits freedom of expression leading to rejection and reluctance to use masks.19


It is necessary to continuously strengthen multisectoral coordination in fostering awareness of using masks during the Covid-19 period.

Conflicts of interest

The authors declare no conflict of interest.


The researchers would like to thank the school for supporting the implementation of this research.

J. Bedford, D. Enria, J. Giesecke, et al.
COVID-19: towards controlling of a pandemic.
Lancet, 395 (2020), pp. 1015-1018
M. Gordon, T. Kagalwala, K. Rezk, et al.
Rapid systematic review of neonatal COVID-19 including a case of presumed vertical transmission.
Rolling updates on coronavirus disease (COVID-19).
B. Qin, D. Li.
Identifying facemask-wearing condition using image super-resolution with classification network to prevent COVID-19.
Sensors, 20 (2020), pp. 5236
M.I. Uddin, S.A.A. Shah, M.A. Al-Khasawneh.
A novel deep convolutional neural network model to monitor people following guidelines to avoid COVID-19.
J Sensors, 2020 (2020),
A.A. Chughtai, H. Seale, C.R. Macintyre.
Effectiveness of cloth masks for protection against severe acute respiratory syndrome coronavirus 2.
Emerg Infect Dis, 26 (2020),
Y. Wang, H. Tian, L. Zhang, et al.
Reduction of secondary transmission of SARS-CoV-2 in households by face mask use, disinfection and social distancing: a cohort study in Beijing, China.
BMJ Glob Health, 5 (2020), pp. e002794
B.N. Kantor, J. Kantor.
Non-pharmaceutical interventions for pandemic COVID-19: a cross-sectional investigation of US general public beliefs, attitudes, and actions.
Front Med, 7 (2020), pp. 384
M. Liao, H. Liu, X. Wang, et al.
A technical review of face mask wearing in preventing respiratory COVID-19 transmission.
Curr Opin Colloid Interface Sci, (2021), pp. 101417
T. Kabakian-Khasholian, J. Makhoul, M. Bardus.
To wear or not to wear a mask in the COVID-19 era? The broken bridge between recommendations and implementation in Lebanon.
J Glob Health, 10 (2020),
M. Lee, M. You.
Psychological and behavioral responses in South Korea during the early stages of coronavirus disease 2019 (COVID-19).
Int J Environ Res Public Health, 17 (2020), pp. 2977
S. Feng, C. Shen, N. Xia, et al.
Rational use of face masks in the COVID-19 pandemic.
Lancet Respir Med, 8 (2020), pp. 434-436
G. Seres, A.H. Balleyer, N. Cerutti, et al.
Face masks increase compliance with physical distancing recommendations during the COVID-19 pandemic.
N. Hertz-Palmor, et al.
Association among income loss, financial strain and depressive symptoms during COVID-19: evidence from two longitudinal studies.
J Affect Disord, 291 (2021), pp. 1-8
N. Fernandes.
Economic effects of coronavirus outbreak (COVID-19) on the world economy.
L. Gray, C. MacDonald, N. Tassell-Matamua, et al.
Wearing one for the team: views and attitudes to face covering in New Zealand/Aotearoa during COVID-19 Alert Level 4 lockdown.
J Prim Health Care, 12 (2020), pp. 199-206
Pew Research Center. Public assessments of the U.S. coronavirus outbreak. [Internet]. Pew Research Center; 2020. Available at:
H. Xu, Y. Gan, D. Zheng, et al.
Relationship between COVID-19 infection and risk perception, knowledge, attitude, and four non-pharmaceutical interventions during the late period of the COVID-19 epidemic in China: online cross-sectional survey of 8158 adults.
J Med Internet Res, 22 (2020), pp. e21372
B. Vai, S. Cazzetta, D. Ghiglino, et al.
Risk perception and media in shaping protective behaviors: insights from the early phase of COVID-19 Italian outbreak.
Front Psychol, (2020), pp. 11

Peer-review under responsibility of the scientific committee of the 3rd International Nursing, Health Science Students & Health Care Professionals Conference. Full-text and the content of it is under responsibility of authors of the article.

Copyright © 2021. SESPAS
Gaceta Sanitaria
Article options
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?