title: The use of facemasks to prevent respiratory infection: a literature review in the context of the Health Belief Model.
abstract: BACKGROUND
  Acute respiratory infections are prevalent and pose a constant threat to society. While the use of facemasks has proven to be an effective barrier to curb the aerosol spread of such diseases, its use in the local community is uncommon, resulting in doubts being cast on its effectiveness in preventing airborne infections during epidemics. We thus aimed to conduct a literature review to determine the factors that influence the use of facemasks as a primary preventive health measure in the community.
  
  
  METHODS
  A search for publications relating to facemask usage was performed on Medline, PubMed, Google, World Health Organization and Singapore government agencies' websites, using search terms such as 'facemask', 'mask', 'influenza', 'respiratory infection', 'personal protective equipment', 'disease prevention', 'compliance' and 'adherence'. Findings were framed under five components of the Health Belief Model: perceived susceptibility, perceived benefits, perceived severity, perceived barriers and cues to action.
  
  
  RESULTS
  We found that individuals are more likely to wear facemasks due to the perceived susceptibility and perceived severity of being afflicted with life-threatening diseases. Although perceived susceptibility appeared to be the most significant factor determining compliance, perceived benefits of mask-wearing was found to have significant effects on mask-wearing compliance as well. Perceived barriers include experience or perception of personal discomfort and sense of embarrassment. Media blitz and public health promotion activities supported by government agencies provide cues to increase the public's usage of facemasks.
  
  
  CONCLUSIONS
  Complex interventions that use multipronged approaches targeting the five components of the Health Belief Model, especially perceived susceptibility, are needed to increase the use of facemasks in the community. Further studies are required to evaluate the effectiveness of implemented interventions.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore 119228. simshinwei@gmail.com.
authors.forename: Shin Wei
authors.initials: SW
authors.lastname: Sim
authors.forename: Kirm Seng Peter
authors.initials: KS
authors.lastname: Moey
authors.forename: Ngiap Chuan
authors.initials: NC
authors.lastname: Tan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003140:Communicable Disease Control; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008297:Male; D008397:Masks; D012141:Respiratory Tract Infections / Q000517:prevention & control*; D012737:Sex Factors; D012846:Singapore; D055815:Young Adult