Psychosocial Determinants of Hand Hygiene, Facemask Wearing, and Physical Distancing during the COVID-19 Pandemic: A Systematic Review and Meta-analysis

Wei Liang, Yanping Duan, Feifei Li, Ryan E Rhodes, Xiang Wang, Ishanka Harshani Kusum Peiris Dehiwala Liyanage, Lin Zhou, Borui Shang, Yide Yang, Julien S Baker, Jiao Jiao, Wei Han*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

12 Citations (Scopus)


Background: Hand hygiene, facemask wearing, and physical distancing play a crucial role in the prevention of the COVID-19 pandemic. Identifying the key psychosocial determinants of these precautionary behaviors contributes to effective intervention and policymaking for COVID-19 and future pandemics. Purpose: This study aimed to systematically review and meta-analyze available evidence on psychosocial determinants of the general population's practice of three precautionary behaviors, based on the Risk, Attitudes, Norms, Abilities, and Self-regulation (RANAS) framework. Methods: Literature was identified by searching seven databases and relevant review papers. Observational and experimental studies targeting the general population (≥18 years) published between January 2020 to September 2021 were included. Pooled effect sizes were calculated with the inverse-variance method using random-effects models. Results: A total of 51 studies (64 samples) were included in the qualitative synthesis, of which 30 studies (42 samples) were included in the meta-analysis. RANAS-based constructs including knowledge, pros attitudes, and perceived norms were identified as significant determinants of all three behaviors in the meta-analysis. Perceived susceptibility and cons attitudes showed no significant associations with any behaviors. Perceived severity, perceived control, self-efficacy, and behavioral intention were significantly associated with one or two behaviors. Country (western vs. eastern hemispheres) significantly moderated the effects of certain risk and ability factors. Conclusions: More research is needed with respect to the intention-behavior relationship, self-regulatory and reflexive factors of precautionary behaviors, as well as the exploration of the potential moderating effect of sociodemographic factors.

Original languageEnglish
Pages (from-to)1174-1187
Number of pages14
JournalAnnals of Behavioral Medicine
Issue number11
Publication statusPublished - Nov 2022

Scopus Subject Areas

  • Psychology(all)
  • Psychiatry and Mental health

User-Defined Keywords

  • COVID-19
  • Facemask wearing
  • Hand hygiene
  • Physical distancing
  • Psychosocial determinants
  • RANAS model


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