Do they really wash their hands? Prevalence estimates for personal hygiene behaviour during the COVID-19 pandemic based on indirect questions

Abstract

Abstract Background During the COVID-19 pandemic, billions of people have to change their behaviours to slow down the spreading of the virus. Protective measures include self-isolation, social (physical) distancing and compliance with personal hygiene rules, particularly regular and thorough hand washing. Prevalence estimates for the compliance with the COVID-19 measures are often based on direct self-reports. However, during a health crisis there is strong public pressure to comply with health and safety regulations so that people’s responding in direct self-reports may be seriously compromised by social desirability. Methods In an online survey, an indirect questioning technique was used to test whether the prevalence of hygiene practices may be lower than in conventional surveys when confidentiality of responding is guaranteed. The Extended Crosswise Model is an indirect questioning technique that guarantees the confidentiality of responding. To the degree that direct self-reports are biased by social desirability, prevalence estimates of hygiene practices such as thorough hand washing based on the Extended Crosswise Model should be lower than those based on direct self-reports. Results We analysed data of 1434 participants. In the direct questioning group 94.5% of the participants claimed to practice proper hand hygiene; in the indirect questioning group a significantly lower estimate of only 78.1% was observed. Conclusions These results indicate that estimates of the degree of commitment to measures designed to counter the spread of the disease may be significantly inflated by social desirability in direct self-reports. Indirect questioning techniques with higher levels of confidentiality seem helpful in obtaining more realistic estimates of the degree to which people follow the recommended personal hygiene measures. More realistic estimates of compliance can help to inform and to adjust public information campaigns on COVID-19 hygiene recommendations.