BACKGROUND
The mental health of international students studying abroad has been neglected during the COVID-19 pandemic.
OBJECTIVE
This mixed-method study examined perceived public attitudes, personal beliefs, practice and stress toward facemask wearing as a preventive measure against COVID-19 among international university students from Hong Kong studying in the United Kingdom (UK) in the early stage (January – March 2020) of the pandemic.
METHODS
Our study included 2 parts: (i) an exponential, non-discriminative snowball sampling strategy was used to recruit 91 Chinese students studying in the UK to complete an online questionnaire survey, and (ii) online Zoom focus group interviews were conducted with 16 students to gain an in-depth understanding on their experiences and coping methods during the pandemic.
RESULTS
Of the 91 students, 92.3% reported the UK public did not view facemask wearing as a preventive measure. 98.9% believed facemask wearing was an effective preventive measure, but 56% wore facemasks more than half of the time when out in public. 50.5% of them had internal conflicts of feeling stressed both when wearing facemasks and not wearing facemasks, which was more common in females than males [(62.5% versus 31.5%, P=0.004, Relative Risk (RR): 1.99 (1.17, 3.38)]. 61.5% reported public prejudiced attitudes against facemask wearing, also more females than males (71.4% versus 45.7%, P=0.02, RR: 1.56 (1.05, 2.32). Qualitative findings showed feeling of conflicts between personal beliefs and social norms, feeling stressed about wearing facemasks as a preventive measure, and experience of prejudice. Peer and family support helped students face such difficulties. Positive thinking and being adaptable were effective methods of stress management. Qualitative findings corroborated the quantitative results.
CONCLUSIONS
Prejudiced attitudes and behaviours from others, and differences in public attitudes toward facemask wearing resulted in much stress in students’ stress. Clear and accurate public health messaging regarding facemask wearing is needed to change public attitudes and mitigate prejudice. Owing to the ongoing pandemic and rising xenophobia, specifically Sinophobia, academic institutions and public health professionals should take initiative in reaching out to urgently address the needs of international students and provide support in managing their ongoing stress and enhance mental wellbeing.
CLINICALTRIAL
Ethics approval was granted by the Institutional Review Board of The University of Hong Kong / Hospital Authority Hong Kong West Cluster (reference number: UW20-298). The study was registered with the National Institutes of Health (identifier number: NCT04365361).
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Experience