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Is social media, as a main source of information on COVID-19, associated with perceived effectiveness of face mask use? Findings from six sub-Saharan African countries

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Background The use of face masks as a public health approach to limit the spread of coronavirus disease 2019 (COVID-19) has been the subject of debate. One major concern has been the spread of misinformation via social media channels about the implications of the use of face masks. We assessed the association between social media as the main COVID-19 information source and perceived effectiveness of face mask use. Methods In this survey in six sub-Saharan African countries (Botswana, Kenya, Malawi, Nigeria, Zambia and Zimbabwe), respondents were asked how much they agreed that face masks are effective in limiting COVID-19. Responses were dichotomised as ‘agree’ and ‘does not agree’. Respondents also indicated their main information source including social media, television, newspapers, etc. We assessed perceived effectiveness of face masks, and used multivariable logistic models to estimate the association between social media use and perceived effectiveness of face mask use. Propensity score (PS) matched analysis was used to assess the robustness of the main study findings. Results Among 1988 respondents, 1169 (58.8%) used social media as their main source of information, while 1689 (85.0%) agreed that face masks were effective against COVID-19. In crude analysis, respondents who used social media were more likely to agree that face masks were effective compared with those who did not [odds ratio (OR) 1.29, 95% confidence interval (CI): 1.01–1.65]. This association remained significant when adjusted for age, sex, country, level of education, confidence in government response, attitude towards COVID-19 and alternative main sources of information on COVID-19 (OR 1.33, 95%CI: 1.01–1.77). Findings were also similar in the PS-matched analysis. Conclusion Social media remains a viable risk communication channel during the COVID-19 pandemic in sub-Saharan Africa. Despite concerns about misinformation, social media may be associated with favourable perception of the effectiveness of face masks.
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https://doi.org/10.1177/17579759211065489
Global Health Promotion 1757-9759; Vol 0(0): 1 –11; 1065489 Copyright © The Author(s) 2022, Reprints and permissions:
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1065489PED0010.1177/17579759211065489Global Health PromotionI. Iyamu et al.
research-article2022
1. Pan African Research Consortium, Federal Capital Territory, Abuja, Nigeria.
2. School of Population and Public Health (SPPH), University of British Columbia, Vancouver, Canada.
3. Episolution Public Health Services, Federal Capital Territory, Abuja, Nigeria.
4. National Primary Health Care Development Agency (NPHCDA), Abuja, Nigeria.
5. Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
6. FHI 360 (Family Health International), Tanzania.
7. FHI 360 (Family Health International), Zambia.
8. National Agency for the Control of AIDS (NACA), Abuja, Nigeria.
9. Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
10. Egerton University, Kenya.
Correspondence to: Ihoghosa Iyamu, School of Population and Public Health, University of British Columbia, 2206 East
Mall, Vancouver, BC V6T 1Z3, Canada. Email: i.iyamu@alumni.ubc.ca
(This manuscript was submitted on 8 February 2021. Following blind peer review, it was accepted for publication on 13
November 2021.)
Is social media, as a main source of information on COVID-19,
associated with perceived effectiveness of face mask use? Findings
from six sub-Saharan African countries
Ihoghosa Iyamu1,2 , Glory Apantaku1, Zeena Yesufu1,
Edward Adekola Oladele1,3 , Ejemai Eboreime4,5 , Barinaadaa Afirima1,
Emeka Okechukwu1,6, Gabriel Isaac Kibombwe1,7, Tolulope Oladele1,8,
Taurayi Tafuma1, Okiki-Olu Badejo1,9, Everline Ashiono1,10
and Mulamuli Mpofu1
Abstract:
Background: The use of face masks as a public health approach to limit the spread of coronavirus
disease 2019 (COVID-19) has been the subject of debate. One major concern has been the spread of
misinformation via social media channels about the implications of the use of face masks. We assessed
the association between social media as the main COVID-19 information source and perceived
effectiveness of face mask use.
Methods: In this survey in six sub-Saharan African countries (Botswana, Kenya, Malawi, Nigeria,
Zambia and Zimbabwe), respondents were asked how much they agreed that face masks are effective
in limiting COVID-19. Responses were dichotomised as ‘agree’ and ‘does not agree’. Respondents
also indicated their main information source including social media, television, newspapers, etc. We
assessed perceived effectiveness of face masks, and used multivariable logistic models to estimate the
association between social media use and perceived effectiveness of face mask use. Propensity score
(PS) matched analysis was used to assess the robustness of the main study findings.
Results: Among 1988 respondents, 1169 (58.8%) used social media as their main source of information,
while 1689 (85.0%) agreed that face masks were effective against COVID-19. In crude analysis,
respondents who used social media were more likely to agree that face masks were effective compared
with those who did not [odds ratio (OR) 1.29, 95% confidence interval (CI): 1.01–1.65]. This
association remained significant when adjusted for age, sex, country, level of education, confidence in
government response, attitude towards COVID-19 and alternative main sources of information on
COVID-19 (OR 1.33, 95%CI: 1.01–1.77). Findings were also similar in the PS-matched analysis.
Original Article
I. Iyamu et al.
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IUHPE – Global Health Promotion Vol. 0, No. 0 201X
Introduction
The novel coronavirus disease 2019 (COVID-19)
pandemic continues to pose significant challenges
for health systems around the world (1). Despite the
development of new vaccines, the emergence of new
viral strains of concern, delays and logistic challenges
inherent in large scale immunisation campaigns
across countries of the world reinforce the need to
strengthen existing nonpharmaceutical interventions
(NPI) to limit disease spread (2,3). One such NPI
that has gained public interest is the use of face
masks by individuals in the community as a way to
prevent disease spread, especially from infected
persons who are asymptomatic (3–6). The World
Health Organisation (WHO) and other health
authorities in various jurisdictions have made
evolving and sometimes confusing recommendations
about this issue (6,7).
There is growing concern about the role of social
media in spreading misinformation about the
effectiveness of face masks and other NPIs in
preventing the spread of COVID-19 (8,9). While
concerns about health misinformation via social
media are not new, the COVID-19 pandemic has
amplified these concerns (9–12). Suboptimal
regulation of information sources and the
propensity for social media algorithms to prioritise
the most popular posts make it inherently difficult
for the public to verify health information via
modern media channels like Twitter, Facebook
and Instagram, and messaging platforms like
WhatsApp (9,13,14). Yet these channels are
major channels for risk communication and
health promotion, especially in health emergencies
like COVID-19 (10,11,15).
In resource-limited settings like sub-Saharan
Africa, the importance of social media in health
prevention and promotion, especially during COVID-
19, cannot be overstated (16). However, social media
has been seen as a medium for misinformation,
especially about reduced vulnerability to COVID-19
and the availability of untested therapies (17,18).
Concerted efforts at misinformation have been shown
to be often politically motivated, especially in a health
emergency like COVID-19, resulting in the
development of an ‘infodemic’ – a situation defined
by the uncontrolled spread of low-credibility, false,
misleading and unverified information (11,12,17).
Misinformation via social media is also suggested to
be fuelling untoward perceptions of the effectiveness
of NPIs, particularly the use of face masks (19–21).
Despite these concerns, evidence is limited on the
relationship between the use of social media as the
main COVID-19 information source and perceived
effectiveness of face masks as a public health strategy.
The limited and emerging evidence suggests that
social media may play a role in informing people’s
perception of the effectiveness of face mask use (22).
Yet, no study has specifically assessed this relationship
in the sub-Saharan African region. This region may
have escaped the first wave and second waves of the
COVID-19 with relatively less morbidity and
mortality than the rest of the world, but emerging
data from the third wave is raising concerns as
morbidity and mortality rates are on the increase
(23–25). More evidence is required to inform
ongoing public health engagement strategies that
will continue to protect the health of Africans in
subsequent waves. In this context, this study seeks to
assess the association between use of social media as
the main COVID-19 information source and
perceived effectiveness of face mask use in six sub-
Saharan countries.
Methods
Study design, setting and population
We conducted a cross-sectional survey of 1198
respondents from six sub-Saharan African countries:
Botswana, Kenya, Malawi, Nigeria, Zambia and
Conclusion: Social media remains a viable risk communication channel during the COVID-19
pandemic in sub-Saharan Africa. Despite concerns about misinformation, social media may be
associated with favourable perception of the effectiveness of face masks.
Keywords: nonpharmaceutical interventions, COVID-19, social media, face masks, health promotion
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IUHPE – Global Health Promotion Vol. 0, No. 0 201X
Zimbabwe. These countries, although largely
diverse, share similarities. In terms of the variations,
population sizes range from 2.2 million in Botswana
to about 200 million in Nigeria (26). However, there
is a shared growth in the adoption of mobile and
internet technologies that facilitate access to social
media platforms. For example, between January
2019 and January 2020, the number of internet
users increased by 2.2 million (2.6%), 3.2 million
(16%) and 595,000 (16%) in Nigeria, Kenya and
Zambia, respectively (27). Large variations in
education have been noted for the selected countries.
For instance, less than 1% of Zimbabwean children
of primary school age are out of school. The same
applies to Malawi, where only 2% of children are
out of school (26). However, 15%, 19% and 34% of
children were reported out of school in Zambia,
Kenya and Nigeria, respectively (26).
Sample size and sampling
We selected a sample of respondents from six
countries in West (1), East/Central (1) and Southern
Africa (4). These countries were selected to give a
geographic representation across the different sub-
Saharan African blocs that typically differ in
national culture and context. For each country, since
the population was greater than 20,000, we
determined, at 95% confidence level, a sample of
384 respondents to have sufficient power to provide
generalisable results in each country at a total
sample size of 2304 (28).
Data collection
The survey was administered online, between
17 May 2020 and 15 June 2020 using structured
questionnaires on Google forms (Alphabet Inc.,
Mountain View, CA, USA), with appropriate skip
logics and patterns as indicated. Respondents
were recruited via email listservs, Facebook,
Twitter, Telegram and WhatsApp. Enrolment in
the study occurred on a first-come, first-served
basis. As part of the survey, we assessed
respondents’ perceived effectiveness of face mask
use in limiting COVID-19, and their main
source of information including social media,
television, newspapers, employers, family,
friends, and online/web channels. Further,
data on respondents’ sociodemographic
characteristics, COVID-19 risk perception and
attitude to COVID-19 were collected.
Analytic sample and study variables
Our study sample included all respondents who
had valid responses to our outcome question, which
assessed how much they agreed that the use of face
masks was effective in limiting COVID-19 in their
countries, on a 5-point Likert scale ranging from
‘strongly disagree’ to ‘strongly agree’. Responses
were dichotomised as ‘agree’ and ‘does not agree’.
Responses such as ‘don’t know’, or ‘does not apply to
my country’ were excluded from the analysis. For
our exposure variable, respondents were asked to
indicate their main source of information on COVID-
19. Participants were allowed to provide up to three
main sources of information on COVID-19. Potential
confounders and predictors of the outcome were
included based on an a priori framework informed
by the literature (9,29,30) (Figure 1). The following
variables were included in our analysis: alternate
sources of COVID-19 infor mation (including
television, radio, newspapers, family/relatives,
employers, and other online/web channels),
COVID-19 risk perception, confidence in government
COVID-19 response and attitude to COVID-19.
Sociodemographic variables like age, sex, level of
education and occupation were also included. Where
potentially important sociodemographic variables
like socioeconomic status were unmeasured, we
ensured that we included proxy variables that could
potentially account for these variables (Figure 1).
Data analysis
Simple descriptive analysis was used to summarise
the characteristics of study respondents using
frequencies and proportions. Unadjusted odds of our
outcome given the exposure and covariate
were generated using logistic regression models.
Thereafter, multivariate logistic regression models
were used to estimate the adjusted effect of social
media as a main COVID-19 information source on
the perceived effectiveness of face masks, using odds
ratios (ORs) and 95% confidence intervals (CI). After
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IUHPE – Global Health Promotion Vol. 0, No. 0 201X
Figure 1. The DAG for assessing the relationship between social media as a main source of COVID-19 information and perceived effectiveness of face
masks as an NPI for COVID-19. This illustrates the confounding effects of age, sex, occupation, country, level of education, confidence in government
response, perceived COVID-19 risk, attitude towards COVID-19, first source of information on COVID-19, and alternative main sources of
information on COVID-19 including television, radio, friends and family, online/websites, newspapers and employers. It also shows social media type
as a mediator of this association. Socioeconomic status is an unmeasured variable.
COVID-19: coronavirus disease 2019; DAG: directed acyclic graph; NPI: nonpharmaceutical intervention.
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IUHPE – Global Health Promotion Vol. 0, No. 0 201X
retaining confounders and predictors identified in the
literature (9,29,30), automated backward elimination
method based on the Akaike information criterion
(AIC) was used to select the final model (31). We
also assessed possible effect modifiers and covariate
interactions including age, sex and country of
residence. No significant interactions were identified,
therefore the simpler model was considered as the
final model. In terms of model diagnostics, we
assessed the model using the area under the operating
characteristics curve (AUC) (32), and the Hosmer–
Lemeshow goodness-of-fit test (33). Collinearity was
assessed using a cut-off for variance inflating factor
as < 10.
To assess the robustness of our findings and our
multivariate model specification, we conducted a
propensity score (PS) matched analysis to balance
covariates between the exposure and control
groups (34). Covariate balance was assessed using
a standardised mean difference (SMD < 0.2) with
1:2 nearest neighbor matching without replacement.
All covariates from the main analysis were included
in the PS logistic model. All analyses were tested at
the 5% significance level and were conducted using
R-4.0.2 (35).
Ethical approval
The survey protocol was approved by the Health
Research Development Committee (HRDC) of the
Ministry of Health and Wellness, the local
institutional review board of Botswana (REF
Number HPDME 13/18/1). Informed consent was
collected electronically from respondents completing
the survey. Participation was voluntary and those
who consented were allowed to exit the survey at
any time by simply closing the browser page.
Results
Study sample characteristics
Among 1988 respondents included in the analysis,
1084 (54.5%) were males, 782 (39.3%) were aged
30–39 years, 1257 (63.2%) resided in urban settings
and 522 (26.3%) were from Kenya (Table 1).
Further, 1454 (73.1%) felt at risk of COVID-19,
while 623 (31.3%) were fearful of COVID-19. A
total of 1169 (58.8%) respondents used social
media as their main source of information, while
1689 (85.0%) agreed that face masks were effective
in reducing the spread of COVID-19.
Association between social media and
perceived effectiveness of face masks
Table 2 illustrates the unadjusted and adjusted
relationship between social media as main COVID-
19 information source and perceived effectiveness of
face masks. In unadjusted analysis, respondents who
used social media as their main COVID-19
information source, had greater odds of agreeing
that face masks were effective compared with those
who did not (OR 1.29, 95% CI: 1.01–1.65). This
association remained the same when adjusted for
age, sex, country, level of education, confidence in
government response, attitude towards COVID-19
and alternative main sources of information on
COVID-19 (aOR 1.33, 95% CI: 1.01–1.77).
PS matching analysis
In sensitivity analysis using PS matching, we
achieved considerable improvements in the balance
of covariates between exposed and unexposed in the
PS matched sample (all SMD < 0.2) compared with
the main sample. Table 3 describes the PS-adjusted
relationship between using social media as the main
source of COVID-19 information and perceived
effectiveness of face masks. Findings were similar to
those obtained in the main analysis (aOR: 1.44,
95% CI: 1.04, 2.00).
Discussion
In this study, we found that over half of
respondents used social media as their main source
of information on COVID-19 and most respondents
perceived facemasks to be effective as an NPI for
preventing COVID-19. We also found that
respondents using social media as their main source
of information on COVID 19 had 33% (95% CI:
1–77%) greater odds of perceiving face masks as
being effective in preventing COVID-19. This
association was significant in the main analysis, and
remained significant in sensitivity analysis using PS
matching methods to ensure covariate balance
between the exposed and control groups.
Findings from this study agree with emerging
findings from Africa on the perceived effectiveness
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Table 1. Study sample characteristics stratified by social media as main COVID-19 information source, yes or no.
Variables
Overall sample
Main COVID-19 info
source: social media – No
Main COVID-19 info
source: social media – Yes
n (%) n (%) n (%)
1988 819 1169
Perceived effectiveness of face masks
Does not agree 299 (15.0) 139 (17.0) 160 (13.7)
Agree 1689 (85.0) 680 (83.0) 1009 (86.3)
Sex
Female 846 (42.6) 311 (38.0) 535 (45.8)
Male 1084 (54.5) 472 (57.6) 612 (52.4)
Prefer not to say 58 (2.9) 36 (4.4) 22 (1.9)
Residence
Peri-urban 421 (21.2) 197 (24.1) 224 (19.2)
Rural 310 (15.6) 142 (17.3) 168 (14.4)
Urban 1257 (63.2) 480 (58.6) 777 (66.5)
Country
Botswana 489 (24.6) 262 (32.0) 227 (19.4)
Kenya 522 (26.3) 214 (26.1) 308 (26.3)
Malawi 167 (8.4) 74 (9.0) 93 (8.0)
Nigeria 493 (24.8) 146 (17.8) 347 (29.7)
Zambia 179 (9.0) 69 (8.4) 110 (9.4)
Zimbabwe 138 (6.9) 54 (6.6) 84 (7.2)
Confidence in government response
Very low 150 (7.5) 55 (6.7) 95 (8.1)
Low 264 (13.3) 90 (11.0) 174 (14.9)
Indifferent 435 (21.9) 153 (18.7) 282 (24.1)
High 705 (35.5) 295 (36.0) 410 (35.1)
Very high 434 (21.8) 226 (27.6) 208 (17.8)
Age
<30 years 565 (28.4) 220 (26.9) 345 (29.5)
30–39 years 782 (39.3) 304 (37.1) 478 (40.9)
40–49 years 481 (24.2) 208 (25.4) 273 (23.4)
50 years and above 160 (8.0) 87 (10.6) 73 (6.2)
Level of education
Primary/Secondary 179 (9.0) 110 (13.4) 69 (5.9)
Tertiary 1809 (91.0) 709 (86.6) 1100 (94.1)
Occupation
Employed 1510 (76.0) 610 (74.5) 900 (77.0)
Student 281 (14.1) 109 (13.3) 172 (14.7)
Unemployed/retired 197 (9.9) 100 (12.2) 97 (8.3)
Alternative main COVID-19 info sourcesa
Television 1257 (63.2) 551 (67.3) 706 (60.4)
Radio 530 (26.7) 286 (34.9) 244 (20.9)
Friends 179 (9.0) 65 (7.9) 114 (9.8)
Family & relatives 107 (5.4) 43 (5.3) 64 (5.5)
(Continued)
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IUHPE – Global Health Promotion Vol. 0, No. 0 201X
of face mask use in preventing COVID-19. For
example, a study in Uganda found that over 80% of
people perceived face masks to be effective in
preventing COVID-19 infections (30). Our findings
also support studies suggesting positive associations
between information seeking on social media and
various aspects of face mask use, including perceived
effectiveness. A study in China linked information
seeking on social media with perceived effectiveness
and compliance with face mask use (36). Another
study assessing content from Twitter related to face
masks, revealed that clusters of conversations were
facilitated by influential accounts run by citizens,
politicians and popular culture figures (22). These
conversations commonly encouraged the public to
wear masks. Further, a study in the United States
(US) described personal stories of loss from COVID-
19 reported on social media as a motivation to
support community use of face masks to prevent
COVID-19 (5). Our study provides evidence of the
association between the use social media as the main
COVID-19 information source and perceived
effectiveness of face masks in preventing disease
spread, especially in the sub-Saharan context.
Despite the obvious limitations in available
evidence, plausible causal explanations for these
associations have been proffered. It has been
suggested that the personalisation and catchiness of
information sharing experiences may explain the
association (5). The emotional nature of the
messaging in such contexts as exist on social media
may also elicit feelings of worry, which have been
described as a mediating factor for preventive
behaviours such as compliance with face masks
(36). However, this mechanism has been disputed, as
beliefs about consequences and benefits of face
masks may be more important than exposure and
belief in misinformation (37).
Our findings support the role of social media as
an effective COVID-19 risk communication channel.
As successive COVID-19 waves exert their toll on
already vulnerable health systems in sub-Saharan
Africa, public health interventions leveraging social
media may be useful, especially in urban centres
where crowding and reliance on subsistent earnings
may imply that lockdown measures and stay-at-
home orders may not be feasible for extended
periods (38). However, health authorities must
be aware of the debate about ongoing misinforma-
tion via the same channels (13). As has been
described, suboptimal regulation, propagation of
misinformation based on popularity metrics by
Variables
Overall sample
Main COVID-19 info
source: social media – No
Main COVID-19 info
source: social media – Yes
n (%) n (%) n (%)
1988 819 1169
Online/Web 577 (29.0) 223 (27.2) 354 (30.3)
Employer 179 (9.0) 84 (10.3) 95 (8.1)
Newspaper 186 (9.4) 96 (11.7) 90 (7.7)
Perceived COVID-19 risk
Not at risk 534 (26.9) 232 (28.3) 302 (25.8)
At risk 1454 (73.1) 587 (71.7) 867 (74.2)
Attitude to COVID-19
Calm 339 (17.1) 146 (17.8) 193 (16.5)
Doubt 160 (8.0) 73 (8.9) 87 (7.4)
Fear 623 (31.3) 257 (31.4) 366 (31.3)
Worry 689 (34.7) 286 (34.9) 403 (34.5)
Others 177 (8.9) 57 (7.0) 120 (10.3)
aMultiple response question.
COVID-19: coronavirus disease 2019.
Table 1. (Continued)
I. Iyamu et al.
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IUHPE – Global Health Promotion Vol. 0, No. 0 201X
Table 2. Estimates from logistic regression assessing the relationship between social media as main COVID-19
information source and perceived effectiveness of face masks.
Variables Crude relationship Adjusted relationship
OR (95% CI) aOR (95% CI)
Main info source: social media
No Reference Reference
Yes 1.29 (1.01, 1.65)b1.33 (1.01, 1.77)b
Sex
Female Reference Reference
Male 0.94 (0.73, 1.21) 1.13 (0.85, 1.51)
Prefer not to say 0.40 (0.22, 0.72)a0.47 (0.24, 0.92)b
Residence
Peri-urban Reference
Rural 1.02 (0.67, 1.56)
Urban 0.93 (0.68, 1.27)
Country
Botswana Reference Reference
Kenya 2.33 (1.56, 3.47)a4.00 (2.35, 6.81)a
Malawi 0.26 (0.17, 0.38)a0.52 (0.31, 0.86)b
Nigeria 1.16 (0.82, 1.64) 2.30 (1.44, 3.68)a
Zambia 2.76 (1.47, 5.20)a4.49 (2.21, 9.13)a
Zimbabwe 1.17 (0.69, 1.99) 2.62 (1.39, 4.96)a
Confidence in government response
Very low Reference Reference
Low 1.16 (0.75, 1.80) 1.12 (0.70, 1.80)
Indifferent 2.26 (1.48, 3.45)a2.39 (1.50, 3.79)a
High 4.97 (3.23, 7.65)a5.51 (3.41, 8.93)a
Very high 4.77 (2.96, 7.67)a6.46 (3.65, 11.41)a
Age
<30 years Reference Reference
30–39 years 0.80 (0.58, 1.10) 0.98 (0.66, 1.44)
40–49 years 0.65 (0.46, 0.93)b0.89 (0.58, 1.36)
50 years and above 0.45 (0.29, 0.70)a0.52 (0.30, 0.88)b
Level of education
Primary/Secondary Reference Reference
Tertiary 1.48 (1.00, 2.18)b1.51 (0.4, 2.41)
Occupation
Employed Reference
Student 1.59 (1.05, 2.39)b
Unemployed/retired 0.79 (0.54, 1.16)
Alternative main COVID-19 infoc sources
Television 1.24 (0.97, 1.60) 0.87 (0.66, 1.16)
Radio 1.08 (0.81, 1.43) 1.32 (0.91, 1.91)
Friends 0.80 (0.53, 1.19)
Family and relatives 0.71 (0.43, 1.16)
Online/Web 0.72 (0.55, 0.93)b0.73 (0.54, 1.01)
Employer 1.54 (0.94, 2.52) 1.84 (1.08, 3.15)b
(Continued)
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IUHPE – Global Health Promotion Vol. 0, No. 0 201X
Table 3. Sensitivity analysis using PS matching to assess the relationship between social media as main COVID-
19 information source and perceived effectiveness of face masks.
Variables Adjusted association (OR)a (95% CI)
Model: PS matched (1:2 nearest neighbor without replacement)
Main info source: social media
No Reference
Yes 1.44b,c (1.04, 2.00)
aPSs were adjusted for sex, age, country, level of education, confidence in government response, perceived COVID-19
risk, attitude towards COVID-19, first source of information on COVID-19, and alternative main sources of information
on COVID-19 including television, radio, friends and family, online/websites, newspapers and employers.
bPropensity score matched estimates not adjusted for sex, age, country, confidence in government response, level of
education, perceived COVID-19 risk, attitude towards COVID-19, and alternative main sources of information on CO-
VID-19 including TV, radio, friends and family, online/websites, newspapers and employers.
cEstimate significant at P < 0.05.
CI: confidence interval; COVID-19: coronavirus disease 2019; OR: odds ratio; PS: propensity score.
Variables Crude relationship Adjusted relationship
OR (95% CI) aOR (95% CI)
Newspaper 1.28 (0.81, 2.02) 1.64 (1.00, 2.70)
Perceived COVID-19 risk
Not at risk Reference Reference
At risk 0.97 (0.74, 1.29) 0.93 (0.67, 1.28)
Attitude to COVID-19
Calm Reference Reference
Doubt 0.67 (0.42, 1.09) 0.62 (0.37, 1.06)
Fear 1.30 (0.89, 1.91) 1.21 (0.79, 1.86)
Worry 1.05 (0.73, 1.52) 0.96 (0.64, 1.43)
Others 0.71 (0.44, 1.14) 0.89 (0.53, 1.49)
Adjusted model discrimination and calibration: AUC = 0.77, Archer-Lemeshow (P = 0.19).
VIF < 3.
aSignificant at P < 0.01.
bSignificant at P < 0.05.
cReference groups are those who did not indicate using each alternative main source of COVID-19 information.
AUC: area under the operating characteristics curve; COVID-19: coronavirus disease 2019; OR: odds ratio; aOR: ad-
justed odds ratio; CI: confidence interval; VIF: variance inflating factor.
Table 2. (Continued)
social media algorithms and unwitting social media
users often spread harmful messages that are often
politically motivated (8,17,18,39). Concerted efforts
by media, scientific organisations and government
institutions are therefore needed to leverage the
availability of social media in disseminating
important information on the effectiveness of NPIs
for COVID-19 including face masks (39), and the
benefits of compliance (37).
Future research will be necessary to explore if
perceived effectiveness of face masks ultimately result in
compliance with mask use. Research will also be
necessary to fully understand the mechanisms that result
in perceived effectiveness of face mask use in preventing
infections with social media use as main source of
COVID-19 information. Efforts should also seek to
understand the differences in this relationship between
various social media platforms. Such information will
I. Iyamu et al.
10
IUHPE – Global Health Promotion Vol. 0, No. 0 201X
be useful to inform replicable public health promotion
strategies via various social media platforms that are
better positioned to influence people’s behaviour to
achieve improved health outcomes.
The strengths of our study findings are inherent in
the consistency of the observed association in sensitivity
analysis using PS matching methods. The association
remained significant in both analyses. Moreover, to the
best of our knowledge, this is the first study assessing
the relationship between social media as a main source
of COVID-19 information and perceived effectiveness
of face masks in sub-Saharan Africa. This is despite
widespread debate about the role of social media
misinformation, especially in the context of COVID-
19 risk communication. However, our study must also
be viewed in light of its limitations. First, our route of
participant recruitment implies that the study
respondents may not necessarily be representative of
the study population of interest. For example, with our
online recruitment strategy, respondents included were
more likely be those who regularly access online
services like social media, and 91% of our sample had
tertiary level of education, whereas Nigeria for instance
had only 62% adult literacy rates in 2018 (26).
However, given that our findings remained consistent
in PS analyses where we attempted to account for
potential selection bias, we remain confident in our
findings. Further, we only recruited 86.3% of our
intended sample size and this may have limited the
power of our study. We posit that existing fears about
government involvement with such types of research
may have discouraged participation. Finally, while we
considered it expedient to dichotomise our outcome
variable for ease of interpretation and applicability to
policy discourse, we realise that this may result in loss
of statistical information (40).
Conclusion
In this study of respondents in six sub-Saharan
African countries, we found that people who used
social media as their main COVID-19 information
source were more likely to perceive face mask as
effective in preventing COVID-19 spread and this
association was statistically significant. With current
fears of more deadly waves of infection in the sub-
continent, health ministries and agencies may
leverage social media to strengthen health promotion
messaging on the effectiveness of face masks with a
view on promoting widespread mask use.
Data availability
The data that support the findings of this study are available
from the corresponding author upon reasonable request.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest
with respect to the research, authorship, and/or publication
of this article.
Funding
The author(s) disclosed receipt of the following financial
support for the research, authorship, and/or publication of
this article: The authors received no specific grant from any
funding agency in the public, commercial, or not-for-profit
sectors for this research. I.I is supported by the Canadian
Institutes of Health Research (CIHR) Frederick Banting and
Charles Best Doctoral Award and the University of British
Columbia Four Year Doctoral Fellowship (4YF).
ORCID iDs
Ihoghosa Iyamu https://orcid.org/0000-0003-0271-9468
Edward Adekola Oladele https://orcid.org/0000-0003-
4999-1397
Ejemai Eboreime https://orcid.org/0000-0001-8277-2570
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