Facemask-wearing behavior to prevent COVID-19 and associated factors among public and private bank workers in Ethiopia.

BACKGROUND: Given widespread vulnerability to COVID-19 infection in areas with low vaccination rates, facemask wearing is repeatedly emphasized for the general population including bank workers, who have contact with many customers each day. Over the first year of the COVID-19 pandemic, studies focused on facemask wearing among healthcare workers but not among bank workers, who are also at risk of COVID-19. To address this gap and to consider intervention measures that encourage the wearing of facemasks, this study was conducted to identify behaviors of facemask wearing and associated factors among bank workers in Dessie City, Ethiopia.
MATERIALS AND METHODS: An institution-based cross-sectional study was conducted among 413 bank workers who were selected using a simple random sampling technique from January 1st to 30th, 2021 in Dessie City, Ethiopia. Data were collected using a structured questionnaire and on-the-spot observational checklist. The collected data were checked, coded and entered to EpiData version 4.6 and exported to Statistical Package for Social Sciences (SPSS) version 25.0 for data cleaning and analysis. Data were analyzed using bivariable (crude odds ratio [COR]) and multivariable (adjusted odds ratio [AOR]) logistic regression model at 95% confidence interval (CI). Variables from the bivariable analysis with a p-value <0.25 were considered for multivariable analysis. Then, variables that had a p-value <0.05 were declared as factors significantly associated with behavior of facemask wearing. MAIN
FINDINGS: In this study, the behavior of facemask wearing among bank workers was 50.4% [95%CI: 45.3-55.2%] with 21.1% always wearing a facemask, 72.4% sometimes, and 6.5% never. A majority of the bank workers 350 (84.7%) had good knowledge of COVID-19 and half of them 208 (50.4%) had a positive attitude towards taking precautions against COVID-19. Just over two-thirds of the respondents 284 (68.8%) preferred to wear a non-medical mask. Two hundred fifty-five (61.7%) said wearing a facemask interfered with communication and 259 (62.7%) felt that wearing a facemask was not comfortable. Facemask-wearing behavior was significantly associated with a high level of positive attitude towards taking precautions against COVID-19 (AOR = 3.27, 95% CI: 1.75-6.11), the perception that the consequences of getting COVID-19 could be serious (AOR = 4.87, 95% CI: 2.38-9.94), the presence of chronic illness (AOR = 2.19, 95% CI: 1.07-4.48), sex being female (AOR = 1.87, 95% CI: 1.06-3.32) and age being greater or equal to 35 years (AOR = 9.25, 95% CI: 4.79-17.88).
CONCLUSION: The main finding of the study showed that the behavior of facemask wearing among bank workers was relatively low (50.4%) compared to other types of workers as found in other studies. To increase the behavior of facemask wearing among bank workers, health decision makers need to develop updated guidance for promotion of facemask wearing to increase the practical and appropriate use of facemasks among bank workers. Bank managers and concerned government bodies should enforce mask use to change behavior of these workers.

Introduction

Coronavirus disease 2019 (COVID-19) is an emerging respiratory disease that was first reported in Wuhan, Hubei Province, China, on December 31st, 2019 as a cluster of pneumonia cases. The disease is caused by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) [1]. On January 7th, 2020, the etiological agent of the pneumonia was officially announced as a novel coronavirus. Among the coronaviruses that infect humans, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome-related coronavirus (MERS-CoV) are highly pathogenic [2].

COVID-19 has an incubation period of between 2 and 14 days, with an average of 5 days [3]. After the incubation period, COVID-19 shows a mild course in 80.0% of observed cases and a severe course in 20.0%, with a lethality rate of 0.3–5.8% [4]. The world entered the second year of the COVID-19 pandemic applying preventive measures only, but after over 110 million global infections and 2.4 million deaths, the development of COVID-19 vaccines offered a glimmer of hope, although they have not yet been distributed throughout all countries. Vaccinations help to create herd immunity when vaccine coverage reaches sufficient levels, and they reduce morbidity and mortality induced by the virus [5].

At the onset of the pandemic, public health interventions including facemask wearing, handwashing or sanitizer use, and keeping physical distance were practiced by government enforcement in Dessie City, although the punishment had been abolished by the time the data were gathered. Facemask wearing is available and advisable for preventing transmission pathways for coronavirus by acting as a mechanical barrier [4,6]. Facemask wearing is also used to protect the self against the spreading of droplets from sick to healthy individuals by completely covering the mouth and nose and adjusting well to the face [7,8]. The use of masks is part of a comprehensive package of prevention and control measures that can limit the spread of certain respiratory viral diseases, including COVID-19. Masks can be used either for protection of healthy persons or to prevent persons having COVID-19 disease from transmitting it to others [9].

Bank workers are among the many service-sector employees who have frequent and close interaction with many people. Many of these workers have either direct or indirect physical contact with the public through exchange of money, which is an exposure route for COVID-19 transmission that is not clearly seen [8,10]. The banking industry’s major working tool is cash that is processed by cashiers, which allows the chance of COVID-19 exposure to various individuals [11]. Cases of COVID-19 spread all over the world, increasing rapidly due to the presence of community transmission [12].

Globally, there were 111,518,562 confirmed cases, 2,468,646 deaths and 62,903,843 recoveries as of February 22, 2021 at 9:24 GMT. The first case of COVID-19 on the continent of Africa was reported on February 14th, 2020. By May 13th, cases had been reported in all 54 African countries [13]. In Ethiopia, the first case of COVID-19 was reported on March 13th,2020, and the number of reported cases is increasing with improved testing [14,15]. By February 22, 2021, 19:15 GMT, COVID-19 cases rose to 153,541, with deaths of 2,293 and 131,713 recoveries in Ethiopia [16]. COVID-19 cases were also being reported in Dessie City at the time of this study’s inquiry.

Bank employees come into contact with the virus by close interaction with clients or coworkers without appropriate physical distancing [10]. Given widespread population vulnerability to COVID-19 infection, facemask wearing is repeatedly emphasized for the whole population including public and private bank workers, but until very recently, studies focused on the importance of facemask wearing in healthcare workers [17] and did not consider bank workers, who are also at risk of COVID-19.

Ensuring that evidence-based preventive measures and practices are consistently applied among public and private bank workers will help to prevent human-to-human transmission of pathogens including SARS-CoV-2 [18]. There had been no studies on the prevalence of and preventive strategies against COVID-19 among bank employees in Dessie City before the start of this study. To address the gap and better understand the current situation of facemask-wearing behavior and its associated factors among public and private bank workers, this study was conducted in Dessie City, Ethiopia.

Materials and methods

Study area

The study was conducted in private and public banks located in Dessie City, the capital city of south Wollo Zone, on the eastern margin of Amhara Regional State in the north central part of Ethiopia, 401km from Addis Ababa. According to the 2007 national census conducted by the Central Statistical Agency (CSA), Dessie City’s total population was projected at 212,436 for 2014. In the year 2020, there were 17 government and 24 private bank branches having around 2647 workers in Dessie City [19,20].

Study design, period and population

An institution-based cross-sectional study was conducted to determine facemask-wearing behavior and associated factors among bank workers in Dessie City from January 1st to 30th, 2021. All workers in bank branches of Dessie City were the source population, while selected bank workers from selected branches of banks in Dessie City were the study population.

Sample size determination and sampling technique

Sample size was determined using single population proportion formula, considering the assumptions that the proportion of facemask wearing in institutions including banks of Dessie City at 50% (50% was considered since there had been no previous study conducted on bank workers in the study area), a 95% CI and 5% margin of error. After considering a 10% non-response rate from the initial calculated sample size, the final sample size for this study became 422.

There were 17 government and 24 private bank branches in Dessie City, for a total of 41 bank branches, from which 50% (21 bank branches, 9 government and 12 private) were randomly selected. The numbers of workers were taken from attendance sheets in each selected branch. After getting their number, samples were taken randomly from the sheet first by allocating the entire sample proportionally to the total number of workers in the selected bank branches.

Operational definitions

Bank workers

Both back- and frontline officers in the bank who are responsible for accepting customers’ cash deposits and utility payments, recording transactions, printing receipts, cashing cheques and advising customers about investments, foreign currency exchange and loans frequently have contact with customers.

Facemask-wearing behavior

The practice by bank workers of wearing a facemask covering the nose, mouth, and lower jaw at the time of data collection divided by the total number of study participant bank workers.

High level of positive attitude

Those bank workers responding positively to more than or equal to the mean out of 11 attitude questions about taking precautions to prevent COVID-19 transmission.

Low level of positive attitude

Those bank workers responding positively to fewer than the mean out of 11 attitude questions about taking precautions to prevent COVID-19 transmission.

Good knowledge

Those bank workers responding correctly to more than or equal to the mean of a total of 16 knowledge questions.

Poor knowledge

Those bank workers responding correctly to fewer than the mean of a total of 16 knowledge questions.

Medical masks

Surgical or procedure masks that are flat or pleated; and also N95 facemasks affixed to the head with straps that go around the ears or head or both [21,22].

Non-medical masks

Masks made out of different combinations of fabrics (cloth), layering sequences and available in diverse shapes [22].

Data collection procedures and quality assurance

A structured questionnaire and an observational checklist were developed after reviewing the literature [23-26], a WHO report on COVID-19 [9], and an Ethiopian Ministry of Health report [27]. To keep the questions consistent, the instrument was prepared in English, translated to the local language (Amharic) and then retranslated to English. The first part of the questionnaire asked about facemask-wearing behaviors, scored according to whether or not the respondents wore a facemask at the time of data collection, which is a method similar to other study [28]; the next part included questions about risk factors for those behaviors to be poor or good, including information on socio-demographic and economic factors; bank environment and service-related factors; knowledge and attitude about COVID-19; behavioral factors; and factors related to medical history and subjects’ source of information about COVID-19.

Knowledge and attitudes towards COVID-19 were also probed via 16 and 11 questions, respectively. One point was awarded for each correct answer, while zero points were given for each item that was answered incorrectly or left unanswered by selecting the response ‘do not know.’ The possible knowledge score ranged from 0 to 16, with a score higher than the mean indicating a better level of knowledge on COVID-19 possessed by the participant [25]. Each item on attitude towards taking precautions against COVID-19 was rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The mean score of each subscale was calculated to indicate the degree of participant’s attitudes in the respective domains [3].

Before the commencement of the actual data collection, the questionnaire was pretested on five other bank branches that had not been selected for the study. The data were collected by self-administration and observation of utilization of facemask and other bank service-related questions. Three data collectors were recruited and given one day of training about study objectives, data collection tools and ethical issues; they distributed the questionnaires and observed the bank environment using the checklists. The investigator and supervisors checked the completeness of the questionnaires on a daily basis for data quality control.

In order to assure the survey tool’s validity, the questionnaire was created after analyzing a variety of published literature and reports. Data entry was also reviewed in a randomly selected 10% of the surveys to ensure the questionnaire’s reliability, and double data entry was performed to prevent data entry errors. Data cleaning prior to statistical analysis was also carried out.

Data management and analysis

Data were checked for completeness and consistency, then coded and entered to EpiData version 4.6 and exported to SPSS version 25.0 for data cleaning and analysis. Descriptive analysis was carried out and the results were presented using frequencies with percentages (%) for categorical variables and mean with standard deviations (SD) for continuous variables. Bank workers wearing a facemask at the time of observation were represented with ‘1’ and those not wearing a facemask with ‘0’. The number of bank workers wearing a mask covering the nose, mouth, and lower jaw at the time of observation divided by the total number of study participants was considered as the proportion of those with “good behavior of facemask wearing”; whereas the proportion of those with ‘poor face-mask wearing behavior’ was calculated the same way using the number who were not similarly wearing a mask. Study participant wearing of any type of mask as observed during data collection was considered as facemask-wearing behavior in the study.

A binary logistic regression model was used for data analysis at 95% CI; bivariable (crude odds ratio [COR]) analysis was performed and variables with p-value <0.25 were transported to multivariable logistic regression model to identify factors independently associated with the behavior of facemask wearing. Finally, variables with p-value <0.05 in multivariable logistic regression were taken as statistically significant, and adjusted odds ratio (AOR) with 95% CI was considered to see strength and significance of the association, respectively. Multicollinearity test carried out between independent variables where the standard error cut-off point was greater than 2 showed it did not happen. The Hosmer–Lemeshow goodness-of-fit test was used, finding the p-value was 0.938, indicating that the model was fit.

Ethical considerations

An ethical clearance letter was obtained from the ethical review committee of Wollo University College of Medicine and Health Science. Letters of permission from the Dessie City health bureau and government and private bank branches were obtained. As per WHO guidelines to prevent COVID-19 transmission, data collectors wore facemasks, used hand sanitizer during distribution and collection of questionnaires, and kept physical distance of two meters (6’8”) at the time of data collection. Before distributing the questionnaire, written consent was obtained from participants by attaching one page to the beginning of the questionnaire. Possible identifiers such as names of the participants were not requested to ensure confidentiality. Study participants who did not wear a facemask at the time of interview were advised to wear a facemask if they had one, and a face-mask was provided o those who did not have one during the data collection.

Results

Socio-demographic and economic characteristics of bank workers

The response from the total sample of 422 was 413 (97.9%), including 208 (50.4%) government and 205 (49.6%) private bank branches. Of the total respondents, 233 (56.4%) were male, 180 (43.6%) had a first degree and a majority of the respondents 247 (59.8%) were within the age range of 18–34 years, with a mean age of 33.18 years (SD [standard deviation ±8.13 years) (Table 1).

Table 1

Socio-demographic and economic factors and bivariable analysis with facemask-wearing behaviors among bank workers in Dessie City, Ethiopia, January 2021.

Variables	Categories	Frequency	Facemask-wearing behavior		COR (95% CI)	p-value
		n (%)	Good	Poor
Sex of respondent	Male	233 (56.4)	90	143	1
	Female	180 (43.6)	118	62	3.02 (2.02–4.53)	<0.001
Age of respondent (years)	18–34	247 (59.8)	64	183	1
	> = 35	166 (40.2)	144	22	18.7 (11.0–31.8)	<0.001
Education level	Diploma	101 (24.5)	38	63	1
	1st degree	180 (43.6)	71	109	1.08 (0.65–2.83)	0.764
	2nd degree	132 (32.0)	99	33	4.97 (2.83–8.74)	<0.001
Monthly income (USD, United States Dollar) *	127.8–299.0	210 (50.8)	72	138	1
	299.1–689.9	203 (49.2)	136	67	3.89 (2.59–5.85)	<0.001
Marital status	Not married	179 (43.3)	52	127	1
	Married	234 (56.7)	156	78	4.89 (3.20–7.45)	<0.001
Experience at the bank (years)	<2	71 (17.2)	22	49	1
	2–5	194 (47.0)	69	125	1.23 (0.69–2.20)	0.487
	>5	148 (35.8)	117	31	8.41 (4.43–15.9)	<0.001
Position as cashier (days/week)	0–4	130 (31.5)	59	71	1
	5 or 6	283 (68.5)	149	134	1.34 (0.88–2.03)	0.171
Family size (persons)	<5	245 (59.3)	89	156	1
	>/ = 5	168 (40.7)	119	49	4.26 (2.79–6.50)	<0.001
Have children in household	No	196 (47.5)	78	118	1
	Yes	217 (52.5)	130	87	2.26 (1.52–3.35)	<0.001
Have family member >65 years old in household	No	333 (80.6)	167	166	1
	Yes	80 (19.4)	41	39	1.05 (0.64–1.70)	0.860

1, reference category; COR, crude odds ratio; CI, confidence interval.

*Average exchange of 1 USD (United States Dollar) to ETB (Ethiopian Birr) was 39.13224 during January 2021.

Bank environment related factors

Almost equal numbers of workers were taken from government (50.4%) and private (49.6%) bank branches for this study. The mean number of staff and daily customers were 23 and 305, respectively (Table 2).

Table 2

Bank environment-related factors and bivariable analysis with facemask-wearing behaviors among bank workers in Dessie City, Ethiopia, January 2021.

Variables	Categories	Frequency	Facemask-wearing behavior		COR (95% CI)	p-value
		n (%)	Good	Poor
Bank branch type	Government	208 (50.4)	118	90	1.68 (1.14–2.47)	0.009
	Private	205 (49.6)	90	115	1
No. of staff in the bank	<23	234 (56.7)	121	113	1
	> = 23	179 (43.3)	87	92	0.88 (0.59–1.30)	0.532
No. of customers of the bank	8–304	272 (65.9)	124	148	1
	305–1,400	141 (34.1)	84	57	1.76 (1.17–2.67)	0.007

1, reference category; COR, crude odds ratio; CI, confidence interval.

Knowledge and attitude factors about COVID-19

The majority of respondents 350 (84.7%) had good knowledge about COVID-19 and 63 (15.3%) had poor knowledge about COVID-19, while half of the respondents 208 (50.4%) had a high level of good attitude towards taking precautions against COVID-19 (Table 3).

Table 3

Knowledge- and attitude-related factors and bivariable analysis with facemask-wearing behaviors among bank workers in Dessie City, Ethiopia, January 2021.

Variable	Categories	Frequency	Facemask-wearing behavior		COR (95% CI)	p-value
		n (%)	Good	Poor
Knowledge about COVID-19	Poor knowledge	63 (15.3)	16	47	1
	Good knowledge	350 (84.7)	192	158	3.57 (1.95–6.54)	<0.001
Attitude towards taking precautions against COVID-19	Low level of positive attitude	205 (49.6)	46	159	1
	High level of positive attitude	208 (50.4)	162	46	12.2 (7.66–19.4)	<0.001

1, reference category; COR, crude odds ratio; CI, confidence interval.

Behavioral factors among bank workers

Of the total sample in this study, 50.4% (95% CI: 45.3–55.2) of bank workers showed good mask-wearing behavior and 49.6% (95% CI: 44.8–54.7) showed poor mask-wearing behavior. Over two-thirds of respondents 284 (68.8%) preferred a non-medical mask for protection from inhalation of droplets and air from outside. More than three-fourths 330 (79.9%) of bank workers felt fear of COVID-19 and 245 (59.3%) felt that the consequences of getting COVID-19 could be serious. One-third 138 (33.4%) of the bank workers kept a physical distance from customers. Two hundred fifty-five (61.7%) said wearing a facemask interfered with communication and 259 (62.7%) felt that wearing a facemask was not comfortable (Table 4).

Table 4

Behavioral factors and bivariable analysis with facemask-wearing behaviors among bank workers in Dessie City, Ethiopia, January 2021.

Variables	Categories	Frequency	Facemask-wearing behavior		COR (95% CI)	p-value
		n (%)	Good	Poor
Type of mask	Medical	129 (31.2)	70	59	1
	Non-medical	284 (68.8)	138	146	0.80 (0.53–1.21)	0.286
Feel vulnerable to contracting COVID-19	No	216 (52.3)	60	156	1
	Yes	197 (47.7)	148	49	7.85 (5.06–12.19)	<0.001
Feel fear of COVID-19	No	83 (20.1)	27	56	1
	Yes	330 (79.9)	181	149	2.52 (1.52–4.19)	<0.001
Feel that the consequences of getting COVID-19 could be serious	No	168 (40.7)	23	145	1
	Yes	245 (59.3)	185	60	19.44 (11.47–32.94)	<0.001
Know someone who had positive test results for SARS-CoV-2	No	207 (50.1)	64	143	1
	Yes	206 (49.9)	144	62	5.19 (3.41–7.89)	<0.001
Know someone who died from COVID-19	No	231 (55.9)	74	157	1
	Yes	182 (44.1)	134	48	5.92 (3.85–9.12)	<0.001
Travel outside the country	No	381 (92.3)	189	192	1
	Yes	32 (7.7)	19	13	1.49 (0.71–3.09)	0.291
Money-counting techniques	Using saliva	54 (13.1)	17	37	1
	Using chemical	188 (45.5)	101	87	2.53 (1.33–4.80)	0.005
	Using water	75 (18.2)	45	30	3.27 (1.56–6.82)	0.002
	Don’t use any liquid	96 (23.2)	45	51	1.92 (0.95–3.87)	0.068
Keep physical distance from coworkers	No	275 (66.6)	130	145	1
	Yes	138 (33.4)	78	60	1.45 (0.96–2.19)	0.077
Keep physical distance from customers	No	271 (65.6)	130	141	1
	Yes	142 (34.4)	78	64	1.32 (0.88–1.99)	0.180
Comfortable wearing facemask	No	259 (62.7)	80	179	1
	Yes	154 (37.3)	128	26	11.02 (6.70–18.11)	<0.001
Communication interference caused by facemask	No	158 (38.3)	125	33	7.85 (4.93–12.49)	<0.001
	Yes	255 (61.7)	83	172	1
Facemask leaves marks on face	No	277 (67.1)	143	134	1.17 (0.77–1.76)	0.465
	Yes	136 (32.9)	65	71	1

1, reference category; COR, crude odds ratio; CI, confidence interval.

Medical history-related and COVID-19 source-of-information factors

Less than one-third 112 (27.1%) of bank workers had presence of a respiratory condition and about one-fifth 80 (19.4%) had a chronic illness. From a total of 318 respondents who had received health information about COVID-19, 257 (80.82%) received it from television, radio or newspaper, 112 (35.22%) from health care providers, 213 (66.98%) from social media and 159 (50%) from friends. About three-fourths 300 (74.8%) of bank workers had received training on COVID-19, whereas 104 (25.2%) had not received training about COVID-19. Thirty-seven respondents had taken training about COVID-19 on only one occasion from a total number of respondents of 104 who got the training (Table 5).

Table 5

Medical history-related and COVID-19 source-of-information factors and bivariable analysis with facemask-wearing behaviors among bank workers in Dessie City, Ethiopia, January 2021.

Variables	Categories	Frequency	Facemask-wearing behavior		COR (95% CI)	p-value
		n (%)	Good	Poor
Presence of respiratory condition	No	301 (72.9)	145	156	1
	Yes	112 (27.1)	63	49	1.38 (0.89–2.14)	0.145
Presence of chronic illness	No	333 (80.6)	155	178	1
	Yes	80 (19.4)	53	27	2.25 (1.35–3.76)	0.002
Training on COVID-19	No	309 (74.8)	125	184	1
	Yes*	104 (25.2)	83	21	5.82 (3.43–9.88)	<0.001
Given health information on COVID-19	No	95 (23.0)	20	75	1
	Yes**	318 (77.0)	188	130	5.42 (3.16–9.32)	<0.001

1, reference category; COR, crude odds ratio; CI, confidence interval.

*Thirty-seven respondents had taken training about COVID-19 on only one occasion from a total number of respondents of 104 who got the training.

**257 (80.82%) received it from television, radio and newspaper, 112 (35.22%) from health care providers, 213 (66.98%) from social media and 159 (50%) from friends.

Multivariable logistic regression analysis

From a total of 28 variables with p<0.25 that were entered to multivariable logistic regression (MLR) analysis model, five variables were found to have significant and independent association with facemask-wearing behavior. The main findings of this study showed that female respondents were 1.87 times (AOR = 1.87; 95%CI: 1.06–3.32) more likely to wear a facemask compared to male workers, those 35 years of age or over were 9.25 times (AOR = 9.25; 95%CI: 4.79–17.88) more likely to wear a facemask than those who were 18–34. Those having a high level of positive attitude towards taking precautions against COVID-19 were 3.27 times (AOR = 3.27; 95%CI: 1.75–6.11) more likely to wear a facemask compared to those having a low level of positive attitude towards taking precautions against COVID-19 (Table 6).

Table 6

Factors associated with facemask-wearing behavior from multivariable logistic regression analysis among bank workers in Dessie City, Ethiopia, January 2021.

Variables	Categories	Facemask-wearing behavior		AOR (95% CI)	p-value
		Good	Poor
Sex of respondent	Male	90	143	1
	Female	118	62	1.87 (1.06–3.32)	0.031
Age of respondent (years)	18–34	64	183	1
	> = 35	144	22	9.25 (4.79–17.88)	<0.001
Attitude towards taking precautions against COVID-19	Low level of positive attitude	46	159	1
	High level of positive attitude	162	46	3.27 (1.75–6.11)	<0.001
Feel that the consequences of getting COVID-19 could be serious	No	23	145	1
	Yes	185	60	4.87 (2.38–9.94)	<0.001
Know someone who had positive test results for SARS-CoV-2	No	64	143	1
	Yes	144	62	1.91 (0.96–3.80)	0.067
Know someone who died from COVID-19	No	74	157	1
	Yes	134	48	0.48 (0.22–1.04)	0.063
Presence of chronic illness	No	155	178	1
	Yes	53	27	2.19 (1.07–4.48)	0.032

AOR, adjusted odds ratio; CI, confidence interval; 1, reference category.

Furthermore, bank workers who felt that the consequences of getting COVID-19 could be serious were 4.87 times (AOR = 4.87; 95%CI: 2.38–9.94) more likely to wear a facemask compared to those who didn’t feel that the consequences of getting COVID-19 could be serious, and the odds of wearing a facemask among those participants having a chronic illness were 2.19 times (AOR = 2.19; 95%CI: 1.07–4.48) higher than those who did not have a chronic illness (Table 6).

Discussion

In this institution-based cross-sectional study conducted to determine factors related to the behavior of facemask wearing among public and private bank workers of Dessie City, it was found that 50.4% of respondents had good facemask-wearing behavior and that the behavior of facemask wearing among bank workers was significantly associated with female sex, age being > = 35 years, having a high level of positive attitude towards taking precautions against COVID-19, feeling that the consequences of getting COVID-19 could be serious, and presence of chronic illness.

Facemask-wearing behavior among bank workers in this study was 50.4%. This result is similar to the findings of a study among primary school students in Wuhan, China 51.6% [28], 50.0% found in study by Barasheed et al. [29], and 54.68% found in a study done on taxi drivers in Dessie City and Kombolcha Town [30]. This similar result of studies on facemask-wearing behavior may be due to similarity of study sources being from institutions.

Facemask-wearing behavior was found to be lower in this study than in a study done in Brazil where it was 95.5% [7], in Nigeria where it was 64.5% [31], and in Hong Kong where wearing masks in public was found to be 94.3% [32]. In a South Korean study, 63.2% reported always wearing a face mask when outside [33] while 97.9% used a facemask in a community in China [34]. Overall, 61.2% of respondents reported consistent use of a facemask to prevent SARS in Hong Kong [35] and in China, nearly all of the participants (98.0%) wore a facemask when going out [25]. Mask mandates enacted in the United States of America in late July and August increased mask-wearing compliance to over 90% in all groups of population [36]. The reason for facemask wearing to be lower in our study may be due to the fading of government pressure that occurred early in the pandemic to wear a facemask and the ceasing of punishment of those who did not. The difference may also be due to factors such as different study area and study period.

But the behavior of facemask wearing in this study was higher than found in a study in Japan where it was 38% [37], and in Ghana where 31.5% of the students wore a facemask often or always [38]. This may be due to a lack of action being taken to improve rates in areas where facemask-wearing behavior is low. And individuals may not understand that facemask use could result in a large reduction in risk of infection.

In our study, bank workers who were female had 1.87 times greater chance of wearing a facemask. There are similar studies showing that being a woman increased the likelihood of wearing facemasks in Wuhan, China (p<0.001) (29), and in Brazil [7]. Women were more likely to practice these behaviors than men (p<0.001) in other studies also [35,36]. The odds of an individual wearing a mask increased significantly with female sex and were 1.5-times greater for females than males, according to a study in America [36]. Participants who were male were less likely to implement preventive measures including facemask wearing in Hong Kong [33]. This may be because women worry more than men about COVID-19 disease for themselves, their families and for individuals with whom they have contact.

This study shows that respondents whose age was > = 35 years were 9.25 times more likely to have good facemask-wearing behavior. Older adults are likely to have better COVID-19 preventive practices than younger people [39]. The odds of an individual wearing a mask increased significantly with age [7]. And those in an older age group of 50–59 years were more likely to wear a facemask [35]. Older individuals are more highly vulnerable to getting a serious case of COVID-19 compared to younger people, which may be the reason for older people protecting themselves from exposure by having good facemask-wearing behavior.

In this study, those with a perception of serious consequences of getting COVID-19 had 4.87 times higher chance of practicing facemask-wearing behavior. A study done on perception and practices during the COVID-19 pandemic in an urban community in Nigeria revealed that a perception of the likelihood of contracting COVID-19 was a factor for applying COVID-19 preventive measures [31]. From a study conducted on barriers to mask wearing for influenza-like illnesses among urban Hispanic households, the perception of the risk of disease was one factor [40].

Perceived fatality, efficacy of wearing facemasks, and mental distress because of influenza A/H1N1 were associated with facemask use in public areas (AOR, 1.53 to 2.52) [41]. Correlation results indicated that perceived risk was related to preventive behaviors like facemask wearing [42]. Participants who perceived a lower risk of being infected were less likely to implement preventive measures such as facemask wearing [32]. This perception of risk of getting the disease became a factor for wearing facemask due to the fact that a person who perceives risk tries to use preventive techniques to protect him- or herself.

This study also shows that bank workers with a chronic illness were 2.19 times more likely to wear a facemask. People with chronic diseases are important populations to consider with respect to the current wide-spread recommendation for facemask use; for example, wearing either a half-mask respirator or an N95 mask among individuals with mild pulmonary diseases including asthma, chronic rhinitis, and chronic obstructive pulmonary disease (COPD) may be considered [43].

Based on the wide range of chronic diseases and severity of each person’s disease, the decision to wear a mask will likely need to be made individually and with consultation from a physician, given the individual’s particular circumstances. Individuals with pre-existing chronic diseases such as diabetes, hypertension and obesity (metabolic syndrome) are at an increased risk of hospitalization and mortality with COVID-19 [44]. This underscores the importance of wearing masks to help protect this vulnerable population. That said, if an individual with a chronic disease is unable to safely wear a mask, the responsibility may fall to other healthy individuals to wear masks to protect the vulnerable [43].

Limitations of the study

Limitations of the study include the fact that we did not observe the home environment of the workers, which limited our ability to examine COVID-19 prevention in their living environment. In addition to this, the scarcity of COVID-19-related studies on the behavior of facemask wearing among bank workers forced us to use other studies conducted in different source populations at institutions and at community levels, which reduces the strength of the discussion.

The data collection being self-administered for the sake of COVID-19 prevention and the short time workers had to respond might have biased the self-reported data. Besides these limitations, overall, this study can provide appropriate information about bank workers in Dessie City regarding facemask-wearing behavior, especially at their work sites where they have contact with many people while providing service for customers. It also supports the need for measures to help bank workers wear facemasks and for bank managers to enforce the wearing of facemasks to prevent COVID-19 transmission.

Conclusion

The main finding of the study was that the behavior of facemask wearing among bank workers was relatively low at 50.4%, and the factors significantly associated with good facemask-wearing behavior among the bank workers were sex, age, attitude towards taking precautions against COVID-19, perception towards getting COVID-19 (felt that the consequences of getting COVID-19 could be serious) and chronic illness.

We recommended that concerned individuals should play their part to increase behavior of facemask wearing among bank workers to minimize the spread of COVID-19. This includes health decision makers who should develop updated guidance for bank workers on the use of facemasks; bank managers who are responsible to address different types of facemasks in reducing both inhaled and surface transmission, to change the behavior of workers towards COVID-19 to reduce the risk of transmission and to enforce wearing of facemasks by workers.

Researchers are recommended to use other strong research designs to perform further study on what control measures are likely to be most effective both to protect workers and to prevent workers spreading disease in the workplace, including banks, and also to protect population as a whole, since bank workers are part of the community; although some variables apply only to bank workers, many of the variables addressed by this study may apply to the general population also.

English version of the questionnaire.

(DOCX)

Click here for additional data file.

Amharic (local language) version of the questionnaire.

(DOCX)

Click here for additional data file.

(XLSX)

Click here for additional data file.

15 Jun 2021

PONE-D-21-11265

Facemask wearing behavior to prevent COVID-19 and associated factors among bank workers in Dessie City, Ethiopia

PLOS ONE

Dear Dr. Hassen,

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PLOS ONE

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2.  Please amend your current ethics statement to address the following concerns: Please explain why written consent was not obtained, how you recorded/documented participant consent, and if the ethics committees/IRBs approved this consent procedure."

3. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information.  If the original language is written in non-Latin characters, for example Amharic, Chinese, or Korean, please use a file format that ensures these characters are visible."

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Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: Yes

Reviewer #2: Yes

**********

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Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: 1. P4, line 76: there should be a period after the citation.

2. P5, line 89: I suggest to combine the paragraph beginning with “cases of COVID-19” with the first paragraph as these two paragraphs were more closely related, which introduced the situation of COVID-19 pandemic

3. The introduction should provide information about the preventive measures in the Dessie City. Many countries have implemented massive preventive measures to contain the spread of COVID-19 such as lockdown, social distancing, and face-masking wearing in all public venues. Any preventive measures in the investigated city? Is it mandatory? Such background information should be introduced to help readers understand the situation.

4. Any similar COVID-19 research among bank workers (e.g., the prevalence of COVID-19 infection or prevalence of preventive measures in this population)? I think the introduction should give more discussion about this specific population.

5. P6, line 109: as this study was only conducted in the Dessie city, I suggest to describe the COVID-19 situation in Dessie city during the time of investigation.

6. P7, line 31: what about the proportion of randomly selected participants from each back?

7. The author should provide more information about the measurements, e.g., the reliability of the used scales and whether these scales have been used in previous studies or they were self-constructed items. I suggest to add an appendix about the measurements as it was only briefly mentioned in the text.

8. P13, line 277: there should be a period after the citation.

9. Did the participants know they would have a survey about face-masking in advance? This might have an influence on their face-masking behavior due to social desirability. The author may discuss this point.

10. There are some spelling errors (e.g., p12 line 252, it should be "showed"). The author should have a careful check.

11. For discussion, the author should consider the local context and local COVID-19 situation to discuss and interpret the findings as the study was conducted in a single city. The generability of findings should also be discussed.

Reviewer #2: This is an interesting study exploring the associated factors of mask wearing behaviours among bank workers. However, substantial revision is suggested. My major comments are listed below:

1. It is suggested further elaborating on the high risk of COVID-19 infection/transmission and thus needs for targeted health promotion among this population. Now the authors only mentioned that these workers have frequent direct or indirect contact with the public, however, this also applies to many other types of workers in the service industry. It is not clear how the findings would contribute to the extant literature.

2. Although the study focused on a special population group, the studied factors are quite general. To inform the development of tailored promotion strategies among this population, more bank worker-specific factors should be included, such as some contextual factors regarding protection measures provided in the working environment. It shall be mentioned somewhere in the Discussion that how the identified relationships are different from/consistent with those found among general population or other working population.

3. Now the measures of knowledge and attitudes were dichotomized for analysis based on the mean score of the sample rather than a more valid and meaningful cut-off point. I suggest treating them as the original continuous variables as dichotomization itself caused loss of information and reporting the reliability alpha for the attitude scale as well. Also, it is not suggested defining those with higher scores as “positive attitudes” and those with lower scores as “negative attitudes”, as the valence of attitude shall be inherently determined by the measurement items, for example, there are both positive and negative attitudes toward mask wearing.

4. The study explored the use of “non-medical mask” which is good, but please clarify a bit whether the measure of “facemask wearing behaviour” captured this aspect when defining good behaviour of facemask wearing. Please also clarify that whether this behaviour was self-reported or objectively observed by the interview fieldworkers.

5. The study used “cluster random sampling” but not “simple random sampling”, please revise the related parts accordingly. The selected banks shall be included as a covariate in the analysis or multilevel regression models shall be used for handling such clustered data.

6. Table 1-5 shall be combined into one table to make the presentation more succinct.

**********

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Reviewer #1: No

Reviewer #2: No

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13 Jul 2021

Line-by-line response to reviewers

We would like to express our gratitude to the academic editor and both reviewers for their comments and ideas. We revised the manuscript and our responses are here below.

For journal office requirements

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming.

Response: - Thank you for this key comment. We formatted the manuscript according to PLOSE ONE author’s guidelines.

2. Please amend your current ethics statement to address the following concerns: Please explain why written consent was not obtained, how you recorded/documented participant consent, and if the ethics committees/IRBs approved this consent procedure."

Response: - Sorry for the confusion we created during writing the ethical statement. We already used written consent based on the decisions of ethical review board committee of Wollo University College of Medicine and Health Science.

3. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information. If the original language is written in non-Latin characters, for example Amharic, Chinese, or Korean, please use a file format that ensures these characters are visible."

Response: - Thank you for these key comments. As supporting information, we provided the questionnaire by original language and local language version.

4. Please state whether you validated the questionnaire prior to testing on study participants. Please provide details regarding the validation group within the methods section.

Response: - As discussed in the data quality assurance to keep the validity of the questionnaire, we developed the questionnaire from different published literature and COVID-19 related reports to make it more available. We did a pre-test for the questionnaire before data collection to improve the content of the questionnaire (Please see the revised version in page 9 from lines 186-189).

Response to reviewer #1

1. P4, line 76: there should be a period after the citation.

Response: - Sorry for this error. We accepted the comment and it’s corrected.

2. P5, line 89: I suggest to combine the paragraph beginning with “cases of COVID-19” with the first paragraph as these two paragraphs were more closely related, which introduced the situation of COVID-19 pandemic.

Response: Thank you and we updated accordingly. (You can see lines 93 for the improvement.)

3. The introduction should provide information about the preventive measures in the Dessie City. Many countries have implemented massive preventive measures to contain the spread of COVID-19 such as lockdown, social distancing, and face-masking wearing in all public venues. Any preventive measures in the investigated city? Is it mandatory? Such background information should be introduced to help readers understand the situation.

Response: Thank you for the very important comments. We included those preventive measures in the introductory part. (Please see in page 4 from lines 77-79 for the improvement.)

4. Any similar COVID-19 research among bank workers (e.g., the prevalence of COVID-19 infection or prevalence of preventive measures in this population)? I think the introduction should give more discussion about this specific population.

Response: Although we appreciate the comments, we are unable to find out any study on prevalence and preventive measures of COVID-19 in this study population before this study is conducted. We mentioned this gap in the background section of the last paragraphs (from line 109-111) and that is way this study was conducted.

5. P6, line 109: as this study was only conducted in the Dessie city, I suggest to describe the COVID-19 situation in Dessie city during the time of investigation.

Response: - Thank you; we described the situation of COVID-19 in Dessie city. (please see line 100 and 101 of page 5)

6. P7, line 31: what about the proportion of randomly selected participants from each back?

Response: - The numbers of workers were taken from attendance sheets in each selected branch by proportionally determining how much samples to be taken from each branch. After getting their number, samples were taken randomly from the sheet first by allocating the entire sample proportionally to the total number of workers in the selected bank branches using proportional allocation.

7. The author should provide more information about the measurements, e.g., the reliability of the used scales and whether these scales have been used in previous studies or they were self-constructed items. I suggest adding an appendix about the measurements as it was only briefly mentioned in the text.

Response: - we tried to elaborate the reliability of the questionnaire as well as the scales used in line with previous used studies as a reference in ‘Data collection procedures and quality assurance ’ part of the manuscript.

8. P13, line 277: there should be a period after the citation.

Response: - corrected

9. Did the participants know they would have a survey about face-masking in advance? This might have an influence on their face-masking behavior due to social desirability. The author may discuss this point.

Response: - They are told about the objective of the study therefore they know about face-masking since one objective is addressing face-mask wearing behavior of respondents, but we minimize social desirability bias by observing utilization of facemask at the time of data collection.

10. There are some spelling errors (e.g., p12 line 252, it should be "showed"). The author should have a careful check.

Response: - We corrected all these spelling errors

11. For discussion, the author should consider the local context and local COVID-19 situation to discuss and interpret the findings as the study was conducted in a single city. The generality of findings should also be discussed.

Response: - The reason for using COVID-19 situation at global level and study area other than bank was scarcity of COVID-19 related studies on the behavior of facemask wearing among bank workers at local level.

For reviewer #2

1. It is suggested further elaborating on the high risk of COVID-19 infection/transmission and thus needs for targeted health promotion among this population. Now the authors only mentioned that these workers have frequent direct or indirect contact with the public, however, this also applies to many other types of workers in the service industry. It is not clear how the findings would contribute to the extant literature.

Response: - Starting from the title the target of the study is on bank workers even if there are other sectors that have direct or indirect contact with many peoples. Additional reasons were also included in the manuscript.

2. Although the study focused on a special population group, the studied factors are quite general. To inform the development of tailored promotion strategies among this population, more bank worker-specific factors should be included, such as some contextual factors regarding protection measures provided in the working environment. It

shall be mentioned somewhere in the Discussion that how the identified relationships are different from/consistent with those found among general population or other working population.

Response: - Despite the fact that general factors were included in the research, this study also included specific factors to analyze the bank environment and bank personnel.

3. Now the measures of knowledge and attitudes were dichotomized for analysis based on the mean score of the sample rather than a more valid and meaningful cut-off point. I suggest treating them as the original continuous variables as dichotomization itself caused loss of information and reporting the reliability alpha for the attitude scale

as well. Also, it is not suggested defining those with higher scores as “positive attitudes” and those with lower scores as “negative attitudes”, as the valence of attitude shall be inherently determined by the measurement items, for example, there are both positive and negative attitudes toward mask wearing.

Response: - The reason for using mean for categorizing continuous variables of knowledge and attitude is to get appropriate number of responses. And this method was used by other several published COVID-19 papers. The other reason for using the mean is when other way of classification was applied we faced less observation which can’t allow as for further analysis.

4. The study explored the use of “non-medical mask” which is good, but please clarifies a bit whether the measure of “facemask wearing behavior” captured this aspect when defining good behavior of facemask wearing. Please also clarify that whether this behavior was self-reported or objectively observed by the interview fieldworkers.

Response: - Our criteria for saying good/poor behaviors of face mask wearing; not include type of face mask used as operationally defined, but this descriptive data were collected based on self-reported data since there were respondents who don’t were face mask at the time of data collection.

5. The study used “cluster random sampling” but not “simple random sampling”, please revise the related parts accordingly. The selected banks shall be included as a covariate in the analysis or multilevel regression models shall be used for handling such clustered data.

Response: -There was no clustering applied in this study, the only reason for saying government and private bank was to describe and see the difference if any among the two. Like other variables used which were expected to be a factor or not. Simply we select 50% of the bank branches randomly either from government or private and the workers were selected by proportionally allocating their number in that selected branch.

6. Table 1-5 shall be combined into one table to make the presentation more succinct.

Response: -If we merge the 5 tables as one Table, it becomes very large and bulky to understand it.

We would be happy to make further corrections if necessary and look forward to hearing from you all soon.

I hope that the revised manuscript is accepted for publication in PLoS ONE.

Submitted filename: Response to Reviewers.docx

Click here for additional data file.

25 Aug 2021

PONE-D-21-11265R1

Facemask wearing behavior to prevent COVID-19 and associated factors among bank workers in Dessie City, Ethiopia

PLOS ONE

Dear Dr. Hassen,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Oct 09 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

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If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Zixin Wang, PhD.

Academic Editor

PLOS ONE

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Additional Editor Comments (if provided):

I noticed that some comments raised by Reviewer 2 were not addressed during the revision. The authors should address all comments raised by the reviewers.

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Reviewers' comments:

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Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: The authors have addressed some of my previous comments, but the others are left unsolved.

First, please discuss the generalizability of the findings to general population and other work populations. Please refer to my previous #2 comment.

Second, regarding my previous #3 comment, 1) I suggest not defining those with higher scores as “positive attitudes” and and those with lower scores as “negative attitudes”. Instead, high/low level of attitudes can be used; 2) Please report the reliability alpha for the attitude scale. This is necessary even if a dichotomized form was used for analysis.

Third, regarding my previous #4 comment, necessary information has been provided by the authors, please also include it in the manuscript, e.g., the measure of facemask wearing behavior” captured whether wearing a facemask of any type; and it is a self-reported measure.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Rui She

Reviewer #2: No

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15 Sep 2021

Response to editor and reviewer #2

We would like to express our gratitude to the academic editor and both reviewers for their comments and ideas for the first revision. We revised the manuscript for the second time and our responses are here below.

Additional editor comments

1. “I noticed that some comments raised by reviewer 2 were not addresses during the revision. The author should address all comments raised by the reviewers”

Response: - Thank you for this main comment for second revision. We see all the comments that were not seen.

For reviewer #2

1. First, please discuss the generalizability of the findings to general population and other work population. Please refer to my previous #2 comment.

Response: - Since the study includes both variables for the general population and specific variables for bank workers we can show the generalizability of the study can be for bank workers as well as for the general population. This generalizability of the study was indicated in the manuscript, line 375-378 of page 17.

2. Second, regarding my previous #3 comment, 1) I suggest not defining those with higher scores as “positive attitude” and those with lower scores as “negative attitude”. Instead, high/low level of attitudes can be used; 2) please report the reliability alpha for the attitude scale. This is necessary even if a dichotomized form was used for analysis.

Response: - It was corrected as high/low level of attitude, changed in all parts in the manuscript and Cronbach alpha or reliability alpha coefficient for attitude was 0.87.

3. Third, regarding my previous #4 comment, necessary information has been provided by the authors, please also include it in the manuscript, e.g., the measure of facemask wearing behavior” captured whether wearing a facemask of any type; and it is a self-reported measure.

Response: - Thank you for all your comments and suggestion, it was indicated in line 197-204, page 9&10 of the manuscript.

We would be happy to make further corrections if necessary and look forward to hearing from you all soon.

I hope that the revised manuscript is accepted for publication in PLoS ONE.

Submitted filename: Response to Reviewers second.docx

Click here for additional data file.

25 Oct 2021

Facemask wearing behavior to prevent COVID-19 and associated factors among bank workers in Dessie City, Ethiopia

PONE-D-21-11265R2

Dear Dr. Hassen,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Zixin Wang, PhD.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

19 Nov 2021

PONE-D-21-11265R2

Facemask-wearing behavior to prevent COVID-19 and associated factors among Public and Private Bank Workers in Ethiopia

Dear Dr. Hassen:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

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on behalf of

Professor Zixin Wang

Academic Editor

PLOS ONE