Reducing touching eyes, nose and mouth ('T-zone') to reduce the spread of infectious disease: A prospective study of motivational, volitional and non-reflective predictors

• Published in: British journal of health psychology 2023-11, Vol.28 (4), p.893-913
• Main Authors: Wilson, Mackenzie, van Allen, Zachary M, Grimshaw, Jeremy M, Brehaut, Jamie C, Durand, Audrey, Lalonde, Jean-François, Manuel, Douglas G, Michie, Susan, West, Robert, Presseau, Justin
• Format: Article
• Language: English
• Subjects: Action planning; Automaticity; Behavior; Coping strategies; Efficacy; Infectious diseases; Mouth; Prevention; Psychological aspects; Questionnaires; Risk perception; Social support; Sociodemographics; Touch
• ISSN: 1359-107X; 2044-8287
• DOI: 10.1111/bjhp.12660

The route into the body for many pathogens is through the eyes, nose and mouth (i.e., the 'T-zone') via inhalation or fomite-based transfer during face touching. It is important to understand factors that are associated with touching the T-zone to inform preventive strategies. To identify theory-informed predictors of intention to reduce facial 'T-zone' touching and self-reported 'T-zone' touching. We conducted a nationally representative prospective questionnaire study of Canadians. Respondents were randomized to answer questions about touching their eyes, nose, or mouth with a questionnaire assessing 11 factors from an augmented Health Action Process Approach at baseline: intention, outcome expectancies, risk perception, individual severity, self-efficacy, action planning, coping planning, social support, automaticity, goal facilitation and stability of context. At 2-week follow-up, we assessed HAPA-based indicators of self-regulatory activities (awareness of standards, effort, self-monitoring) and self-reported behaviour (primary dependent variable). Of 656 Canadian adults recruited, 569 responded to follow-up (87% response rate). Across all areas of the 'T-zone', outcome expectancy was the strongest predictor of intention to reduce facial 'T-zone' touching, while self-efficacy was a significant predictor for only the eyes and mouth. Automaticity was the strongest predictor of behaviour at the 2-week follow-up. No sociodemographic or psychological factors predicted behaviour, with the exception of self-efficacy, which negatively predicted eye touching. Findings suggest that focusing on reflective processes may increase intention to reduce 'T-zone' touching, while reducing actual 'T-zone' touching may require strategies that address the automatic nature of this behaviour.