Gender differences in health protective behaviours and its implications for COVID-19 pandemic in Taiwan: a population-based study

  1. Jasmine Tan
  2. Yilin Yoshida
  3. Kevin Sheng-Kai Ma
  4. Franck Mauvais-Jarvis
  5. Chien-Chang Lee

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Abstract

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection produces more severe symptoms and a higher mortality in men than in women. The role of biological sex in the immune response to SARS-CoV-2 is believed to explain this sex disparity. However, the contribution of gender factors that influence health protective behaviors and therefore health outcomes, remains poorly explored.

Methods

We assessed the contributions of gender in attitudes towards the COVID-19 pandemic, using a hypothetical influenza pandemic data from the 2019 Taiwan Social Change Survey. Participants were selected through a stratified, three-stage probability proportional-to-size sampling from across the nation, to fill in questionnaires that asked about their perception of the hypothetical pandemic, and intention to adopt health protective behaviors.

Results

A total of 1,990 participants (median age = 45·92 years, 49% were women) were included. Significant gender disparities (p < .001) were observed. The risk perception of pandemic (OR = 1·28, 95% CI [1·21 − 1·35], p < .001), older age (OR = 1·06, 95% CI [1·05 − 1·07], p < .001), female gender (OR = 1·18, 95% CI [1·09-1·27], p < .001), higher education (OR = 1·10, 95% CI [1·06 − 1·13], p < .001), and larger family size (OR = 1·09, 95% CI [1·06 − 1·15], p < .001) were positively associated with health protective behaviors. The risk perception of pandemic (OR = 1·25, 95% CI [1·15 − 1·36]), higher education (OR = 1·07, 95% CI [1·02 − 1·13], p < .05), being married (OR = 1·17, 95% CI [1·01–1·36, p < .05), and larger family size (OR = 1·33, 95% CI [1·25 − 1·42], p < .001), were positively associated with intention to receive a vaccine. However, female gender was negatively associated with intention to receive a vaccine (OR = 0·85, 95% CI [0·75 − 0·90], p < ·01) and to comply with contact-tracing (OR = 0·95, 95% CI [0·90 − 1·00], p < .05) compared to men. Living with children was also negatively associated with intention to receive vaccines (OR = 0·77, 95% CI [0·66 − 0·90], p < .001).

Conclusion

This study unveils gender differences in risk perception, health protective behaviors, vaccine hesitancy, and compliance with contact-tracing using a hypothetical viral pandemic. Gender-specific health education raising awareness of health protective behaviors may be beneficial to prevent future pandemics.

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  1. Version published to 10.1186/s12889-022-14288-1
  2. ScreenIT

    SciScore for 10.1101/2021.04.14.21255448: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: Written informed consent was obtained from each respondent.
    IRB: The ethics committees/institutional review boards of the Academia Sinica, Taiwan approved this study and the consent procedure.
    Sex as a biological variableEach dimension was treated as a dependent variable for multivariate analysis to examine the difference between men and women.
    RandomizationRespondent was randomly selected by methods of clustering and systematic sampling.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The findings of this study should be considered in the context of certain limitations. First, the study population only included participants from Taiwan, and the findings may not be generalizable to other populations. However, the three stage random sampling procedures, face-to-face interviews and validation of TSCS provided a valuable insight into the whole population residing in Taiwan.36 Second, the measurement of household members relied on participants’ characteristics and the questionnaire did not measure the relationship between gender and family, such as by asking men and women separately about whether they felt worried about the effect of pandemic on their household members.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.04.14.21255448v1 on medRxiv