A cross sectional survey of personal hygiene positive behaviour related to COVID-19 prevention and control among Indonesian communities

Fatma Lestari (  fatma@ui.ac.id ) Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia Abdul Kadir Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia Muhammad Idham Indonesia National Occupational Safety & Health Council Fahrul Azwar Indonesia National Occupational Safety & Health Council Ganis Ramadhany Indonesia National Occupational Safety & Health Council Fredy Sembiring Indonesia National Occupational Safety & Health Council Ghazmahadi Ghazmahadi Indonesia National Occupational Safety & Health Council Abdul Hakim Indonesia National Occupational Safety & Health Council Robiana Modjo Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia Baiduri Widanarko Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia Yuni Kusminanti Occupational Safety, Health and Environmental Unit (OSHE), Universitas Indonesia

The research was conducted based on study design of a cross sectional survey. The respondents of this survey were from 32 provinces in 6 (six) mainlands in Indonesia which derived from Indonesia National Safety & Health Council network and Universities network. Data were collected using an online survey questionnaire. The survey was conducted from 31 st April to 29 th May 2020, a period at which most of provinces in Indonesia particularly in Java Island was endorsed to stay home based on the government of provinces policy to conduct limited Large Scale Social Restrictions or PSBB (Pembatasan Sosial Berskala Besar). In order to ensure the validity and accuracy of the data collected, the instruments were validated and check its reliability by conducted a preliminary survey. All subjects have been informed about the survey objectives, the bene t of the survey for the community, and signed a written informed consent prior to voluntarily join the study. Informed consents consist of the information of the purposed of study, ethical approval, and terms of condition. The researchers applied the informed consent during the study with the principle of bene cial, no harm, con dential, justice and voluntary participants. Hence, several information should be agreed by participants prior data collection. Particularly, if the participant under 18 years old, those have to ask permission to their parent or legal guardian. If it does not meet the criteria, the system automatically stops the survey. The informed consent has been describe in details during the Ethics Approval and Consent before the study conducted, and has been approved under the Ethics Approval Letter from Ethics Committee Faculty of Public Health, Universitas Indonesia Number: Ket-435/UN2.F10.D11/PPM.00.02/2020. Hence, all methods for this study were performed in accordance with the relevant guidelines and regulations of ethical committee. No animal and human body handling were involved for this present study.
Questionnaire A self-reported questionnaire of Coronavirus prevention and control was administrated by researchers and distributed using google forms: http://tiny.cc/z0d7lz [see additional File 1]. The questionnaire consists of 5 parts: 1) demographic information (age, gender, occupation, provinces, and hometown in JABODETABEK, where the vibrant area in Indonesia); 2) activities during COVID-19 pandemic (type of work, indoor and outdoor activities); 3) personal hygiene (the use of masker, disinfectant, hand sanitizer, behavior in touching face, and hand-washing); 4) the perception of COVID-19; 5) the source of COVID-19 related information and supporting aspects in facing COVID-19. As a guideline for developing a survey tools, the study referred to Covid-19 Prevention and control protocol published by Ministry of Health of Indonesia. The link of questionnaire, then, had been shared through Indonesia National Safety Council network, universities network, and shared on social media such as online website, Facebook, Instagram, and WhatsApp.
Data and Statistical Analysis SPSS 24.0 was utilized to compute and analyse the data. The descriptive and binary variables were performed as a percentage. Regarding the questionnaire of perception of COVID-19 which had been developed as Linkert scales (strongly not suitable -strongly appropriate), the validity and reliability were tested. As a r statistics or correlated itemcorrelation > r table (0.4438) (CI:95%) and Cronbach's Alpha=0.903, it means that the items of questionnaire had a good concurrent validity. In addition, Chi-square test was performed to determine whether there is a signi cant relationship between categorical variables for characteristic of demographic and personal hygiene based on p value < 0.05 and odds ratio (OR) with 95% con dential interval (CI).

Ethical Consideration
The study was reviewed and approved by the ethics committee of the Research and Community Engagement of Faculty of Public Health, Universitas Indonesia under Ethics Approval Letter No: Ket-435/UN2.F10.D11/PPM.00.02/2020.

Subjects Demographic Characteristics
The total of 784 subjects were responded in this survey. After ltering and cleaning the data, 771 valid questionnaires were obtained and 13 samples were excluded because of inappropriate responses. The participants originated from 32 of 34 provinces that lived in 6 main islands of Indonesia, the majority were Java (69.6%) and non-Java (30.4%). The majority respondents derived from the area in Java particularly they were based on Jakarta 153 (19.8%), West Java, 152 (19.7%), East Java 91 (11.8%) and Yogyakarta 80 (10.4%), while the majority of participant in non-Java island was Sumatera (14.1%). The mean age was >35 years (Standard Deviation: 1.94). In addition, the participants were relatively almost balance between male and female, which was cited at 50.1% and 49.9% respectively. The most participant were employment (69.9%) and worked in private companies (24.4%). 55.5% of participants stayed at the centre of Indonesia, which is JABODETABEK (Jakarta, Bogor, Depok, Tangerang, Bekasi). Table 1. below depicts the characteristic of study respondents in detail:  (Table 2). Moreover, respondents stated that working (30%), cooking (24%), studying (19%) and online lecturer (13%) were the main indoor activities (Figure 1).

Personal Hygiene Factors
It has been observed that a positive behaviour has been implemented as a good personal hygiene practices at individual level (Table 3). There were 96.8% of participants wearing a mask when travelling outside or to another place. However, participants stated that sometimes they do not wear a mask (3.2%). The majority of mask were cloth based, it was cited at 73% ( Figure 3). Furthermore, with the objectives of protecting their families from the corona virus, almost 67.3% of respondents employed disinfectant at their house with 1-2 times of spraying in a month ( Figure 4) and the antiseptic/sanitizer was brought during their activities (61%). Also, 40% of respondents declared to consume supplement during the pandemic ( Figure 5)  Figure 6. depicts the frequency and duration in holding an object surface. The majority of participants hold a door handle and desk more than 6 times a day with 37.2% and 28.1% respectively. Additionally, the duration of handling that objects were 3 seconds (71.6%) for former object and >7 second for latter object (37.9%). Regarding the use of handphone, 42% of respondents reported using their handphone more than 6 hour in a day ( Figure 7).
The frequent hand washing behaviour was shown on Figure 8. The results showed that 8.2% of participants did hand washing at least once in a day and maximum of >6x times (35.5%of respondents) after going to toilet. Also, 38.5% of participants practised hand washing for 3 times/day prior eating and approximately about 23% did it every return to home for 1-2 times a day. While it was also reported that 27% of participants did this personal hygiene implementation for >6 times in every touching and object. Figure 9. depicts the percentage of touching face among participated study. At least the respondents touched their part of face once in an hour, it was cited at 39% (hair), 53.2% (forehead), 57.2% (neck), 54.6% (ears), 47% (eyes), 51.4% (mouth), 53.7% (chin), and 47.3% and 43.8% for cheek and nose respectively.
Regarding the source information related to COVID-19 update, the government website of COVID19.GO.ID was the most media (64%) used by respondents, while the other platforms such as WhatsApp, Instagram, Facebook and Twitter was cited at 56%, 38% , 25% and 15% each. An active gure or in uencer that encourage participants to apply COVID-19 prevention was also observed, at least more than one responses was obtained. 43.4% of their parents was being the main role, 41.9% was the government, and 32.3% was the relative.

The Perception of COVID-19
In this survey 388 (50%) respondents thought that they understood the hazard and risk of COVID-19 derived from various resources, and 404 (52%) thought that they could classi ed the risky groups that need to be monitored regarding coronavirus disease (Table 4). Additionally, The participants applied the ethics of coughs and sneeze in avoiding the spread of droplet by covering with the hand or elbows, with strongly agree 362 (47%). Similarly, it can be seen that the participants was strongly agree in implementing social/physical distancing with 366 responses (48%). An average in the context of carrying a hand sanitizer, 354 (46%) respondents reported that they brought this item. Participants said that they changed immediately the clothes and soaked them with detergents when returned home with strongly agree of 339 (44%) and agree of 260 (33%). In contrast, 219 (28%) respondents disagree that they take a shower using warm water after returning home and only 238 (31%) respondents did not use special treatment on footwear 238 (31%). Furthermore, postman.  The association of sociodemographic characteristics and participants who take a trip to home town and type of work are shown in Table 5. There was signi cant correlation between gender and type of work. The OR of male was 1.99 times more likely (95% CI = 1.430-2.642, , p< 0.05) to work from o ce as opposed to female.   18 . Having said that, a basic principle of personal hygiene requires to be implemented in order to minimize the risk of COVID-19 transmission such as avoiding close contact with people from coronavirus infection, wearing mask and cough and sneezes with tissues or clothing as well as frequent handwashing 19 .
This cross sectional survey on 771 respondents found that the majority of the Indonesian community have been practiced good personal hygiene behaviour on their daily life towards the prevention to COVID-19 transmissions. Several best personal hygiene factors that reduce the transmission of COVID-19 have been implemented including the majority of the participants choose not to take travel to home town during the long holiday. Indeed, the participants knows that someone with frequent travelling, will increase the risk of coronavirus exposure 20 . This result is consistent with the ndings from previous studies that reduced people mobility will reduce the transmission of COVID-19 21,22 . It is indicated that the massive and aggressive health education performed by the government of Indonesia has been received well by the communities, especially the education and information shared daily by the Indonesian COVID-19 taskforce in collaboration with media pool press release.
Working from home policy has been effectively implemented since March 2020 after the pandemic declaration by the Indonesian President. Activities in the workplace has also being affected since the employees have to work from home. This research indicates that 67.3% of Indonesian people are performing their job remotely from home or work from home. International Labour Organization estimates that approximately 7.9% (260 million workers) of the world's workforce worked from home. Even though working from home can cause the decrease of physical activity and increase to high-risk exposure to screen exposure, which affect the sleep de ciencies 23 , yet this typical work is one of means to further physical distancing and strategy for mitigation in unemployment and keeping the dwellers safe 24 . Moreover, The quarantine, involving stay at home can effectively minimize the peak of pandemic as well as contribute in decrease the number of case by 25% 25 . However, outdoor activities can be found in the society such as shopping a grocery in the market or mall. At the beginning, the government has implemented a regulation of large social restriction, a part of enterprises and stores that provides a basic community's consumption. In managing covid-19 prevention in this sector, the Ministry of Trade has set up a circular instruction No. 12 of 2020 regarding the recovery of trading activities carried out during the pandemic coronavirus disease 2019 and new normal. When the communities want to ful l household need, even for those who cannot work from home, the way how communities travel by using a means of transportation is very important. Our ndings identi ed that the majority of participant preferred to drive using their private care (46.9%) or motorcycle (48.5%). Yet, it also has identi ed for those who took a public transportation such as online taxi, bus and commuter line rail. Transportation is being a concerned in the transmission of COVID-19. In addition, public transportation have an important role in the spread of COVID-19, particularly the risk in accordance with the connectivity, distance and destination 26 . In Indonesian context, a Minister of Transportation Regulation No. 18 of 2020 on Transportation Control to Prevent the spread of Coronavirus has been issued on 9 April 2020. One of the rules is the use of private and public motor cycle, involving application-based motorcycle taxi. It has implemented with strict requirement due to of PSBB by consideration of health protocol in preventing COVID-19 transmission 27 .
It is strongly advised in the emergence of the coronavirus to implement the health protocol and a strict self-protection.
Personal Protection Equipment (PPE) is one of hierarchy control that can be applied to eradicate COVID-19 28 .
Furthermore, the previous study reported that coronavirus might spread through aerosols from respiratory droplets 29 . The common protection used for respiratory infections such as novel coronavirus are masks and respirators with different indication for healthcare employees, illness patients and societies 30 . The masks are also worn to forbid pathogens entering respiratory tract by cutting the droplet transmission path directly 31 . Our ndings show that 96.8% of respondents worn the masks during their activities. This mask-wearing rates was similar nding with the study conducted in Japan with 99.4%, while in the South Korea was cited at 85.5% 32 . As far as types of masks used, cloth masks were the most dominant masks that worn by individuals (73%), while surgical masks and N95 also identi ed at 22% and 3% respectively. In fact, it has been undebatable for the effectiveness of cloth masks as there are a few research conducted on it. Some research nding shows that cloth masks caused a higher rates of infection as opposed to medical masks. Hence, it is not recommended for health workers 33 . In addition, cloth masks may rise the infection risk due to its physical properties such us reuse, frequency and effectiveness of washing up, and moisture 34 . The study showed that cloth masks had a higher penetration of particles as opposed to medical masks, it was cited at 97% and 44% respectively. Based on this study, the cloth mask have potential to cause illness much higher than medical masks 34 .
On the other hand, cloth mask can reduce the virus particles into the air when people have an conversation, sneezes or coughs. It also can minimize the spread of COVID-19 35 . According to Adelayanti 36 , cloth mask can be worn as last alternative in protecting from the spread of COVID-19 on human, particularly in crisis situation. Hence, at the population level, the use of masks, is very important to minimize the exposure to droplets, aerosol and particle and spread the infection to others 37 .
The use of disinfectant in handling COVID-19 was also familiar in Indonesia. 67.7% of respondents did a disinfectant spraying for at least once in a month with chlorine-based products. Environmental surface are likely possible to be contaminated with SARS-CoV-2, both in health care and non-health care settings such as walls, chairs, electronic equipment's, and tables. Hence, these surfaces must be disinfected in preventing and controlling the hazard and risks of transmission 38 . Furthermore, the transmission has been associated between individuals and contacts with surface in the environment 39 . In fact, since disinfectant has detrimental effects such as irritation and/or allergens 40 . Hence, the safety operation should be considered such as wearing PPE during the use of disinfectant in order to minimise the risk of infection on human body 41 . It has been obtained in the current study that the respondents did a treatment on packages/ or items using disinfectant received from postman as infection prevention during the pandemic situation.
Another crucial strategy for communities in prevention of the risk of COVID-19 is the use of portable hand sanitizer. The majority of participants (61%) brought this item to protect the virus transmission. The hand sanitizer or antiseptic hand sanitisation, is known as antiseptic hand rubs which contains alcohol based. It is used as one of protection in minimizing the transmission of infection among communities as well as health professionals 42 . In addition, this item usually is effective and helpful in situation where the hand washing facilities are not available in public places or at work.
Several studies have shown that COVID-19 exists and persistent on various surfaces. Chin et al. 43 reported that the novel coronavirus can survive up to 1 day on wood and cloth, 2 and 4 days on glass and stainless steel and plastic respectively. Van Doremalen et al. 44 also pointed out that this virus remained stay up to 4 hours on copper and 24 hours on carboard. For this reason, societies have a potential risk for exposure to the virus. Our ndings reveal that the majority of respondents hold a door handle and a desk for at least more than six times for three to seven seconds in a day. In fact, the use of mobile phone was massively frequent with average more than six hours in a day. While the COVID-19 is present on different surface, it is possible to being infected by touching that surface, involving door handles, mobile phones, and public transport handholds, and subsequently transmitted to body through our hand, mouth, nose or eyes 45 .
The nding on our study found that male are less likely to perform better hand hygiene as opposed to female. In addition, participants with low education tend to touch the part of face often than those who had higher education. The previous study reported that girls tend to have a frequent best practise in handwashing behavior, and educational background with higher education reported to practice better behavior on personal hygiene 31 . Our Study also found that 38.5% of subject respondents did hand washing for three times before eating. Almost 23.2% of respondents declared hand washing for twice per day in every return home. Moreover, 35.5% and 27% of respondents declared hand washing for six times after going the toilet and every touching an object each. The polish study showed that it has been indicated that approximately 40% of respondents did hand washing after handshaking, while this basic hygiene behaviours also indicated in the subject studies doing hand wand washing after touching their part of bodies such as nose (39%), sneezing (44%), and coughing (40%) 46 .
This study is an early detection to obtain an overview of positive behaviour of personal hygiene for the prevention and control towards COVID-19 among dwellers in Indonesia. It contributes to deliver an information and give better understanding regarding on how communities can support the government in handling the pandemic situation. This study, however, has several limitations. First, the sample size is limited. Second, online questionnaire may not re ects the real situation of the communities. Third, the study was conducted during the Large Scale Social Restrictions which may not re ect the real situation during the released of Large Scale Social Restrictions where public may have a varied activities while they may no longer implement positive behaviour of personal hygiene. Further studies are needed to explore whether the positive behaviour may reduce or change after the release of Large Scale Social Restrictions. Fourth, the majority of respondents were coming from the Java Island, while the representativeness of the population might not be covered, and this might be a bias factor. The last, the data was administrated in bivariate analysis, hence multivariate analysis is needed for further analysis.

Conclusions
Pandemic COVID-19 has a huge impacts on societies around the world, including Indonesia. The community has an integral part in taking action to prevent the spread of transmission as well as to minimize the impact of outbreak and controlling the diseases. The most crucial strategy for the population is practising positive behaviour of better personal hygiene such as frequently hand-washing, wearing masks, use hand sanitizer if the hand-washing facilities is not available, avoid face-touching, avoid crowds and avoid close contact with individual. The positive behaviour of personal hygiene need to be maintain during the pandemic in order to controlled the COVID-19 spreads. There should be a good The informed consent has been describe in details during the Ethics Approval and Consent before the study conducted, and has been approved under the Ethics Approval Letter from Ethics Committee Faculty of Public Health, Universitas Indonesia Number: Ket-435/UN2.F10.D11/PPM.00.02/2020. Inform consent was obtained from respondents by agreeing and ful l the terms condition to participate in the study. The researchers applied the informed consent during the study with the principle of bene cial, no harm, con dential, justice and voluntary participants. Hence, several information should be agreed by participants prior data collection. Particularly, if the participant under 18 years old, those have to ask permission to their parent or legal guardian. If it does not meet the criteria, the system automatically stops the survey.

Consent for publication
Not Applicable Availability of data and materials The dataset utilized and/or analysed during the present study are available on reasonable request from the corresponding author.

Competing Interest
The authors declare no con ict interest.