A total of 15 participants were interviewed in this study, including 8 males and 7 females. Participants ranged in age from 60 to 80 years old, with an average age of 68.3 years. Four key themes relating to rural elderly wearing mask behavior were identified from the data. These include access to epidemic information, awareness of wearing masks, physical illnesses and labor habits, and social relationships. Sub-themes were also identified, as shown in Fig. 1. Following a further review of codes and definitions, thematic network diagrams were drawn, based on Attride-Stirling's work[] to assist in visualising and reporting themes and interrelationships.
3.1 Channels for Rural Elderly to Access to Epidemic Information
Although in the latest report of the China Internet Network Information Center, China's Internet infrastructure has been fully covered, and made the realization of "5G access to every county and broadband access to every village"[]. However, because the village is located in the deep mountains, there is currently no broadband connection, Only 4G network is available for mobile phone, and the low-lying settlements often cannot receive the signal. Therefore, in remote rural areas, television is the most important media for famers in rural area to get information, and they do not rely on the Internet in their daily lives. In fieldwork, 15 elderly adults have televisions at home. Watching "CCTV News" and "Weather Forecast" every night has become a ritual in their lives. Under this media ecology, when asked about the channels for obtaining information related to the epidemic, all respondents answered that they knew that the COVID-19 pandemic was happening in China and other countries in the world. However, they all showed certain difficulties in describing details of epidemic situation and national epidemic.
The most important channel for understanding COVID-19 information and the national epidemic prevention policy is TV. During the worst period of the epidemic, village cadres went to households to conduct propaganda, but I don't remember a single one of the specifics. It has been three years since the epidemic, I have never heard of anyone in our village being infected with COVID-19, so none of us concern about it.(F3)
The oldest among the respondents (80 years old) also could not recall the detailed epidemic prevention requirements issued by the country, because the most exposed medium was the elderly singing machine.He rarely watches television due to the poor eyesight. Different from the city's three-dimensional epidemic prevention publicity channels, the elderly in this village is a group "forgotten" by the national epidemic prevention policy. Walking in the village, you can neither see or hear various epidemic prevention audio-visual media content, nor any visible epidemic prevention propaganda slogans.
To be honest, I have never been required to wear a mask when I go out. (M2)
Once, I was sick and my wife went to the county hospital to see a doctor. Because the elderly non-smartphones we used could not provide the health code and nucleic acid code, the security guard at the entrance of the hospital would not let me in. Where do we have these codes? Since the epidemic, I was taken by the village committee by bus to the township to get a vaccine and a nucleic acid test. Later, no one asked us to get a vaccine or a nucleic acid test without going far. Therefore, we did not know whether to enter the hospital, supermarkets and shopping centers must wear masks and provide green codes. (F8)
Unlike urban residents who register for various online forms, small programs and apps for epidemic prevention, and grid management that have been incorporated into many WeChat groups, the penetration rate of smartphones among the elderly in this village is very low. On the one hand, it is because the elderly are not used to or cannot use smartphones; on the other hand, the key constraints are the lack of broadband and poor mobile network. Therefore, under this circumstance, it is difficult for the "border residents" in the digital society to experience the troubles brought by the COVID-19 pandemic to their lives, and it is also difficult for them to understand measures such as "mask order", "stay-at-home order" adopted in epidemic prevention and control.
In daily life, the village is mainly composed of elderly people. Due to inconvenient transportation, people rarely enter the city. I only saw some relevant news on TV, but what is the virus-like? What are the symptoms of the infection? Are masks qualified? I don't know about these, and I'm not worried about it, because what does this virus have to do with me? (M7)
wearing a mask is the best decision, but who knows how effective wearing a mask can be? Few of the elderly in our village have masks on hand, so we usually chat together and do farm work without wearing a mask. You can see that we are all still very well, and no one has been infected. So the stories told on the TV news are all from the urban people, and have nothing to do with us in rural. If our remote villages are infected, then the urban will be infected. It's going to get worse. (F6)
Although they are under China's dynamic clearing policy, the differences in information acquisition channels have led to the acceptance of the epidemic prevention and control policies by the elderly in the village, and this impact is cumulative. Therefore, in the interviews, it is easy to find that their perception of the national epidemic prevention policy is related to their long-term single information acquisition channel.
3.2 Awareness of Wearing Masks
Throughout the interview, the participant's cognition of masks had the most historical sense, and this thought was often related to their personal hygiene concepts, the development of basic conditions of rural public health, and their psychological attitudes. In China's recent history, the Chinese people's wearing of masks and their acceptance of masks can be found in Wu Liande's narrative. During the plague outbreak in Northeast China in the 1910s, Wu Liande designed China's first mask. Although there was an interweaving of superstition and national collectivism in the promotion and operation of masks, the Chinese people have been exposed to masks, a modern medical item, objectively earlier[]. However, for the villagers in the village, masks as medical supplies are still far from their lives, and they have not resonated with the official symbolism of politicizing, emotional, and moralizing masks.
I think masks are worn by people in white coats, and only doctors and nurses in township health centers used to wear them. (M6)
We are farmers, we just farm. Have you ever seen farmers wearing masks to do farm work? Before this epidemic, I had never worn a mask in my life, and even the barefoot doctor who often came to our village hasn't worn a mask. (F1)
For me, who has lived in the countryside all my life, a mask is a foreign thing. In the past, most people who were not in special occupations have never worn a mask. (F5)
One interviewee also emphasized that in his memory, when SARS broke out in 2003, no one in his village had ever worn a mask. Facing the COVID-19 pandemic, he has his philosophy on dealing with the virus.
In 2003, SARS was also very serious. I never wore a mask, and I didn't know what a mask was at that time, but I still survived. Therefore, it is said that things are impermanent, and life always has to face some disasters, or natural disasters, or man-made disasters. (F8)
From the above-mentioned sets of quotes, it can be seen that in relatively stable rural areas that lack frequent information exchange with the outside world, the elderly's cognition of masks mainly comes from their simple life experience history. This group's cognitive rejection of masks is deeply rooted in their understanding and memory of masks as sanitary tools. Especially for the left-behind elderly people in the mountains, masks are associated with the symbols of hospitals, doctors, and diseases in their memory. In the process of keeping epidemic prevention and control measures in China, when local governments use various media to symbolize and abstract masks in the framework of collectivism, patriotism, and moral obligation to mobilize the whole society to establish new public health concepts and wearing habits of masks, personal factors such as diverse life experiences are ignored in some way. The embedded concepts and collective symbolic meaning of masks may lead to conflicts over whether to wear masks in public area.
In fact, research has shown that the older you get, the more your behavior is influenced by the cognitive system, which is built on people's past life experiences. Their cognitive systems are also more solid, and difficult to change. When encountering things, the elderly are accustomed to seeking answers from past experiences and following past practices. And for things that have not been experienced in the past, they will show abnormal resistance and it is difficult to accept[]. The cognition and concept of masks of the elderly in the village are also affected by the cognitive system to a large extent, because the new crown epidemic is the first time for everyone, and the need to wear masks when going out is also a new thing that appeared after the epidemic began. In the past, even during SARS, it was not necessary to wear a mask when going out. It is hard for the elderly to understand and accept face mas, ,because they never have such experienced before. In addition, they are also affected by blind confidence. As we get older, the accumulation of life experience will give old people confidence that their choices are wiser and more correct than young people's, and the same is true of refusing to wear masks.
My expectation is to live to be 60, but now I'm over 70, so I've earned 10 more years. I haven't been in a hospital for decades, and I'm in good health. If I contract the virus, I'll die but it's not a pity . (M6)
Through the dialogues in the interviews, we found that the concepts and behaviors of the rural elderly were generated in specific historical conditions and living environments, and inevitably bear the imprint of history and reality. In other words, the hygiene concept of the rural left-behind elderly cannot be separated from the specific life context and the historical space of growth. Although the concept of individuality is far from the concept of social integrity, to clarify such differences and contradictions, it is necessary to understand this minority group in its specific life situation and historical space.
3.3 Physical Illness and Labor Habits of Rural Elderly
In addition to cognitive factors, another important aspect that affects the choice of whether or not seniors wear a mask is the elderly's physical diseases and labor habits. On Chinese social media, young netizens generally have a stereotyped image of the elderly in response to the controversy and discussion over "the elderly do not wear masks", believing that the elderly are one of the stubborn and disobedient groups. On Weibo, the topic of #stubborn elders who don't want to wear masks when they are talking# has reached 450 million views and 184,000 discussions. Compared with the critiques and narratives of young people who are full of the Internet on the elderly, the words and behavioral logic of the elderly are missing and invisible in the process of epidemic prevention. Few netizens can realize that the choice of the elderly, especially those in rural areas, to wear masks has a lot to do with their health and diseases. In the interview, an old man who once worked as a rural teacher emphasized that his not wearing a mask was not all indifferent to health risks, but that wearing a mask would cause physical discomfort.
The elderly people in our village have some underlying diseases and poor cardiopulmonary function. Some elderly people have chronic pulmonary obstruction, bronchiectasis, heart disease, coronary heart disease, thrombosis, etc. If these people wear masks when they go out, they will feel chest tightness, shortness of breath, and difficulty breathing. I am an early-stage lung cancer patient, and I usually have difficulty breathing, coughing, and stuffiness, so I can't stand wearing a mask. (M1)
When the epidemic started in Wuhan, Hubei, my child brought us some N95 masks. This kind of mask is uncomfortable to wear, and it takes a lot of effort to breathe after walking for a while. If you wear it for a long time, you will experience dizziness and nausea. After wearing the mask for a long time, it makes smell bad. (F2)
When young netizens criticize the elderly on social media for not wearing masks and regard seniors are too confident and selfish, they ignore the working habits of the elderly in rural areas. Farmers in China, especially those in remote areas, will never retire. As long as their bodies can still move, they will not stop farming. In contrast to the dense urban population, farmers work in open and mostly manual labor, so they need to keep their faces uncovered to breathe smoothly. Therefore, wearing masks to do farm work is completely inconsistent with the labor habits they have been engaged in for a long time. Therefore, on the Douyin platform, there was a short video of farmers wearing protective clothing working on crops, which attracted millions of comments from netizens. From the comments of netizens, it can be concluded that the epidemic prevention measures of some local governments do not respected the labor habits and actual needs of farmers. These practices will objectively deepen farmers' dissatisfaction with the epidemic prevention measures, which will lead to unnecessary conflicts.
Most of the outbreaks are in cities, and rural people don't run around. Wearing a mask is not only a waste, but the weather is so hot in summer, and the face is sweaty during labor, and it's unbearable to be covered. (F4)
One of the reasons for aggravating the contradictions and conflicts between farmers and epidemic prevention policies in epidemic prevention and control is that policymakers ignore the understanding and respect for the labor habits of farmers, and deal with them in a rude and authoritarian way. For example, according to news reports, in a poor village in Hebei province, farmers working in the fields required the village committee to issue a "farm work permit", and it was strictly stipulated that only one person could work on the farm with the permit and wear a mask throughout the process.
3.4 Social Network Relationships
Compared with the more complex social network relationships of urban residents, the social relationships in the villages are much more simple. As empty-nest elderly, their daily interpersonal communication is mainly in the countryside, and their social activities include visiting doorsteps, gathering in the village to chat, playing card games, and visiting relatives. The social objects are mainly family members, villagers in the same village, relatives, and other acquaintances. Among the 15 respondents, 11 had no children and grandchildren to accompany them, and only 4 lived with their children in the same village. Based on interviews, it was found that children, as an external social force, make the elderly more aware of their identities and roles in the family, and are more easily influenced by children's opinions and values.
I've lived for a long time, and it doesn't matter whether I wear a mask or not. But I take care of my grandson during the day and cook for the family, so for my grandson's consideration, I sometimes wear a mask when I go out. (M2)
Usually when there are not many people in the village, I usually don't wear a mask. But when the children take me to the city supermarket to buy things or go to the market, I will wear a mask, and I will wash my hands several times when I get home. It's not for myself but mainly for the child's feelings, otherwise, when you talk, you will quarrel and make it unhappy. (F7)
In the interviews with these elderly people, although they were reluctant to wear masks, they put family interests above personal interests, and chose to compromise to a certain extent in their daily communication with their children. On the contrary, unlike the selective adoption of masks due to the influence of children living in the same village, the elderly with children far away from each other have a lack of intergenerational feedback, resulting in resistance to interaction with their children. Some of them psychologically believe that wearing a mask is not just to protect the body, but there is also a subtext behind the struggle for the dscourse right in the family; Not caring on the phone, but lecturing and criticizing.
Because of the epidemic, my child has not been home for three years. Usually, I rarely call him/her. As soon as I make a call, I ask for this and that and hang up after a few words. For your health! This is what children call us the most during the epidemic. If they really care about us, they could go back home frequently. (F3)
Maybe because of the boy, my son rarely talks to me about his work, life and emotions on the phone. He often tells us to wash our hands frequently at home, wear masks when going out, and don't get together. But did they really care about us? What are we going to do at home without getting together with the old people in the village, playing mahjong and chatting together? Could they understand our feelings of loneliness? (F6)
Through the comparison of the above two situations, the intergenerational life and emotional feedback of children constitute an important factor in the adoption of masks by the elderly in rural areas. Rejection of masks are due to the challenges and emotional conflicts of children over their authority; selective wearing of masks is a consideration for family harmony and the health of children living in the same village. Therefore, based on this conflicting factor, researchers, policy makers and epidemic prevention workers need to take intergenerational support into consideration when facing the question of whether the elderly wear masks or not. From the intergenerational interaction between children and the elderly, let the young people go back to the elderly and explain the COVID-19 information and the role of masks to them through the offspring feeding back their parents. We can't simply look at the problem that the elderly don't wear masks, thus ignoring that people are a holistic system. Through the overall pressure at the family level and the care of the family, it is also more conducive to protecting personal health than conflict and resistance to prompt the elderly to show "compromising compliance" in wearing masks.
I thought it didn't matter if I wore it or not. I was persuaded by (the child) to put the mask in my hand, but I still put it on. " "I know it is important to develop good habits, and I can understand what the children say, so I try to follow the children's instructions. Let’s do it. (F7)
Compared with the political, moral and legal connotations of masks at the national level, masks are more of an emotional meaning within the family. Whether accompanied by children or left alone at home, they did not appear to be a group that actively adopted and complied with the use of masks, and they did not readily accept the persuasion of the younger generation. However, intergenerational persuasion presents a dynamic game process within the family. When persuasion is inappropriate or emotional care is lacking, there will be resistance or slight resistance; on the contrary, when health persuasion obeys family and children's interests and health considerations, Compromise and obedience will appear, especially in traditional Chinese culture, the family ethic of "cross-generational parenting" between elders and younger generations will play a role, which will lead to the strengthening of epidemic prevention behaviors. Under this circumstance, during the special period of the epidemic, families and intergeneration operate like cooperatives, guided by the overall interests of the family, and middle-aged and elderly people work together to maintain the family's stability and health in a community.
It's scary to see so many infected people on TV. I am a farmer, if there is a patient in my family, it will be ruined. If anyone in the family (because of us) has this disease, we will not be able to cope psychologically, and it will be uncomfortable for the rest of our lives. (M4)