Factors Influencing the Wearing of Masks Among the Elderly During COVID-19 and Their Root Causes in Remote Rural China: A Qualitative Study

1. Introduction

Since the beginning of the COVID-19 pandemic,masks have become an essential part of our daily lives. They are integral to controlling the community spread of the novel coronavirus. Wearing masks as a policy order is still implemented in China. In the discourse of Chinese policymakers and the media, the correct wearing of masks is the key to epidemic prevention and control[]. Not only that, Some cities have introduced "mask-wearing" into the law, stipulating that during the epidemic prevention and control period, people who do not wear masks when going out must bear legal responsibility[]. However, in western countries, the existence of mask-wearing controversy leading to public compliance with mask-wearing guidelines remains a challenge. This is because “wearing a mask or not” goes beyond a public health issue in the US[], and masks are not only partisan but also a political and ideological symbol[]. At the individual level, wearing a mask in public is considered a violation of personal freedom and isolation[]; in addition, in the COVID-19 pandemic, individual differences in political preferences, numeracy, and perception of risk also influenced people's decision to wear masks[].

Different from the political affiliation of masks in western countries such as the United States, the United Kingdom, and Sweden, the use of masks in China is related to social and cultural factors. The researchers believe that there are more complex differences beyond the "wearing" and "not wearing" of masks. A mask presents a series of moral decisions that must be made for people in different societies, cultures, and political systems. Masks also contribute to a framework for interpretation and evaluation of the different natures of moral decision-making through the symbolic construction of their symbolic meanings. In this context, masks are regarded as moral objects[], and by forcing individuals to wear them in public places and instilling moral values in the public, the wearing of masks is linked to the public order and good customs of the social collective. Therefore, during the epidemic, China's "Guangming Daily" once published a commentary, entitled “Refusing to wear facemasks is a threat to civilization”, cited Xi Jinping’s political view of “community with a shared future for mankind” to emphasize wearing a face mask as a legal obligation to promote public civilization[]. Also in the same newspaper, in another commentary published on 4 February, the official scholar Zhou Qisen referred to the “naked mouth” problem encountered in epidemic prevention practices in rural places as not only a manifestation of the “lack of knowledge of virus transmission” but also a “lack of civilized nutrition”, “lack of social morality” and “lack of traditional Confucius family-country ethics”[].

Entering the third year of the COVID-19 pandemic, mask-wearing in China has become normalized. But incidents of elderly groups refusing to wear masks and clashing with epidemic prevention personnel and others have been reported in the media, many of which have died in disputes. In this regard, on Chinese social media, young netizens attribute the reluctance of the elderly to wear masks to stubbornness, extremeness, selfishness, backwardness, and lack of public morality. On this basis, ageism and stereotyping of older adults have been formed[], thinking that "the elderly have become bad." However, this age stereotype is dangerous, and it has left older adults who were already marginalized from the pandemic facing discrimination or abandonment in this health crisis[].Not only that, behind the legalization, moralization and emotionalization of masks in Chinese society, the choice of the elderly in remote areas to wear masks has its own cultural and conceptual factors. The adoption of masks reflects the conflict and game between the national epidemic prevention policy and the cultural concepts and behavioral habits of this group. At present, the existing research on the influencing factors of mask-wearing behavior of the elderly in remote villages in COVID-19 is still a blank. Therefore, the purpose of this study is to provide an in-depth and detailed qualitative description to illustrate the deep-seated knowledge and understanding of masks in the elderly in remote areas of China, as well as the conflict of wearing masks caused by cultural and conceptual differences. source. The specific research questions are as follows:

RQ1: How do elderly people in remote areas view masks used for epidemic prevention and control?

RQ2: What factors influence the decision of the elderly in remote areas to wear masks?

RQ3: What are the structural roots that cause these factors to accumulate and form social problems?

2. Research Object And Methods

To solve the above problems, we took a qualitative approach. Qualitative interviews were chosen to allow for social interaction and experiential observation with our research subjects to explore in-depth, rich, and meaningful answers to understand the cultural factors and self-concepts of rural elderly people on the edge of epidemic prevention in their response to COVID-19. Our qualitative research site was located in a remote village in the Dabie Mountains in central China. The choice of this village is mainly based on the researcher's consideration of the local language, cultural habits, and familiarity, to facilitate sample selection and interview communication. At present, the village has a population of more than 100, and the villagers rely on agricultural planting and migrant workers as their sources of income. Similar to the villages in other parts of China, due to the out-migration of the youthful people and their parents, the phenomena of aging is noticeable in the hamlet, with a large number of elderly and empty-nesters left behind[]. After entering the area, the researchers recruited volunteers for a fee through home-based propaganda and random questions in the village streets, and then expanded the research group through snowball sampling.

As shown in Table 1, the researchers finally selected 15 elderly adults over the age of 60 who expressed interest. The author conducted an in-depth field research from January 2022 to June 2022 by methods of participatory observation, semistructured, one-on-one interviews. In that period, researchers insist on going deep into the village every day to participate in and observe the use of masks by the respondents to understand their opinions, attitudes, and Their hygiene habits and concepts, etc., to gain an intuitive experience and understanding, and to record the content of the observations. In the semi-structured interview, the guiding interview questions are shown in Table 2[ ]; impromptu follow-up questions allowed the interviewer to further explore the participants’ responses. Each interview lasted between 40 and 60 minutes and was audio recorded and transcribed with agreement.. Before conducting the full interview, the guiding interview questions were piloted by two villagers to assess question length, language, and general acceptability of the questions. With the consent of the interviewee, the interview process was recorded, and NVivo 12 was used to encode the transcript after the interview. For each interview, the respondents will be paid RMB 50 in cash as an appreciation. To respect the privacy of the respondents, all respondents' names are numbered with letters.

Table 1

Demographic characteristics of participants interviewed.
Numbering	gender	age	Number of children accompanying
F1	male	61	0
F2	male	68	0
M1	Female	65	1
F3	male	70	0
M2	Female	67	2
F4	male	64	0
F5	male	80	0
M3	Female	72	0
M4	Female	60	1
F6	male	68	0
M5	Female	74	0
M6	Female	71	0
F7	male	62	3
F8	male	65	0
M7	Female	78	0

Table 2

Guiding interview questions.
1. What kinds of national epidemic prevention policies do you know? How do you get these information?
2. Do you always keep masks at home? Will you wear it in public? What do you think of masks?
3. why do you choose to wear a mask or not?
4. If you are required to wear a mask in your daily life, what kind of impacts and obstacles will bring about?
5. Is wearing a mask related to your working environment and habits?
6. Will the company of children affect your behavior of wearing masks? Why?

Rather than developing a theory, this research uses the general inductive approach of qualitative analysis to describe a core narrative or theme. The two researchers carefully checked and read each transcript, further immersing themselves in the collected material. The next step is to encode the fragments containing the material data relevant to the research purpose. These codes are then arranged and rearranged to form themes found in the transcribed text.

3. Results

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)

4. Discussion

The study explores a widely debated topic on Chinese social media, "Why don't older people wear masks." Four major themes were identified through participatory observation and semi-structured interviews in a remote mountain village in central China: access to epidemic prevention information, awareness of wearing masks, physical illnesses and habits, and intergenerational care and health advice in social relationships. Different from the strict epidemic prevention measures and infection prevention needs of urban residents, farmers' concept and behavior of wearing masks are closely related to their life experience, information environment, physical condition, and caring interaction within the family. Policy pressure and legal authority outside the countryside play a very weak role in remote villages. This makes the epidemic prevention measures represented by the "mask order" often encounter resistance and indifference when they sink into the social environment of remote rural areas. However, the groups in this community cannot express their voices and demands due to their disadvantaged position, and thus are marginalized and stereotyped. In addition, they were described as stubborn person in social media.. In the long term, with the acceleration of China's aging process, the conflicting narratives about the health and social concepts of the elderly will be a persistent social problem. This is not only manifested in the mask controversy. In this regard, this study summarizes the key crux of this paradoxical problem on a case-by-case basis.

First, the asymmetry of the information environment affects the risk perception of the elderly in rural areas. During the three-year epidemic, its medical resources and information dissemination channels were mainly concentrated in cities. Through newspapers, TV, radio, short videos, social media and other multiple information carriers, publicity and reports, as well as the seamless connection of ubiquitous epidemic prevention and control in governments, factories, schools, companies, and communities, the entire society has formed an always-on Epidemic prevention and control information network. Urban residents are not only immersed in this all-weather information ecology, but also these information and policy requirements are internalized into people's daily life, study and work under various regulations.

In short, all life and work order are inseparable from the epidemic. People's cognition, behavior, thinking and ideas are gradually domesticated by unified information and actions. All kinds of information related to epidemic situation in daily life constitute an important decision-making basis for people's actions. Such information related to the epidemic constitutes an important decision-making basis for their actions. Therefore, the basic epidemic prevention requirement of wearing a mask is taken for granted. However, in rural areas, especially remote rural areas, the media ecology is single. Among them, television plays an important role in the exposure of the elderly to epidemic information. However, compared with the multi-media forms that urban residents are exposed to, it is difficult for TV to generate an immersive information environment. And because of the lack of close-up perception of the risk of the epidemic by urban residents, the judgment of the elderly on the risk of the epidemic will be significantly different from that of urban residents. Therefore, the three-dimensional information environment is deeply embedded in the daily life and work of urban residents, resulting in the penetration of state power, the mobilization of epidemic prevention, the deterrence of policies, and the perception of risks, which are significantly higher than those of the rural elderly. One of the results of the difference between the acquisition of epidemic information knowledge and the perception of epidemic risk caused by the asymmetry of the information environment is that the controversy over wearing masks has intensified. Finally, "wearing masks into the law" has to be legally enforced in public places. Good mask.

Starting from Debray's media theory, the media is not only a technical system and a cultural system, but also a historical structure. From a long-term historical period, any kind of media technology system maintains people's ideas and social relations[]. This means that different media are not only different in terms of reception and content, but also have different effects on individual concepts, ideas, and social relations. Therefore, due to the asymmetry of the information environment between the rural empty-nest elderly and urban residents, the difference in the concept of hygiene between the two is increasing. This difference will inevitably lead to the existence of contradictions and conflicts between the personal hygiene concept and the mainstream hygiene order. The criticism of "the elderly do not wear masks" in social media such as Weibo is essentially a declaration of a dominant health discourse power to another marginal health discourse power.

Second, mainstream society ignores the underlying logic of the rural elderly. The long-term relatively closed rural life and the disconnection from modern medical and health concepts have made the rural elderly form their underlying logic for dealing with the epidemic based on their own life experience and village culture. This underlying logic affects their beliefs, concepts, cognitions, and behaviors. Once it deviates from the ideas advocated by some healthy behaviors, it will present a conflict and contradiction. Not only that, but the underlying logic of the elderly in rural areas is also manifested in a life experience and a philosophy of existence, thus forming a self-proclaimed system of health awareness and habits. The proverbs that have been circulating in the countryside for a long time "If you don't clean, eat without getting sick" and "Life and death depend on wealth and honor", reflects the importance of cleaning, disinfection, washing hands, and wearing clothes in the face of epidemic prevention and control. Resistance to the dominant idea that masks protect life. In fact, between the underlying logic of rural people and the mainstream public health concept, there is no complete distinction between who is right and who is wrong. Because the formation of the underlying logic is often related to the specific living conditions, education, personality, and preferences of rural people. It's like urbanites who are accustomed to bathing every day, despise and despise rural people in remote mountainous areas for not taking a bath for a month. The contradictory framework of the two seems to be caused by concepts, but in fact, it is the difference in the logic of life formed in different environments.

In the prevention and control of the epidemic, the processes of wearing masks, doing nucleic acid tests, scanning codes, showing health codes, and measuring body temperature are repeated in the daily life of urban residents. and recognized the legitimacy of prevention and control policies, thus accepting the domination of the dominant public health concept. However, the disciplinary process of this power excludes the underlying logic of farmers. It requires farmers to give up their concepts and take the initiative to comply with the latest epidemic prevention requirements. However, the fact is not so smooth. In the historical investigation of the sanitation experiments conducted by the Ping Church in Dingxian County in the 1920s and 1930s, the researchers found that public health is a strange concept for farmers, and it has a long-term effect, which is unacceptable to farmers who focus on immediate interests.. In fact, farmers do not listen to publicity about public health such as prevention. Only when you are sick to death do you see modern medicine as the last ray of hope, otherwise, it is impossible to talk to them about public health[].

Third, intergenerational differences result in the lack of shared code. Hall pointed out that meaning is not in objects or things, nor words. It is we who define meanings so firmly that, before long, they become seemingly natural and necessary. Meaning is constructed by the represented system, which is constructed and determined by the code []. Due to differences in letter codes, misreading or ineffective communication often occurs within a culture or between people. In epidemic prevention and control, an important reason for the conflict between the young generation and the elderly regarding the concept of "wearing masks" is the lack of asymmetry of the shared code. When they are in different social relationships and living environments, their conceptual maps and codes for people or things are also different. That is to say, as subjects of different cultures, each acquires language and cultural codes according to the constraints of conventions, social memory and ideology, and then uses these acquired cultural "skills" to understand and express the world.

The empty-nest elderly in the village are reluctant to wear masks, which is not only because of their stubbornness and self-esteem as elderly, but also because of the habitual concepts constructed by various codes in life. This notion becomes an important part of embedding in their body and is continuously activated and extracted throughout their life, continuously influencing their self-identity construction. Social media represented by WeChat has reconstructed the way of communication of the younger generation. Based on differences in work, living area, interests, etc., they have placed their technical bodies in various online communities, thus forming a circle of social media. social life. This stratified life forms the cultural codes shared by this group, and these codes form new cultural representations. During the COVID-19 pandemic, one of the reasons behind the debate among young people on social media about "wearing a mask or not" is that young person and the elderly have difficulty sharing the concept and cultural code of masks. The younger generation sees masks not only as a tool to protect against viruses and health, but also as a moral object and patriotism. In their concept, masks not only protect themselves but also others, and wearing masks is a contribution to the country's fight against the epidemic. Therefore, the concept of masks is not only an intuitive mapping of objects, but also endowed with symbolic meanings of protection, responsibility, morality, and patriotism. But for empty-nesters who are marginalized by the Internet in the deep mountains, masks are foreign objects on the body. Wearing a mask is not only in conflict with the long-term concept of life, but also the effect of wearing a mask on the comfort of the body is considered to be a foreign body invasion of the body.

Factors Influencing the Wearing of Masks Among the Elderly During COVID-19 and Their Root Causes in Remote Rural China: A Qualitative Study

Abstract