FARGO — Doctors recommend them. Public health officials urge people to use them. Science shows they work. But some people nonetheless just don’t want to wear a mask.

Now, more than six months into the coronavirus pandemic with per-capita infection rates leading the nation, North Dakota is ready to put some money behind the message that wearing masks is an important step people should take to curb the spread of the virus.

The North Dakota Department of Health is preparing to launch a public education campaign to encourage people to improve pandemic etiquette by wearing masks, maintaining safe distances and hand-washing.

“I’m not really sure what the hesitancy is to wear a mask,” said Dr. Paul Mariani, an infectious disease specialist who was North Dakota’s interim health officer before stepping down Friday, Sept. 25. “The way I see it, wearing a mask shouldn’t be a wedge issue.”

The state’s public education campaign, which will start soon and run through the end of the year, is backed by a $1.8 million federal grant. Health officials have selected Odney, a Bismarck advertising agency that submitted a $1.59 million proposal, which includes ad buys.

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Mariani said the message needs to become ingrained that individual responsibility is important to get the pandemic under control.

“Let’s tackle this virus as a community,” he said. “We’re asking that people make it their choice.”

A communication professor at North Dakota State University said a public education campaign to promote mask wearing would be more effective if done in combination with a requirement to wear masks.

Carrie Anne Platt, an associate professor of communication, said research has shown that mandates are effective in getting people to wear masks, especially when accompanied by public education campaigns emphasizing the benefits of wearing masks.

“With COVID-19, you can put other people at risk, but we know from research that it’s not very motivating,” she said. A mandate provides the nudge, reinforced by messaging, Platt said.

Effective campaigns should focus on benefits, to the wearer and others, and not try to shame or scare people, she said.

Besides protecting the wearer and others from infection, effective messages could focus on the economic and social benefits of wearing masks to avoid lockdowns and restore life to normal, Platt said.

“We know from research for other public health campaigns that seems to be more effective,” she said.

One obstacle to overcome: mixed messaging from health experts.

Early in the pandemic, leading public health officials instructed people not to wear masks. That was motivated in part to conserve N95 masks, which were in critically short supply.

Since then, however, multiple studies have shown masks are effective in preventing the virus from spreading — and public health officials say it’s critical to wear masks indoors when distancing isn’t possible because people can unknowingly come into contact with asymptomatic carriers.

“The biggest thing is you really don’t know who has the disease,” Mariani said.

North Dakota Gov. Doug Burgum wears a mask during an interview in Bismarck on Sept. 3. Forum News Service file photo
North Dakota Gov. Doug Burgum wears a mask during an interview in Bismarck on Sept. 3. Forum News Service file photo

Medical science has learned a lot about the novel coronavirus since the pandemic began, which is to be expected with a new disease, but much more is known now about the virus, said Desi Fleming, director of Fargo Cass Public Health, which also will soon launch a campaign to promote mask-wearing.

Although the contradictory messages can be confusing, “It also shows that we are learning,” and the scientific verdict now strongly supports mask wearing, she said.

Besides scientific studies, news reports have shown that communities around the world and in the United States have slowed the spread of the virus by wearing masks, Mariani said.

“We can look at real-world examples,” he said. “The best evidence comes from what we’re seeing in other parts of the world and our own country.”

Masks have become a lightning-rod issue, with views sometimes molded by a person’s political or even religious beliefs. There’s also the human trait of resisting something others say you should do.

Fargo Cass Public Health’s education campaign will dovetail with the state’s messaging and will include some of the same tags, including #MaskUpND. “We’re actually building off the state,” she said. “We did a local spin on that.”

An effective education campaign will have to work to overcome the disinformation that is proliferating on social media, Platt said. Also, she added, people tend to tune out messages that don’t conform to their beliefs.

“If you’ve been on social media you know how hard it is to change someone’s mind,” Platt said. Once again, she said, that underscores the need to combine an education campaign with a requirement to help change behavior — something state and local officials in North Dakota have thus far been unwilling to do.

NDSU requires faculty, staff and students to wear masks on campus, including outdoors when in close contact with others, but also provides information about the benefits of wearing masks, she said.

Some males are reluctant to wear masks because they believe they can be perceived as showing weakness or fear, Platt said, adding that one of her graduate students is studying how perceptions of masculinity come into play.

Over time, wearing masks becomes more acceptable and even becomes a social norm, she said. “That social norm is a really strong component and why a mandate is important,” Platt said.

Turning mask wearing into a social norm is one of the goals of the campaign Fargo Cass Public Health is preparing to launch, Fleming said.

One of the campaign’s themes: “Masking for all of us.” Another theme: “Let’s get together so we can get back to normal,” she said.

Surveys indicate one major reason people avoid wearing a mask is that they can be uncomfortable.

There again, Fleming said, an education campaign can help by providing information about how to correctly wear a mask and to choose a comfortable mask.

“Hopefully some of that will help,” she said. “We’re not going to convince everybody.”

The campaign will tailor messages to different target audiences, including young people, American Indians and new Americans. Officials will survey to determine mask compliance and attitudes around the state, Mariani said.

Health officials hope the education campaign will succeed in overcoming resistance to wearing masks and other measures including social distancing.

“Hopefully this is not going to take years,” Mariani said. “We’re asking people to entrust us now.”

Online: #MaskUpND on Facebook.