Gender Differences in Health Protective Behaviours During the COVID-19 Pandemic in Taiwan: A Multistage, Nationwide, Empirical Study

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 2014 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% women) were included. Significant gender disparities (p<0·001) were observed. The risk perception of pandemic (OR=1·28, 95% CI=1·21-1·35, p<0·001), older age (1·06, 95%=1·05-1·07, p<0·001), female gender (OR = 1·18, 95% CI = 1·09‐1·27, p<0·001), higher education (OR=1·10, 95% CI=1·06-1·13, p<0·001), and larger family size (OR=1·09, 95% CI=1·06-1·15, p<0·001) 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<0·05), being married (OR=1·17, 95% CI=1·01-1·36, p<0·05), and larger family size (OR=1·33, 95% CI=1·25-1·42, p<0·001), 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<0·01) and to comply with contact-tracing (OR=0·95, 95% CI=0·90-1·00, p<0·05) 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<0·001). 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. Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: The ethics committees/institutional review boards of the Academia Sinica, Taiwan approved this study and the consent procedure.