Post-COVID-19 mask use for respiratory infections: knowledge, attitudes, practices, and observations from a tertiary care outpatient setting in central Sri Lanka

Mask-wearing reduced disease transmission during the COVID-19 pandemic. Continued use, with proper understanding, could further decrease respiratory tract infections (RTIs), post-pandemic. This study assessed knowledge, attitudes, and practices related to mask-wearing in a Sri Lankan population. A cross-sectional study recruited 423 visitors (patients and accompanying caregivers) aged 18–75 years at the Outpatient Department (OPD), Teaching Hospital, Peradeniya, Sri Lanka, in March 2024, using convenience sampling. Data were collected through a validated self-administered questionnaire. Of the 394 completed questionnaires, 199 (50.5%) were from patients and 195 (49.5%) were from accompanying visitors; 136 (68.3%) patients reported respiratory symptoms and 125 (64.1%) guardians accompanied symptomatic individuals. Most had studied beyond GCE O/L, and 206 (52.3%) reported household income below LKR 50,000. Knowledge of RTI transmission was variable: 330 (83.8%) identified droplets, 306 (77.7%) hands-to-face spread, and 211 (53.6%) aerosols, while 96 (24.4%) and 106 (26.9%) incorrectly cited food and water. Almost all participants (390, 99.0%) acknowledged masks prevent RTIs, but misconceptions remained—73 (18.7%) reported masks alone are sufficient and 79 (20.3%) believed all mask types equally effective. Overall knowledge was good in 140 (35.5%), moderate in 207 (52.5%), and poor in 47 (11.9%), with higher scores among those with greater education and income (p < 0.001). Attitudes reflected mixed views: 311 (78.9%) supported mask use in crowded poorly ventilated places, yet many reported discomforts including sweating (305, 77.4%) and disturbed breathing (227, 57.6%). Mask use declined post-pandemic, with 133 (33.8%) reporting current use. Observation confirmed low adherence: only 74 (18.8%) wore masks, 65 (87.8%) covered nose, mouth, and chin, but 35 (47.3%) had gaps and 23 (31.1%) touched their mask while speaking. The overall knowledge was only moderate. Mask use has decreased post-pandemic, even in situations where it would be beneficial, highlighting the need for renewed public health education.