Respondents were predominantly male (8/10), with an age range of 20 – 60 years, and from a variety of racial/ethnic backgrounds. Most (7/10) had children, with an average of one child each, and a range of 1–12 persons per household. Half were married and half were employed; none were homeless. Respondents had an average of 12 years of education, with 3/8 respondents having a college degree. Most (7/10) thought skin infections were not a new problem in Hawai‘i; (6/8) felt it was a common problem. Many (7/10) were familiar with “staph” as a term for the bacteria Staphylococcus aureus, but only one recognized the term “MRSA.” Perceptions varied as to how people (in general) acquire skin infections versus how the respondents personally acquired the infection. Most respondents identified open sores/cuts, poor hygiene, and activities in the ocean as ways to get MRSA infection (). Other responses included allergies, stress, plants in the jungle, sweat, public items such as a toilet seat or shopping cart, genetics, and too much deodorant. Perceptions regarding how people (in general) and how they personally can prevent infection focused on practicing good personal hygiene and avoiding swimming in bodies of water such as the ocean (). Additional ways to prevent infection mentioned by respondents included avoiding plants, watching where you walk, relax/get a massage, and staying away from others with skin infection.
Reported Routes of Acquisition of CA-MRSA, and Ways to Prevent It, for Interviewees Themselves, as well as the General Public, with Qualitative Quotes Included
The majority (6/9) recognized that they had a skin infection when the area on their skin became swollen. Others noted pain and/or itchiness. Infection sites included the leg, back of head/neck, foot, elbow, buttock, and/or eye. No household family members or friends had a skin infection at the same time; however, 3 respondents did note infection in family members (2 in household family members, and 1 in a non-household family member) following their own infection.
Most (8/9) attempted to self-treat the infection prior to seeking medical care with a range of home remedies (5/8) including hot water and Hawai‘ian salt, lemongrass, baby oil, herbs, popping/draining the sore, warm compresses; and store-bought solutions (3/8) including gout pills, dandruff shampoo, and/or prescription medicines provided by others. The duration of time from onset of illness to clinician-provided medical treatment ranged from one day to several months with no interviewees reporting specific barriers to treatment. Most respondents did not initially comprehend the severity of their infection and only sought medical treatment after pressure/concern from family, unbearable pain, and/or other symptoms of illness (e.g., oozing blisters).
Although there were no specific barriers to treatment reported, psychosocial issues such as depression, embarrassment, and shyness were reported to have influenced time to seeking medical attention. One respondent stated, “… I'm afraid they're going to tell me I, I have something really bad, and then I'm going to, ah, man. I'd rather not know …”
The majority (8/10) of interviewees spent their weekdays or weekends participating in ocean water activities such as swimming, surfing, fishing, diving, and/or kayaking. The majority (8/10) also stated that they showered at least once daily; some persons reported sharing of towels, bedding and clothing.
Most (7/10) felt that having a skin infection affected their life; however, the perceived impact varied, often based on the site and severity of infection. The perceived impact of the infection included not being able to go into the water/ocean, having a scar/blemish, loss of sleep, pain, not being able to wear shorts anymore, and not being able to work anymore. One respondent stated, “The very worst thing is, I guess, just having it, and going to the hospital, and having all kind of needles in me, and the doctors have to come in and peel the skin off… That's, to me, that's the worst that ever happened to me.”
Reported emotional impact of infection on the respondents varied, and included feelings of fear, trauma, irritation, anger, disgust, stress, depression, and the overall feeling of being “puzzled.” Most (8/10) did not remember/did not know what their healthcare provider told them it was or what caused it. Regarding this, one respondent stated, “[The doctor] Told me it was um, ah, ---, it was some, he said it was skin disease. He said a name, but I don't remember the name of it…”
All respondents, however, remembered being informed by a physician of the diagnosis of skin infection. Most (9/10) were given antibiotics and self-reported adherence to the medications was high. Only a few reported having to cover their wounds with dressings and adherence to dressing changes varied.
When asked about the best method for receiving general information, 5/8 respondents stated a printed format such as a newspaper or brochure. Other methods included broadcast media, such as television and radio. The majority of persons did not have a computer and were not comfortable using one. The preferred method for all respondents to receive medical information was a verbal conversation with a medical provider; however, most (7/10) stated they wanted written documents such as pamphlets/brochures as “take homes.” The most trusted source of medical information, however, was friends and family (7/10), especially those employed in healthcare (4/7).
Most said that if they had to give one piece of advice to someone with CA-MRSA it would be to get treatment/go to the doctor as soon as possible. Other responses included to stay out of the water/ocean, ask more questions, take care of your body, and keep clean. Respondents commented, “Go to the doctor… and get it treated… and it, it'll be all over,” and “Be very careful in what you do, and … take care of your body.”