Prevention of Community-Associated Methicillin-Resistant Staphylococcus aureus Infection among Asian/Pacific Islanders: A Qualitative Assessment

Abstract

BACKGROUND: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has been increasingly reported over the past decade, especially in Asian/Pacific Islanders (A/PIs). Most studies to date have been descriptive and have not identified behavioral risk factors for disease prevention. METHODS: To identify barriers and to better understand how best to reach these individuals with prevention messages, ten ethnographic interviews were conducted in September 2003 in Oahu and Kauai, Hawaii, with A/PIs identified as having CA-MRSA infections. A standardized script was used which included questions on the transmission, treatment, and prevention of CA-MRSA. Data were coded using qualitative methods; non-response to individual questions was not included in the analysis. RESULTS: Respondents were predominantly male (80%), with an age range of 20 to >60 years. Most (70%) thought skin infections were not a new problem in Hawaii; however, 75% (6/8) did feel it was a common problem. Many (70%) were familiar with the term “staph,” but only one recognized the term “MRSA.” Responses varied as to how people (in general) get skin infections versus how they personally acquired the infection and most often included open sores/cuts (30% and 50%, respectively), poor hygiene (30% and 10%), and the ocean (30% and 30%). Perceptions regarding how people (in general) and how respondents personally can prevent infection also focused on hygiene (60% and 30%, respectively) and avoiding bodies of water such as the ocean (30% and 30%). Most (89%, 8/9) attempted to self-treat the infection prior to seeking medical care, using a range of home remedies (63%, 5/8) to store-bought solutions (38%, 3/8). Time to medical treatment ranged from 1 day to several months, with none reporting barriers to treatment. When asked about the best method to receive medical information, 63% (5/8) stated a newspaper/brochure. The preferred and most trusted source, however, was friends and family (70%), especially those employed in healthcare (57%, 4/7). CONCLUSIONS: Potential sources of infection and personal measures for control, including self-treatment, were identified in these ethnographic interviews—information infrequently found in medical records or written surveys. Qualitative assessment allows for the identification of these unique factors and may provide valuable insight into the epidemiology of CA-MRSA.