Table 1.

Most Common Thematic Responses From Semistructured Interviews of Management and Frontline Staff from a Tertiary-Care Teaching Center (n=16)

Domain and Stratum	Numerical Response, Median (Range)	Supporting Quote
Concern for potential exposure to SARS-CoV-2
Management	5 (3–10)	“[T]here haven’t been any healthcare workers in the [emergency department] who contracted coronavirus, which is good evidence that PPE is working…”
Frontline	5 (1–10)	“I’m going to keep doing what I’m doing and I should be ok. I know there’s still a risk there, so it’s important to be vigilant.”
Confidence in understanding of institutional policy on universal masking
Management	10 (8–10)	“I get all the information given to me firsthand, so I have to be knowledgeable about the policy and make sure my staff is adhering to it.”
Frontline	10 (8–10)	“On campus we’re always supposed to have a mask on.”
Perceived compliance in accordance with universal masking policy
Management	9 (8–10)	“Sometimes [non-compliance is] inadvertent. Sitting in my office I always have it on my ear and sometimes I forget to put it back over.”
Frontline	9 (7–10)	“Sometimes 12 hours in a mask, you want to pull it under your nose…to take a breath.”
Importance of universal masking among staff/colleagues
Management	10 (10)	“[It is critical] to make sure they were wearing PPE properly.”
Frontline	10 (5–10)	“[High] because one of our coworkers in our unit actually had COVID.”
Feasibility of universal masking
Management	9 (9–10)	“I think we can achieve 90%. [But] you’re with your friends [or] in the break room talking, you might not be paying attention.”
Frontline	10 (7–10)	“It’s feasible, but we have to acknowledge that people are human and we need breaks.”
Significance of the following barriers to mask adherence
Difficulty communicating
Management	8 (6–10)	“Number 1 reason for [noncompliance].”
Frontline	5 (2–10)	“Some people are hard of hearing. I have had to take it off to talk to patients at least 2 or 3 times to read my lips…”
Difficulty breathing
Management	6 (1–8)	“Not that [common], more so N95…”
Frontline	2 (1–6)	“Some [have trouble to] breathe.”
Other discomfort (eg, fogging glasses)
Management	6 (3–9)	“Heat is definitely one, the glasses…”
Frontline	7 (1–9)	“It bothers me that they’re hot and uncomfortable.”
Anxiety
Management	3.5 (1–6)	“At this point… everyone’s so used to wearing it…”
Frontline	1 (1–5)	“I haven’t heard complaints.”
Usefulness of proposed interventions to improve mask compliance
Increased breaks
Management	8 (5–10)	“I definitely think that would be helpful if they were able to get a break alone or distance and pull mask down. If feasible…”
Frontline	8 (1–10)	“Yes, but not feasible.”
Increased education
Management	4 (1–10)	“My personal experience with staff, they’re well educated.”
Frontline	3 (1–10)	“I feel they’re educated, but there’s nothing wrong with re-education.”
Disciplinary action
Management	7 (5–8)	“I guess it would motivate them to adhere to the policy….”
Frontline	6 (1–10)	“It might help some people, maybe.”
Positive reinforcement
Management	9 (8–10)	“Reinforcing people, thank you for wearing mask… I think that’s the best strategy to share the information, give positive reinforcement.”
Frontline	7 (1–10)	“They’ve been doing that.”
Increased communication from hospital leadership
Management	10 (1–10)	“I think that’s something that would promote mask adherence. [It would also help] having Infection Prevention weigh in from their perspective…”
Frontline	7 (3–10)	“Some people like to hear it from higher up, some people could care less.”
Audit and feedback
Management	9 (7–10)	“It’s good to get the feedback and I do find it valuable… [it] gives us an objective number and helps us improve our adherence.”
Frontline	7 (4–10)	“I’m on for hand hygiene, so that would be helpful. Auditing would be a nice reminder.”