Olena Molina, a second-year nursing student at Kauai Community College, quietly observed passersby as she stood in the parking lot of a Hanalei shopping plaza on a recent Saturday morning.

Not only was she observing, she was documenting, using a mobile app built by the Applied Research Laboratory at the University of Hawaii.

“There’s just three buttons and I click,” she said. “If they wore masks correctly or incorrectly or if they’re not wearing a mask at all. And it just keeps a running tally.”

The 100 submissions she would make that day would be fed into a database to fuel a statewide study — one of the first in the country — on how many people are using masks in Hawaii during COVID-19. Utah is another state that gathers statewide data on mask compliance.

Olena Molina, a Kauai Community College nursing student, has been checking to see if shoppers are wearing masks for an ongoing statewide study. Yoohyun Jung/Civil Beat/2020

What the data collected thus far by volunteers like Molina shows is that a lot of people in Hawaii are actually wearing masks. The latest data from the Hawaii Emergency Management Agency study, which is displayed on the new state data dashboard, shows that 73% of people statewide are wearing masks correctly.

“It’s encouraging to see that people are picking up on this behavior,” said Dr. Gary Glauberman, a professor at the University of Hawaii School of Nursing who is leading the study.

The highest rate of mask usage was observed on Oahu at 83%, followed by Hawaii island at 76%, Maui at 71%, and Kauai at 62%.

Volunteers, including nursing students, members of the Medical Reserve Corps, the rotary club and even retirees, are tasked with observing people at locations across the islands, Glauberman said.

He says he can’t say where they are because these observations are supposed to be done discreetly — people tend to change their behavior when they know they’re being watched.

The study is still fairly new, with only weeks worth of data collected, the professor said. Researchers are still working on drawing conclusions from the numbers, but so far Oahu is reaching the goal of 80%  — a target based on recommendations by the public health organization Resolve To Save Lives and its research team, Prevent Epidemics.

“On neighbor islands, it fluctuates,” Glauberman said. “Overall, it seems pretty encouraging, considering that we just started this project.”

Generally, more is better, but 100% is not a realistic goal when it comes to wearing masks, says Dr. Cyrus Shahpar, director of Prevent Epidemics and a former team lead for the U.S. Centers for Disease Control and Prevention’s global rapid response team.

“There are certain scenarios in which people don’t wear masks because of what they’re doing or from a risk perspective, you don’t have to,” he said.

As the study matures and more data is collected, Shahpar said he hopes to see more broken down information and trends from the data, such as where the vulnerable and high-risk areas are, and differences between indoor and outdoor spaces.

Department of Health building sign ‘No Mask no entry’ during Coronavirus pandemic. May 5, 2020
Data on mask use can be useful for public health messaging and help inform public policy, says Dr. Cyrus Shahpar of Prevent Epidemics. Cory Lum/Civil Beat/2020

“This is information that’s useful to public health and can inform public policy,” he said.

Other groups around the country have studied mask compliance before, but not many have done observation studies at the state level as Hawaii and Utah have done.

A group of Philadelphia researchers conducted an observational study in 2020 that showed less than half of the 4,600 people observed wore masks, but it was limited to a three-week time frame.

Another example is an app called MaskCount by an Indiana-based research institute, which enlists anonymous users to report mask-wearing behavior in their region.

Some studies, including one from the UH Public Policy Center, survey people on their mask use. In the UH survey, 99% of respondents in Hawaii reported wearing some face covering when entering a business, but only 29% reported they wore them all or most of the time when visiting family.

Shahpar said he hopes other states and counties will follow Hawaii’s suit and conduct mask studies of their own. “It would be great and helpful if Hawaii can share its best practices,” he said. 

A Collaboration

For Molina, the Kauai nursing student volunteering for the study, the observation has been an extension of her education.

“As a nursing student, we have to look into evidence-based practice before we do some kind of intervention,” she said. “So I’m actually really interested to see what the results are from the data that we’ve collected.”

Olena Molina is getting course credit for her volunteer work in the mask study. Yoohyun Jung/Civil Beat/2020

COVID-19 has limited clinical placements and field training, so participating in the study has been one of the alternatives, said Tammie Napoleon, professor of nursing at Kauai Community College. The students receive course credit for volunteering.

“We had to kind of think outside of the box for how they could meet their objectives for the course as well as provide a service to the community,” Napoleon said. “And we get to be part of a very cool study with the data collection part of the research.”

For engineers at the Applied Research Laboratory at the UH, building the app for the mask study was another way to contribute to the COVID-19 response without being a medical professional, said Margo Edwards, the lab’s director.

“We don’t know the medicine, but we have the ability to help the people understand the ramification of not wearing a mask and help get the data they need to study that,” she said.

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