Discussion

In this research, we captured the views of patients carers, and HCPs on surgery-related infection care and explored opportunities for patient engagement. Click or tap here to enter text. Our study findings underscore how SSIs impact patient and family well-being and quality of life, as noted in previous studies. ^{Reference Rowland, Lindberg-Larsen, Santy-Tomlinson and Jensen17–Reference Mitchell, Northcote and Rickett19}

Our findings revealed a dynamic journey. According to Oben’s framework, the patient begins as an individual in relatively good health postsurgery, prior to SSI development. The patient is nested within a social context where they are supported by family and informal carers. At SSI occurrence, the patient experience shifts dramatically as they move from uncomplicated postsurgery recovery to one requiring SSI treatment. During this time, the patient faces a stage marked by diminished quality of life due to negative effect by the SSI, and a heightened need for psychosocial support. Subsequently, the patient, continuing this journey within the healthcare system, is recognized as a service user, retaining their initial identity as an individual seeking healthcare—like the condition in which they had initially approached the health facility prior to surgery.

We noted gaps in patients’ knowledge of postsurgical self-care, HCAI awareness, and psychosocial support. Several patients were poorly equipped to assess progress of surgical wound healing, following discharge. ^{Reference Rowland, Lindberg-Larsen, Santy-Tomlinson and Jensen17} As such, infection care needs and conditions may go unrecognized by patients who, away from the hospital, manage discrete infection-care risks and care routines as they arise. Inadequate information and communication related to patient care can result in limitations to patients’ navigation of the healthcare journey, ^{18,Reference Mbamalu, Bonaconsa and Nampoothiri9} as noted in this study. However, patients provided with discharge information fared better with postop wound care. ¹⁸ These findings underscore a need to improve discharge planning as a tool to reduce infection complications as low-level and poor quality of discharge education is known to decrease patient readiness for hospital discharge. ^{Reference Mitchell, Northcote and Rickett19} Discharge care information should be provided at an appropriate time for patient engagement, which may differ case by case. ^{Reference Mbamalu, Bonaconsa and Nampoothiri9} Subsequently, information recall by accompanying carers stresses carer roles in patient care and the need for their inclusion in patient-centered infection care programs. ^{Reference Kemp, McCormack, Chan, Santana and Quan20,Reference Pieper, Sieggreen and Nordstrom21}

It is also evident that shortfalls in patient education—whether due to insufficient instruction, ineffective delivery, or patient’s inability to engage at the time—are associated with adverse patient outcomes. Research highlights systemic challenges, such as unclear accountability for education, contributing significantly to this problem. For instance, Lau et al. (2016) and de Silva (2011) noted that organizational ambiguity and structural barriers in primary care often lead to an evidence-to-practice gap, affecting both patient engagement and care continuity, ^{Reference de Silva22} and patient empowerment through education is effective only when established processes exist to verify understanding and ensure accountability. ^{Reference de Silva22,Reference Lau, Stevenson and Ong23} Additionally, Dineen-Griffin et al. (2019) emphasized the need for systematic approaches that go beyond mere information delivery to incorporate structured feedback, ultimately enhancing self-management. ^{Reference Dineen-Griffin, Garcia-Cardenas, Williams and Benrimoj24} These studies collectively reinforce the importance of distinguishing between a lack of education and suboptimal educational delivery, each of which requires distinct strategies to improve patient outcomes.

Another observation, through our interviews, was the participants’ limited awareness of HCAIs such as SSI and AMR. Most participants were referred from one or more facilities before presentation at the study site, given the site’s function as a tertiary facility. Participant’s limited AMR awareness, even after such referrals, highlights an early gap in patient engagement across the healthcare continuum.

Although previous research has also documented patients’ insufficient knowledge and misconceptions of HCAI, ^{Reference Henderson and Zernike25–Reference Tobiano, Webber, Latimer, Kang and Perger27} our findings, together with a nonrandomized survey conducted at this study site, indicated that patients may recognize specific infection care terms when described. ^{Reference Useh, Mfeketo and Mbengo10} Other studies among patients in South Africa highlight issues of comprehension related to antibiotics and AMR when these terms do not exist in the native language. ^{Reference Sono, Mboweni and Jelić28–Reference Mokoena, Schellack and Brink30} These findings support the need to address language challenges when communicating infection care and AMR information for patient and public audiences. ^{Reference Surendran, Castro-Sánchez and Nampoothiri31–Reference Bakhit, Mar, Gibson and Hoffmann33}

Generally, continuity of wound care postdischarge emerged as another critical issue, most patients having been referred to the primary healthcare facility nearest to their residence. However, some patients reported poor experiences and felt their surgical wound condition worsened at these facilities, resulting in their preference for care and follow-up at the tertiary care level study site. Such care continuity at tertiary care level can obstruct referral pathways. However, we acknowledge that patients interviewed in our study had complicated wounds, possibly needing specialist wound-care attention, precipitating their referral to the study site.

The experiences of our interviewed patients traversed multiple domains, which overlapped most of the nine domains reported by Kemp et al. ^{Reference Kemp, McCormack, Chan, Santana and Quan20} These support similarities in domains of healthcare experiences across different settings (eg, communication with HCPs regarding medicines, staff responsiveness, cleanliness of healthcare facility, discharge information) and the importance of such domains for evaluating patient experiences. With AMR often unknown to patients, developing patient-facing materials to raise AMR awareness among patients, carers, and the public would be beneficial. In line with COVID-19 experiences, AMR-related data could be presented with charts and relatable graphics in patient-facing and community-facing formats. Short- and medium-term strategies, supported by universities, can enhance HCP–patient communication in both hospital and ambulatory settings. Furthermore, exploring experiences in surgical infection care shows that professionals should initiate engagement, and patients need support to ask questions and get involved. These findings are timely and align with ongoing national and global efforts to strengthen healthcare systems since the COVID-19 pandemic, ^{Reference Wang and Zhang34} emphasizing the role of informed and involved patients in achieving better care outcomes.

This study benefits from several strengths, including the use of structured data collection guides, methodological triangulation, and involvement of diverse data collectors, including members of the public, which enriched the data with varied perspectives. It also employed local languages, enhancing inclusivity. Our data may have been biased by participant’s recall, and the researchers’ presence may have influenced participant responses. Additionally, purposive sampling of individuals who reported SSIs may limit the generalizability of findings.

Despite this, the study offers valuable insights with practical implications. It underscores the need for care managers to strengthen infection safety nets beyond hospital discharge, which may involve partnerships to improve accessibility. Through the healthcare pathways of various facilities, patient management teams need to factor in patient education on HCAIs to promote patient engagement in infection prevention.