Barriers and Enablers of Health Service Utilisation for Childhood Skin Infections in Remote Aboriginal Communities of Western Australia

Abstract

In Australia, children living in remote Aboriginal communities experience high rates of skin infections and associated complications. Prompt presentation to primary care health services is crucial for early diagnosis and treatment. We performed a qualitative study in four remote Aboriginal communities in the Pilbara region of Western Australia to explore factors that affected health service utilisation for childhood skin infections in this setting. The study consisted of semistructured interviews and focus group discussions with parents and carers (n = 16), healthcare practitioners (n = 15) and other community service providers (n = 25). We used Andersen’s health service utilisation model as an analytical framework. Our analysis captured a wide range of barriers that may undermine timely use of health services for childhood skin infections. These included general factors that illustrate the importance of cultural competency amongst healthcare providers, patient-centred care and community engagement. Relating specifically to health service utilisation for childhood skin infections, we identified their apparent normalisation and the common use of painful benzathine penicillin G injections for their treatment as important barriers. Health service utilisation in this setting may be enhanced by improving general awareness of the significance of childhood skin infections, actively engaging parents and carers in consultation and treatment processes and strengthening community involvement in health service activities.

Improving primary prevention of acute rheumatic fever in Australia: consensus primary care priorities identified through an eDelphi process

“…This resonates with a recently published study on barriers and enablers to skin sore treatment in the Pilbara, which found that shyness, shame, fear of judgement, normalisation and prejudice were significant factors in the decision to seek care. 34 Primary healthcare staff in this eDelphi study, and in the Pilbara study, identified health promotion as a priority to increase health seeking for skin sores. 34 However, a number of participants discussed the risk of inadvertently increasing stigma if skin sores were associated with poor hygiene in health promotion activities.…”

“…34 Primary healthcare staff in this eDelphi study, and in the Pilbara study, identified health promotion as a priority to increase health seeking for skin sores. 34 However, a number of participants discussed the risk of inadvertently increasing stigma if skin sores were associated with poor hygiene in health promotion activities. A strong message from community is to prioritise a strengths-based approach to health promotion.…”

Access to healthcare system of indigenous communities with musculoskeletal disorders and rheumatic disease in Chaco, Argentina: a qualitative study

“…However, the strengths were the qualitative approach, which helped with the understanding of a complex situation, and the fact that the same participants would be those who participate in the educational phase of this project. Through the model proposed by Andersen [7,8], the conceptualization of need, enabling, and predisposing factors was described providing a framework on which to design future educational strategies.…”

“…Andersen's base conceptual model of health service utilization was applied [7,8] for the analysis and for structuring the results. This model proposed three major factors that affected the access to health services: predisposing factors (demographic, social, economic, and cultural factors); enabling resources that influenced health service utilization, such as social relationships, community, and healthcare system characteristics; and needs, as perceived by the different actors.…”

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“… 48 49 54 There are barriers to accessing Indigenous healers, traditional care providers, 41 and traditional medicine, 53 which healthcare providers tend to dismiss. 54 Families also experienced difficulties accessing information in their preferred language 46–48 and a lack of acknowledgement of the spiritual and emotional aspects of care. 48 …”