Talking skin: attitudes and practices around skin infections, treatment options, and their clinical management in a remote region in Western Australia

Abstract

Introduction: Skin infections including scabies and impetigo have a high burden and cause significant morbidity in remote Aboriginal communities in Australia. Nevertheless, there is limited knowledge about community, healthcare practitioner and service provider perspectives on skin infections and treatment preferences. An increased understanding of their respective knowledge, attitudes and practices will contribute to improving healthcare seeking behaviour, improved diagnosis, treatment acceptability and quality of care within remote Aboriginal communities. The aim of this study was to explore Aboriginal parent/carer, healthcare practitioner, and service provider attitudes and practices regarding skin infections in Aboriginal communities in remote communities in the Pilbara, Western Australia. The study documents their perspectives and preferences regarding treatments for skin infections, as well as the perceived barriers and enablers to treatment uptake for scabies and impetigo amongst Aboriginal families in this region. Methods: A qualitative study consisting of semi-structured interviews and focus group discussions was conducted with parents/carers, healthcare practitioners and community service providers in four remote communities in Western Australia. All interviews and focus group discussions were voice recorded and data were analysed using NVivo software and thematic analysis. Results: Despite the high burden, skin infections were considered normal in these communities, and their impact on child health was under-recognised. Common themes identified by all participants included the inadequacy of health services, the pain of the benzathine penicillin G injection, uncertainty regarding the use of oral antibiotics and topical creams, and the need for health practitioner training and improved communication and resources. Conclusion: Documenting carer, service provider and healthcare practitioner perspectives on skin infections provides a more informed understanding of the context in which treatment decisions are made. The ongoing need for culturally appropriate targeted, translational health education; improved treatment guidelines and feasible, painless treatments; and potential for the use of bush medicines for skin infections were themes that emerged.

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

“…Here we report our findings in relation to discussion topic 4. Our other findings are reported elsewhere [32].…”

Formative evaluation of a community‐based approach to reduce the incidence of Strep A infections and acute rheumatic fever

“…13 Attitudes and beliefs about skin sores are also likely to influence reporting of skin sores to clinics and in household surveys, including both stigma and normalisation of skin sores. 20 Limitations of this study are indicative of structural barriers to improving health outcomes in remote Aboriginal communities. Within the health systems, high rates of health worker turnover and limited opportunities for training are well-recognised impediments to sustained, community-led, programs.…”

“…Clinic attendance for skin sores among very young children is frequent but may decline with age, as infections may be less symptomatic in a heavily exposed and hence partially immune population or as skin sores become normalised or, conversely, stigmatised. 9,17,20 Primary participants in this cohort (ranging from 6.9-76.3 years) may have passed the peak incidence of symptomatic skin sores. The sores burden may have been reduced by the relatively high levels of secondary prophylaxis adherence among primary participants.…”

Solving a mighty mite problem

“…Aboriginal people generally seek traditional bush medicine over Western medicine as they feel more in control of their health. 39 Tea tree oil aligns with Indigenous healing culture and demonstrates scabicidal properties. 40 Incorporating this traditional ingredient into treatment programmes may result in greater cultural acceptance.…”