Original Research

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

AUTHORS

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Ingrid Amgarth-Duff1
BBiomedSc (Hons), PhD candidate *

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David Hendrickx2
PhD, Honorary Research Associate

Asha Bowen3 MBBS, FRACP, PhD, Clinical Research Fellow

Jonathan Carapetis 4 MBBS, FRACP, FAFPHM, PhD, Director & Paediatric Infectious Diseases Consultant

Robby Chibawe5 BSc (Nursing), CEO at Puntukurnu Aboriginal Medical Service

Margaret Samson6 0, Chairperson of the Jigalong Community Council and CEO at the Jigalong Community Corporation

Roz Walker7 PhD, Program Head, Aboriginal Maternal Health and Origins of Child Development

AFFILIATIONS

1 IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, 235 Jones Street, Ultimo, NSW, 2007, Australia

2 Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute and Division of Paediatrics, School of Medicine, University of Western Australia, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia

3 Department of Infectious Disease, Perth Children’s Hospital, 15 Hospital Avenue, Nedlands, WA 6009; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009; Division of Paediatrics, School of Medicine, University of Western Australia, Nedlands, WA 6009; and Menzies School of Health Research, Charles Darwin University, NT 0810, Australia

4 Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009; Division of Paediatrics, School of Medicine, University of Western Australia, Nedlands, WA 6009; Department of Infectious Disease, Perth Children’s Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia

5 Puntukurnu Aboriginal Medical Service Unit 5, 15, Iron Ore Parade, Newman, WA 6753, Australia

6 Jigalong Community Council, ‎Pmb 8, Newman, WA 6753, Australia

7 Telethon Kids Institute, Centre for Child Health, The University of Western Australia, Nedlands, WA 6009, Australia

ACCEPTED: 26 April 2019


early abstract:

Background: 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 health care seeking behaviour, improved diagnosis, treatment acceptability and quality of care within remote Aboriginal communities.

Objective: 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 practitionersand community service providers in four remote communities in Western Australia.  All interviews and focus group discussions were voice recorded and data were analysed using QSR NVivo 10 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 (BPG) 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.