Improving skin health is a high priority in Aboriginal communities and a team at the Telethon Kids Institute’s Wesfarmers Centre of Vaccines and Infectious Diseases is at the forefront of developing community-led healthy skin books to increase knowledge and reduce skin infections.
Group A streptococcus (strep A) can cause highly contagious skin infections known as skin sores or impetigo. If untreated, skin infections can cause acute rheumatic fever (ARF), which is an abnormal immune response to strep A and causes sore joints, rashes, fever and heart inflammation.
Severe or recurring ARF can cause scarring of the heart valves and, while ARF symptoms may subside, the resultant damage is known as rheumatic heart disease (RHD). RHD is lifelong and can lead to heart failure and death in young people.
With no cure for RHD, early strep A prevention – starting with healthy skin – is important, especially for Aboriginal and Torres Strait Islander peoples, who suffer RHD at a rate 60-times higher than non-Indigenous people.
Effective prevention starts with strengths-based healthy skin promotion using a biomedical and cultural model. Using this model, the See Treat Prevent (SToP) skin sores and scabies trial co-designed a series of healthy skin books with nine communities in the Kimberley region of Western Australia.
Following interviews and yarns with Elders and community members, a thematic analysis revealed the need to decolonise health promotion. The decolonising process took the form of listening to Elders and community members and introducing cultural knowledge to influence lifestyle changes conducive to good skin health.
A total of 85 members of the Warmun, Balgo, Mulan, Billiluna, Bidyadanga and Ardyaloon communities provided input to create the books. Local languages, artwork, photos of the local landscape and traditional knowledge were interwoven to enable community ownership while aligning with the National Healthy Skin Guideline (2018).
The books’ content includes information on the importance of healthy skin, how to keep skin safe, germ typology, treating skin infections and the consequences of leaving strep A untreated. Educational content is surrounded by Aboriginal art, images of the local landscape and pictures of skin conditions. Books will be available in schools, clinics, councils and communities.
Ultimately, this healthy skin strategy will contribute to preventing longer-term health consequences of untreated strep A, to reduce cases of ARF and RHD.
The SToP trial, while focused primarily on healthy skin, forms part of the broader overarching RHD End Game Strategy, funded by the National Health and Medical Research Council (NHMRC). The strategy developed a road map to eliminate RHD in Australia by 2031. Health promotion and prevention of strep A is one of the strategy’s five key priorities. With strep A as the precursor to ARF and RHD, early prevention is geared towards eradicating the bacteria, contracted via skin and throat, by increasing access to educational tools.
Next, the implementation team will work with communities to translate books into audiovisual and digital versions, link resources into the school curriculum and roll out co-interpretation workshops.
The ground-up approach to healthy skin transcended Western health promotion methods. The project developed two-way trust to reach a shared end goal – healthy skin for kids to limit strep A’s potential to develop into ARF and RHD. The SToP trial has been instrumental in forming part of a larger project where Aboriginal children can eventually be free of preventable diseases.