The impact of health promotion on trachoma knowledge, attitudes and practice (KAP) of staff in three work settings in remote Indigenous communities in the Northern Territory

Background Globally, trachoma is the leading cause of infectious blindness and Australia is the only developed country with endemic trachoma. It is found in remote Indigenous communities burdened with poverty, overcrowding and poor hygiene. Lack of culturally appropriate health promotion, a small trachoma workforce and lack of awareness and support for trachoma elimination in general, were early barriers. Methods A cross-sectional pre-post study using a convenience sample, was conducted in clinics, schools and community work-settings from 63 of the 82 remote Aboriginal communities identified as being at risk of trachoma in the Northern Territory (NT). The study assessed the effect of a multi-component health promotion strategy aimed at increasing knowledge, attitude and practice amongst health, education and community support settings staff. Data were collected between 2010 and 2012. The health promotion initiatives were introduced in communities in staggered delivery over a one-year period; 272 participants were surveyed at baseline and 261 at follow-up. Results Trachoma related knowledge, attitudes and practice increased across all settings and for all primary outcome measures. Across all settings, there was a significant increase in the proportion of participants reporting the most important thing to do if a child has a ‘dirty’ face is to ‘wash it every time its dirty’ (61.6% cf 69.7%; X2p = 0.047), a significant reduction in the proportion of respondents answering ‘no’ to the question “Is it normal for kids to have dirty faces in your community’ (40.5% cf 29.6%; X2p = 0.009) and a significant increase in reported capacity to teach others about trachoma prevention (70.8% cf 83.3%; X2p
Author summary Australia is the only high-income nation with endemic trachoma. It is prevalent in remote Indigenous communities, although it was eliminated from wider society in Australia over one hundred years ago. Trachoma elimination across vast areas of remote Australia is an enormous challenge. Community members are highly mobile, English may be the second, third or fourth language in multiple Indigenous language groups, and trachoma is merely one of many complex health and social issues. A small number of trachoma program staff and frequent staff turnover in all work settings also limit progress. Trachoma elimination has focused on the Surgery & Antibiotic elements of the SAFE strategy. However, Facial cleanliness & Environmental improvements are critical for sustained progress towards elimination. Health promotion offers multiple, engaging approaches to help increase awareness that trachoma is simple to treat and that clean faces and improved hygiene practices help children be healthy and strong. In addition, safe and working bathroom (washing) facilities are needed to carry out hygiene practices. The two target groups for trachoma health promotion were staff who work in remote communities, and children and their carers (mothers, aunties, grandmothers, or other family members). The participants in this study, in the early stages of the health promotion program provides evidence that health promotion made a contribution to improved trachoma knowledge, attitudes and to a lesser extent practices in staff who provided education and support to children and families in trachoma endemic communities. This was achieved in a relatively short time despite high levels of staff turnover. Health promotion for hygiene related behaviour change requires multiple-sector support crucial to operationalise clean faces/hygiene practices more widely and to provide safe and working bathroom facilities in homes, schools, clinics and community work settings. This paper adds to the literature by illustrating some success achieved in a trachoma health promotion strategy in the Northern Territory and may support trachoma elimination in Australia and globally.