. 2024 Oct 9:77:102793.

doi: 10.1016/j.eclinm.2024.102793. eCollection 2024 Nov.

Multi-methods process evaluation of the SToP (See, Treat, Prevent) trial: a cluster randomised, stepped wedge trial to support healthy skin

Hannah M M Thomas¹, Marianne Mullane¹, Stephanie L Enkel¹, Tracy McRae¹, Ingrid Amgarth-Duff¹, Jonathan R Carapetis^{1

2}, Julianne Coffin³, Raymond Christophers^{4

5}, Rebecca Famlonga^{1

3}, John Jacky¹, Mark Jones¹, Julie Marsh¹, Kelli McIntosh¹, Vicki O'Donnell⁵, Edward Pan¹, Glenn Pearson¹, Slade Sibosado^{1

6}, Bec Smith^{7

8}, Thomas Snelling^{1

9}, Andrew Steer^{10

11}, Steven Y C Tong^{12

13}, Roz Walker³, Alexandra Whelan¹, Kristen White¹, Edie Wright¹⁴, Asha C Bowen^{1

2}; SToP (See, Treat, Prevent skin sores and scabies) Trial

Collaborators, Affiliations

Collaborators

SToP (See, Treat, Prevent skin sores and scabies) Trial:
Ingrid Amgarth-Duff, Lorraine Anderson, David Atkinson, David Atkinson, Timothy Barnett, Tina Barrow, Liam Bedford, Asha Bowen, Cheryl Bridge, Jeff Cannon, Jonathan Carapetis, Ray Christophers, Chicky Clements, Juli Coffin, Lucy Davidson, Rhona Dawson, Eloise Delaney, Rachael Donovan, Stephanie Enkel, Rebecca Famlonga, Eleasha Figredo, Abbey Ford, David Hendrickx, Christine Hoy, John Jacky, Mark Jones, Jessica Knight, Francene Leaversuch, Hannah Mann, Julie Marsh, Pippa May, Natasha McGinnis, Kelli McIntosh, Frieda McLoughlin, Janine McNamara, Tracy McRae, Katherine Middleton, Marianne Mullane, Rebekah Newton, Vicki O'Donnell, Edward Pan, Rebecca Pavlos, Glenn Pearson, Emma Pearson, Janessa Pickering, Rahaney Poelina, Clancy Read, Kalindu Rodrigo, Slade Sibosado, Bec Smith, Tom Snelling, Andrew Steer, Hannah Thomas, Steven Tong, Roz Walker, Alexandra Whelan, Kristen White, Bernadette Wong, Edie Wright

Affiliations

¹ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia.
² Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA, Australia.
³ Murdoch University, Murdoch, WA, Australia.
⁴ Nirrumbuk Environmental Health and Services, Broome, WA, Australia.
⁵ Kimberley Aboriginal Medical Service, Broome, WA, Australia.
⁶ Kimberley Aboriginal Health Research Alliance, Broome, WA, Australia.
⁷ Western Australia Country Health Service - Kimberley, Broome, WA, Australia.
⁸ National Indigenous Australians Agency, Canberra, ACT, Australia.
⁹ University of Sydney, Sydney, NSW, Australia.
¹⁰ Murdoch Children's Research Institute, Melbourne, VIC, Australia.
¹¹ Department of Infectious Diseases, Royal Children's Hospital, Melbourne, VIC, Australia.
¹² Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
¹³ Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
¹⁴ Department of Education, East Perth, WA, Australia.

PMID: 39649132
PMCID: PMC11625017
DOI: 10.1016/j.eclinm.2024.102793

Multi-methods process evaluation of the SToP (See, Treat, Prevent) trial: a cluster randomised, stepped wedge trial to support healthy skin

Hannah M M Thomas et al. EClinicalMedicine. 2024.

. 2024 Oct 9:77:102793.

doi: 10.1016/j.eclinm.2024.102793. eCollection 2024 Nov.

Authors

Collaborators

SToP (See, Treat, Prevent skin sores and scabies) Trial:
Ingrid Amgarth-Duff, Lorraine Anderson, David Atkinson, David Atkinson, Timothy Barnett, Tina Barrow, Liam Bedford, Asha Bowen, Cheryl Bridge, Jeff Cannon, Jonathan Carapetis, Ray Christophers, Chicky Clements, Juli Coffin, Lucy Davidson, Rhona Dawson, Eloise Delaney, Rachael Donovan, Stephanie Enkel, Rebecca Famlonga, Eleasha Figredo, Abbey Ford, David Hendrickx, Christine Hoy, John Jacky, Mark Jones, Jessica Knight, Francene Leaversuch, Hannah Mann, Julie Marsh, Pippa May, Natasha McGinnis, Kelli McIntosh, Frieda McLoughlin, Janine McNamara, Tracy McRae, Katherine Middleton, Marianne Mullane, Rebekah Newton, Vicki O'Donnell, Edward Pan, Rebecca Pavlos, Glenn Pearson, Emma Pearson, Janessa Pickering, Rahaney Poelina, Clancy Read, Kalindu Rodrigo, Slade Sibosado, Bec Smith, Tom Snelling, Andrew Steer, Hannah Thomas, Steven Tong, Roz Walker, Alexandra Whelan, Kristen White, Bernadette Wong, Edie Wright

Affiliations

¹ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia.
² Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA, Australia.
³ Murdoch University, Murdoch, WA, Australia.
⁴ Nirrumbuk Environmental Health and Services, Broome, WA, Australia.
⁵ Kimberley Aboriginal Medical Service, Broome, WA, Australia.
⁶ Kimberley Aboriginal Health Research Alliance, Broome, WA, Australia.
⁷ Western Australia Country Health Service - Kimberley, Broome, WA, Australia.
⁸ National Indigenous Australians Agency, Canberra, ACT, Australia.
⁹ University of Sydney, Sydney, NSW, Australia.
¹⁰ Murdoch Children's Research Institute, Melbourne, VIC, Australia.
¹¹ Department of Infectious Diseases, Royal Children's Hospital, Melbourne, VIC, Australia.
¹² Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
¹³ Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
¹⁴ Department of Education, East Perth, WA, Australia.

PMID: 39649132
PMCID: PMC11625017
DOI: 10.1016/j.eclinm.2024.102793

Abstract

Background: Healthy skin is important for maintaining overall physical and cultural health and wellbeing. However, remote-living Australian Aboriginal children contend with disproportionally high rates of Streptococcus pyogenes (Strep A) infected impetigo. The SToP Trial was a large stepped-wedge cluster randomised trial of See, Treat, and Prevent (SToP) skin health activities implemented between 2019 and 2022 in the Kimberley region of Western Australia, during which a decrease in impetigo was observed. We aim to evaluate the implementation of the SToP Trial activities and understand the relationship between the trial methodologies and outcomes observed.

Methods: A trial evaluation framework was developed, with the aim to assess whether the SToP activities were implemented as intended, and to gain insights into the implementation and practice necessary to translate this project more broadly. The evaluation employed a multi-methods approach, drawing on both quantitative (metadata relating to type and frequency of project activities, survey results) and qualitative (interview and yarning) data. The evaluation aimed to assess the delivery of the program in terms of implementation, degree of impact, and context.

Findings: Nine Kimberley communities participated in the SToP Trial between September 2018 and November 2022. During visits at the end of Steps 1 and 2 (October 2021 and October 2022, respectively), 152 people including 46 community members, 69 school staff members, 29 clinic staff members and 8 other service providers participated in a combination of individual and group interviews/yarns. Findings indicate the SToP Trial and associated activities existed and were completed within a culturally complex context with competing health and socioeconomic priorities while retaining specificity to each involved community. Acceptance and uptake of community activities was high, reflected in a marked decrease in skin infection during the Trial period. Trial activities including increased skin surveillance, staff training, availability of study treatment, environmental health initiatives and health promotion could not individually be linked to this improvement in skin health.

Interpretation: The leadership and guidance of community leaders, families, and regional Kimberley partners contributed to the Trial succeeding in its intended delivery of activities. Similar projects should prioritise a co-designed community-wide, holistic approach to health issues.

Funding: This trial was funded by the WA Department of Health, Australian National Health and Medical Research Council (NHMRC), and Healthway.

Keywords: Impetigo; Indigenous health; Randomised controlled trial; Remote health; Scabies; Skin health; Streptococcus pyogenes.

PubMed Disclaimer

Conflict of interest statement

All authors declare that they have no conflicts of interest.

Figures

**Fig. 1**
See, Treat and Prevent activity delivery details and intended timeline – that was disrupted due to the global COVID-19 pandemic (2020–2023).

**Fig. 2**
Frequency and degree of SToP Trial activities completed.

**Fig. 3**
Frequency of sulfamethoxazole-trimethoprim and benzathine benzylpenicillin intramuscular injection prescription for the treatment of skin sores.

**Fig. 4**
Frequency of ivermectin and permethrin prescription for the treatment of scabies.

**Fig. 5**
Observed skin-related clinic presentations per week (all ages).

See this image and copyright information in PMC

References

1. Phillips-Beck W., Sinclair S., Campbell R., et al. Early-life origins of disparities in chronic diseases among Indigenous youth: pathways to recovering health disparities from intergenerational trauma. J Dev Orig Health Dis. 2019;10(1):115–122. - PubMed
1. Thomas H.M.M., Enkel S., McRae T., et al. Skin health in northern Australia. Microbiol Aust. 2022;43(3):98–103.
1. May P.J., Bowen A.C., Carapetis J.R. The inequitable burden of Group A streptococcal diseases in Indigenous Australians. Med J Aust. 2016;205(5):201–203. - PubMed
1. Bowen A.C., Mahe A., Hay R.J., et al. The global epidemiology of impetigo: a systematic review of the population prevalence of impetigo and pyoderma. PLoS One. 2015;10(8) - PMC - PubMed
1. Abdalla T., Hendrickx D., Fathima P., et al. Hospital admissions for skin infections among Western Australian children and adolescents from 1996 to 2012. PLoS One. 2017;12(11) - PMC - PubMed

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Multi-methods process evaluation of the SToP (See, Treat, Prevent) trial: a cluster randomised, stepped wedge trial to support healthy skin

Collaborators

Affiliations

Multi-methods process evaluation of the SToP (See, Treat, Prevent) trial: a cluster randomised, stepped wedge trial to support healthy skin

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources