title: A survey of knowledge, attitudes, and practices towards skin and soft tissue infections in rural Alaska.
abstract: BACKGROUND
  Community-acquired methicillin-resistant Staphylococcus aureus and methicillin-sensitive S. aureus infections are common to south-western Alaska and have been associated with traditional steambaths. More than a decade ago, recommendations were made to affected communities that included preventive skin care, cleaning methods for steambath surfaces, and the use of protective barriers while in steambaths to reduce the risk of S. aureus infection.
  
  
  OBJECTIVE
  A review of community medical data suggested that the number of skin infection clinical encounters has increased steadily over the last 3 years and we designed a public health investigation to seek root causes.
  
  
  METHODS
  Using a mixed methods approach with in-person surveys, a convenience sample (n=492) from 3 rural communities assessed the range of knowledge, attitudes and practices concerning skin infections, skin infection education messaging, prevention activities and home self-care of skin infections.
  
  
  RESULTS
  We described barriers to implementing previous recommendations and evaluated the acceptability of potential interventions. Prior public health messages appear to have been effective in reaching community members and appear to have been understood and accepted. We found no major misconceptions regarding what a boil was or how someone got one. Overall, respondents seemed concerned about boils as a health problem and reported that they were motivated to prevent boils. We identified current practices used to avoid skin infections, such as the disinfection of steambaths. We also identified barriers to engaging in protective behaviours, such as lack of access to laundry facilities.
  
  
  CONCLUSIONS
  These findings can be used to help guide public health strategic planning and identify appropriate evidence-based interventions tailored to the specific needs of the region.
authors.affiliation: Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA.|Epidemic Intelligence Service, Division of Applied Sciences, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Raczniak
authors.affiliation: Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Joanna
authors.initials: J
authors.lastname: Gaines
authors.affiliation: Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Bulkow
authors.affiliation: Epidemic Intelligence Service, Division of Applied Sciences, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Kinzer
authors.affiliation: Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Hennessy
authors.affiliation: Yukon-Kuskokwim Health Corporation, Bethel, AK, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Klejka
authors.affiliation: Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA; zwa8@cdc.gov.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Bruce
mesh_terms: D000413:Alaska / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D020380:Needs Assessment; D012424:Rural Population; D018461:Soft Tissue Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology*; D013207:Staphylococcal Skin Infections / Q000175:diagnosis / Q000453:epidemiology*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Alaska Native people; Aniinguaq; MRSA; Maqiq; Staphylococcus aureus; laundry practices; skin and soft tissue infections; traditional steambath