Combined perspectives from people affected by scabies and healthcare workers: a mixed- methods study in Flanders, Belgium - PUBLIC REPORT

Executive Summary

Scabies cases have increased significantly across Europe in recent years, with Flanders experiencing an estimated 15% annual increase in primary care presentations between 2011 and 2023. This mixed-methods study aimed to improve the understanding of scabies distribution, trends, and management challenges in Flanders from the perspective of both people affected by scabies and healthcare providers across five Flemish cities (Antwerp, Bruges, Ghent, Leuven and Hasselt).

The study combined quantitative and qualitative data from healthcare providers and from people affected by scabies. It collected quantitative data from 83 healthcare providers across 96 medical practices (some healthcare providers worked at several clinics) via a baseline survey, case report forms, and monthly forms. It collected data from 115 people affected by scabies via an online patient survey. Additionally, a number of in-depth qualitative interviews were conducted. Eleven people diagnosed with scabies and 33 care providers were interviewed.

The research revealed that scabies poses a complex healthcare challenge, with significant gaps in care delivery and profound psychological and social impacts extending well beyond physical symptoms. Key findings indicate that people affected by scabies experience acute psychological distress during infection and chronic psychological effects (including hypervigilance, anxiety, and disrupted sleep patterns) that persist after clinical cure, alongside significant social impacts (social isolation, work-related limitations). Healthcare providers highlighted several key challenges such as clinical diagnosis, outdated knowledge on the epidemiology of scabies in Belgium, inconsistent treatment guidelines, and unclear environmental decontamination measures. The limited time allocated to consultations and lack of time for follow-up was a clear barrier for effective doctor-patient communication.

Major recommendations include:

• Integrate environmental and psychosocial support into scabies care

• Standardize diagnostic approaches by offering training on the use of dermatoscopes to General Practitioners (GPs), suggesting their use in routine practice, and providing associated diagnostic guidelines

• Train healthcare providers on new clinical guidelines and up to date epidemiology of scabies

• Supply healthcare providers with easy-to-read patient information material that they can distribute during consultations.

Ultimately, this study demonstrates that effective management of scabies requires the implementation of integrated care approaches that address the full scope of patient needs through evidence-based diagnostic, treatment and environmental management protocols, and psychosocial support. Healthcare systems that can successfully adapt to meet these comprehensive needs will be better positioned to manage not only the current scabies re-emergence but also future public health challenges that require similarly integrated responses.