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Greenwell K, Becque T, Sivyer K, Steele M, Denison-Day J, Howells L, Ridd MJ, Roberts A, Lawton S, Langan SM, Hooper J, Wilczynska S, Griffiths G, Sach TH, Little P, Williams HC, Thomas KS, Yardley L, Muller I, Santer M, Stuart B. Online behavioural interventions for children and young people with eczema: a quantitative evaluation. Br J Gen Pract 2024; 74:e379-e386. [PMID: 38316467 PMCID: PMC11104514 DOI: 10.3399/bjgp.2023.0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/29/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Two online behavioural interventions (one website for parents/carers of children with eczema; and one for young people with eczema) have been shown in randomised controlled trials to facilitate a sustained improvement in eczema severity. AIM To describe intervention use and examine potential mediators of intervention outcomes and contextual factors that may influence intervention delivery and outcomes. DESIGN AND SETTING Quantitative process evaluation in UK primary care. METHOD Parents/carers and young people were recruited through primary care. Intervention use was recorded and summarised descriptively. Logistic regression explored sociodemographic and other factors associated with intervention engagement. Mediation analysis investigated whether patient enablement (ability to understand and cope with health issues), treatment use, and barriers to adherence were mediators of intervention effect. Subgroup analysis compared intervention effects among pre-specified participant subsets. RESULTS A total of 340 parents/carers and 337 young people were recruited. Most parents/carers (87%, n = 148/171) and young people (91%, n = 153/168) in the intervention group viewed the core introduction by 24 weeks. At 24 weeks, users had spent approximately 20 minutes on average on the interventions. Among parents/carers, greater intervention engagement was associated with higher education levels, uncertainty about carrying out treatments, and doubts about treatment efficacy at baseline. Among young people, higher intervention use was associated with higher baseline eczema severity. Patient enablement (the ability to understand and cope with health issues) accounted for approximately 30% of the intervention effect among parents/carers and 50% among young people. CONCLUSION This study demonstrated that positive intervention outcomes depended on a modest time commitment from users. This provides further support that the wider implementation of Eczema Care Online is justified.
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Affiliation(s)
- Kate Greenwell
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine; Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton
| | - Taeko Becque
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton
| | - Katy Sivyer
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton
| | - Mary Steele
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton
| | - James Denison-Day
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton
| | - Laura Howells
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham
| | - Matthew J Ridd
- Population Health Sciences, University of Bristol, Bristol
| | - Amanda Roberts
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham
| | - Sandra Lawton
- Queen's Nurse, Department of Dermatology, Rotherham NHS Foundation Trust, Rotherham
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London
| | - Julie Hooper
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton
| | | | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton
| | - Tracey H Sach
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton
| | - Paul Little
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton; School of Psychological Science, University of Bristol, Bristol
| | - Ingrid Muller
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton
| | - Miriam Santer
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton
| | - Beth Stuart
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London
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Liu X, Kim MK, Du D, Zhou X, Wang L, Jiang X. Patient Education with New Media Integration Self-Management Support Model Improves Therapeutic Outcomes of Rosacea Patients. Patient Prefer Adherence 2023; 17:2395-2400. [PMID: 37790861 PMCID: PMC10544126 DOI: 10.2147/ppa.s431955] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023] Open
Abstract
Objective To retrospectively analyze the factors influencing the treatment of rosacea patients with regular follow-up by self-management support in the new media chronic disease management model, to explore the effect of self-management support and to provide an objective basis for clinical application. Methods Female patients with rosacea who were regularly followed up for more than 6 months at the rosacea follow-up clinic of the Department of Dermatology, West China Hospital, Sichuan University, from March 2022 to June 2023, with erythema and capillary dilation as the main clinical phenotype, met the rosacea diagnostic criteria of the American Rosacea Expert Committee 2017 edition, and received medications recommended by the Chinese Rosacea Treatment Guidelines (2021 edition). A total of 125 patients were treated with combined photobiomodulation therapy (PBMT), and the patients were divided into a standardized group (CEA<1, IGA<1) and a non-standardized group (CEA≥1, IGA≥1) based on significant rosacea efficacy (CEA<1, IGA<1) within 6 months. The age, gender, education level, duration of rosacea, treatment regimen, education intensity, CEA, and IGA baseline data were compared between the two groups, and logistic regression analysis was performed to analyze the factors influencing the significant efficacy of rosacea. Results There was a significant difference in the mean length of education between the two groups (P<0.05), and the differences between the rest of the baseline information of the two groups were not statistically significant (P>0.05). Logistic regression analysis showed that the variable that significantly influenced the efficacy of treatment was the mean length of education (≥130.5 min/month), and the intensity of education was significantly associated with the efficacy of treatment. Conclusion Self-management support in the new media chronic disease management model has a positive impact on the treatment of rosacea patients.
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Affiliation(s)
- Xu Liu
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Min-Kyu Kim
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Dan Du
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Xinyu Zhou
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Lian Wang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Xian Jiang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
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3
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Greenwell K, Sivyer K, Howells L, Steele M, Ridd MJ, Roberts A, Ahmed A, Lawton S, Langan SM, Hooper J, Wilczynska S, Leighton P, Griffiths G, Sach T, Little P, Williams HC, Thomas KS, Yardley L, Santer M, Muller I. 'Eczema shouldn't control you; you should control eczema': qualitative process evaluation of online behavioural interventions to support young people and parents/carers of children with eczema. Br J Dermatol 2022; 188:506-513. [PMID: 36745562 DOI: 10.1093/bjd/ljac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is a lack of well-conducted randomized controlled trials evaluating the effectiveness of theory-based online interventions for eczema. To address these deficiencies, we previously developed and demonstrated the effectiveness of two online behavioural interventions: Eczema Care Online for parents/carers of children with eczema, and Eczema Care Online for young people with eczema. OBJECTIVES To explore the views and experiences of people who have used the Eczema Care Online interventions to provide insights into how the interventions worked and identify contextual factors that may impede users' engagement with the interventions. METHODS Qualitative semistructured interviews were conducted with 17 parents/carers of children with eczema and 17 young people with eczema. Participants were purposively sampled from two randomized controlled trials of the interventions and recruited from GP surgeries in England. Transcripts were analysed using inductive thematic analysis, and intervention modifications were identified using the person-based approach table of changes method. RESULTS Both young people and parents/carers found the interventions easy to use, relatable and trustworthy, and perceived that they helped them to manage their eczema, thus suggesting that Eczema Care Online may be acceptable to its target groups. Our analysis suggested that the interventions may reduce eczema severity by facilitating empowerment among its users, specifically through improved understanding of, and confidence in, eczema management, reduced treatment concerns, and improved treatment adherence and management of irritants/triggers. Reading about the experiences of others with eczema helped people to feel 'normal' and less alone. Some (mainly young people) expressed firmly held negative beliefs about topical corticosteroids, views that were not influenced by the intervention. Minor improvements to the design and navigation of the Eczema Care Online interventions and content changes were identified and made, ready for wider implementation. CONCLUSIONS People with eczema and their families can benefit from reliable information, specifically information on the best and safest ways to use their eczema treatments early in their eczema journey. Together, our findings from this study and the corresponding trials suggest wider implementation of Eczema Care Online (EczemaCareOnline.org.uk) is justified.
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Affiliation(s)
- Kate Greenwell
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Katy Sivyer
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Laura Howells
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mary Steele
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Matthew J Ridd
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Amanda Roberts
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amina Ahmed
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sandra Lawton
- Department of Dermatology, Rotherham NHS Foundation Trust, Rotherham, UK
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Julie Hooper
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sylvia Wilczynska
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Tracey Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Paul Little
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.,School of Psychological Science, University of Bristol, Bristol, UK
| | - Miriam Santer
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ingrid Muller
- Primary Care Research Centre, Primary Care, Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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Standen L, Garip G. The influence of self-management, anxiety and depression on chronic eczema-related quality of life. SKIN HEALTH AND DISEASE 2022; 2:e106. [PMID: 36479268 PMCID: PMC9720206 DOI: 10.1002/ski2.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 06/17/2023]
Abstract
Chronic eczema, a persistent inflammatory skin condition, affects 1 in 12 adults in the United Kingdom and negatively influences quality of life. Self-management can potentially influence chronic conditions, such as eczema, reducing symptoms and positively influencing quality of life; however, there is a lack of public education for eczema. Anxiety and depression negatively influence quality of life, and frequently present alongside eczema. Psychological interventions for anxiety and depression have shown to be effective for eczema-related quality of life. This study aimed at examining the relationship between self-management, anxiety, and depression, on quality of life in individuals with chronic eczema. The main hypothesis proposed that anxiety and depression reduce the influence of eczema self-management on quality of life, potentially as individuals might be less likely to support their eczema treatment when experiencing symptoms of anxiety and depression. A cross-sectional design and opportunistic sampling were used to analyse the data from 77 participants who responded to four self-report scales to assess self-management understanding, anxiety, depression and quality of life in participants with chronic eczema. Data were analysed by a hierarchical multiple linear regression to assess the variance contributed by each variable added to the model. Results from this sample shows a trend whereby self-management of eczema contributes less variance to quality of life alongside comorbid anxiety and depression; this suggests that self-management has reduced influence on eczema-related quality of life when anxiety and depression are present. Furthermore, low self-management, high anxiety, and high depression significantly negatively influence quality of life. The three variables combined accounted for 41.1% of variance in quality of life scores, suggesting anxiety, depression and self-management influence quality of life in the sample. Self-management, anxiety, and depression significantly influence eczema-related quality of life, and participants who reported comorbid anxiety and depression were more likely to report lower levels of self-management in this sample.
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Affiliation(s)
- Laura Standen
- College of Health, Psychology & Social CareUniversity of DerbyDerbyUK
| | - Gulcan Garip
- College of Health, Psychology & Social CareUniversity of DerbyDerbyUK
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5
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Sivyer K, Teasdale E, Greenwell K, Steele M, Ghio D, Ridd MJ, Roberts A, Chalmers JR, Lawton S, Langan SM, Cowdell F, Le Roux E, Wilczynska S, Williams HC, Thomas KS, Yardley L, Santer M, Muller I. Supporting families managing childhood eczema: developing and optimising eczema care online using qualitative research. Br J Gen Pract 2022; 72:e378-e389. [PMID: 35577586 PMCID: PMC9119812 DOI: 10.3399/bjgp.2021.0503] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 02/01/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Childhood eczema is often poorly controlled owing to underuse of emollients and topical corticosteroids (TCS). Parents/carers report practical and psychosocial barriers to managing their child's eczema, including child resistance. Online interventions could potentially support parents/carers; however, rigorous research developing such interventions has been limited. AIM To develop an online behavioural intervention to help parents/carers manage and co-manage their child's eczema. DESIGN AND SETTING Intervention development using a theory-, evidence-, and person-based approach (PBA) with qualitative research. METHOD A systematic review and qualitative synthesis of studies (n = 32) and interviews with parents/carers (n = 30) were used to identify barriers and facilitators to effective eczema management, and a prototype intervention was developed. Think-aloud interviews with parents/carers (n = 25) were then used to optimise the intervention to increase its acceptability and feasibility. RESULTS Qualitative research identified that parents/carers had concerns about using emollients and TCS, incomplete knowledge and skills around managing eczema, and reluctance to transitioning to co-managing eczema with their child. Think-aloud interviews highlighted that, while experienced parents/carers felt they knew how to manage eczema, some information about how to use treatments was still new. Techniques for addressing barriers included providing a rationale explaining how emollients and TCS work, demonstrating how to use treatments, and highlighting that the intervention provided new, up-to-date information. CONCLUSION Parents/carers need support in effectively managing and co-managing their child's eczema. The key output of this research is Eczema Care Online for Families, an online intervention for parents/carers of children with eczema, which is being evaluated in a randomised trial.
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Affiliation(s)
- Katy Sivyer
- Department of Psychology, University of Southampton, Southampton; lecturer, University of Portsmouth, Portsmouth
| | | | | | | | - Daniela Ghio
- University of Manchester, Manchester; research fellow, University of Southampton, Southampton
| | | | | | | | | | | | | | | | | | | | | | - Lucy Yardley
- University of Bristol, Bristol; professor of health psychology, University of Southampton, Southampton
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6
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Sahin U, Reeve K, Tochtermann G, Kilanowski K, Navarini A, Imhof L, Held U, Hofbauer GFL. HautTief Multidisciplinary Educational Program for Patients with Psoriasis or Atopic Dermatitis: A Randomized Controlled Study. Dermatology 2022; 238:1050-1059. [PMID: 35533665 PMCID: PMC9677846 DOI: 10.1159/000524225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/05/2022] [Indexed: 11/29/2022] Open
Abstract
Background Improving health-related quality of life (HRQoL), disease severity, and treatment adherence through patient education is an increasingly important, yet relatively new area in dermatology. This randomized controlled trial aims to contribute to this growing area of research by exploring the effects of a 9-week educational program for patients with chronic skin diseases. Objective The aim of the study was to evaluate the effect of a multidisciplinary educational program on HRQoL and disease severity in patients with psoriasis or atopic dermatitis (AD). Methods Sixty-four patients with diagnosed psoriasis or AD were recruited from University Hospital Zurich and randomized (1:1) to the intervention or control group. To assess HRQoL, the following self-reported questionnaires were used: Dermatology Life Quality Index (DLQI), Skindex-29, EuroQol-5D (EQ-5D), RAND 36-Item Short Form Survey (SF-36), and Beck Depression Inventory (BDI) to measure depression symptoms. Psoriasis Area and Severity Index (PASI) and the Eczema Area and Severity Index (EASI) were used to capture disease extent. These scores were assessed at four study visits, which were performed at baseline and 3, 6, and 9 months after the start of the program. Results At month 6, an improvement of at least 25% in BDI was recorded in 15 (68.2%) of 22 patients in the intervention group and 6 (27.3%) of 22 patients in the control group (difference 40.9%, p = 0.016). 53.3% (16 of 30) of patients achieved an improvement in one subdomain of the SF-36 score (role limitations due to emotional problems) at 6-month follow-up, compared with 23.1% (6 of 26) of those not attending the educational program (difference 30.2%; p = 0.042). No significant differences in DLQI, Skindex-29, EQ-5D, PASI, and EASI between both groups at the three time points were found. Conclusion An educational program may improve HRQoL and depression status of patients with psoriasis or AD.
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Affiliation(s)
- Ugur Sahin
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - Kelly Reeve
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland
| | - Giulia Tochtermann
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - Kamilla Kilanowski
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - Alexander Navarini
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - Laurence Imhof
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - Ulrike Held
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland
| | - Günther F L Hofbauer
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
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7
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Greenwell K, Ghio D, Sivyer K, Steele M, Teasdale E, Ridd MJ, Roberts A, Chalmers JR, Lawton S, Langan S, Cowdell F, Le Roux E, Wilczynska S, Jones H, Whittaker E, Williams HC, Thomas KS, Yardley L, Santer M, Muller I. Eczema Care Online: development and qualitative optimisation of an online behavioural intervention to support self-management in young people with eczema. BMJ Open 2022; 12:e056867. [PMID: 35443955 PMCID: PMC9021764 DOI: 10.1136/bmjopen-2021-056867] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To describe the development of Eczema Care Online (ECO), an online behaviour change intervention for young people with eczema (phase I); and explore and optimise the acceptability of ECO among this target group using think-aloud interviews (phase II). METHODS Theory-based, evidence-based and person-based approaches to intervention development were used. In phase I, a qualitative systematic review and qualitative interviews developed an in-depth understanding of the needs and challenges of young people with eczema. Guiding principles highlighted key intervention design objectives and features to address the needs of this target group to maximise user engagement. Behavioural analysis and logic modelling developed ECO's hypothesised programme theory. In phase II, qualitative think-aloud interviews were carried out with 28 young people with eczema and the intervention was optimised based on their feedback. RESULTS The final intervention aimed to reduce eczema severity by supporting treatment use (emollients, topical corticosteroids/topical calcineurin inhibitors), management of irritants/triggers, emotional management and reducing scratching. Generally, young people expressed positive views of intervention content and design in think-aloud interviews. Quotes and stories from other young people with eczema and ECO's focus on living with eczema (not just topical treatments) were valuable for normalising eczema. Young people believed ECO addressed knowledge gaps they had from childhood and the safety information about topical corticosteroids was reassuring. Negative feedback was used to modify ECO. CONCLUSIONS A prototype of the ECO intervention was developed using rigorous and complementary intervention development approaches. Subsequent think-aloud interviews helped optimise the intervention, demonstrated ECO is likely to be acceptable to this target group, and provided support for our guiding principles including key design objectives and features to consider when developing interventions for this population. A randomised controlled trial and process evaluation of the intervention is underway to assess effectiveness and explore user engagement with the intervention's behavioural goals.
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Affiliation(s)
- Kate Greenwell
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Daniela Ghio
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Katy Sivyer
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Department of Psychology, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Mary Steele
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Emma Teasdale
- School of Primary Care, Population Health and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Matthew J Ridd
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Amanda Roberts
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Joanne R Chalmers
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sandra Lawton
- Department of Dermatology, Rotherham NHS Foundation Trust, Rotherham, UK
| | - Sinead Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Fiona Cowdell
- Faculty of Health Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Emma Le Roux
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Sylvia Wilczynska
- School of Primary Care, Population Health and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hannah Jones
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - H C Williams
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kim Suzanne Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Centre for Academic Primary Care, School of Psychological Science, University of Bristol, Bristol, UK
| | - Miriam Santer
- School of Primary Care, Population Health and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ingrid Muller
- School of Primary Care, Population Health and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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8
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Gundogan B, Dowlut N, Rajmohan S, Borrelli MR, Millip M, Iosifidis C, Udeaja YZ, Mathew G, Fowler A, Agha R. Assessing the compliance of systematic review articles published in leading dermatology journals with the PRISMA statement guidelines: A systematic review. JAAD Int 2021; 1:157-174. [PMID: 34409336 PMCID: PMC8361930 DOI: 10.1016/j.jdin.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background Reporting quality of systematic reviews and meta-analyses is of critical importance in dermatology because of their key role in informing health care decisions. Objective To assess the compliance of systematic reviews and meta-analyses in leading dermatology journals with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. Methods This review was carried out in accordance with PRISMA guidelines. Included studies were reviews published across 6 years in the top 4 highest-impact-factor dermatology journals of 2017. Records and full texts were screened independently. Data analysis was conducted with univariate multivariable linear regression. The primary outcome was to assess the compliance of systematic reviews and meta-analyses in leading dermatology journals with the PRISMA statement. Results A total of 166 studies were included and mean PRISMA compliance across all articles was 73%. Compliance significantly improved over time (β = .016; P = <.001). The worst reported checklist item was item 5 (reporting on protocol existence), with a compliance of 15% of articles. Conclusion PRISMA compliance within leading dermatology journals could be improved; however, it is steadily improving.
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Affiliation(s)
- Buket Gundogan
- University College London Hospital, London, United Kingdom
| | - Naeem Dowlut
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Mimi R Borrelli
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Mirabel Millip
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Christos Iosifidis
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Yagazie Z Udeaja
- Luton and Dunstable University Hospital NHS Foundation Trust, Luton, United Kingdom
| | - Ginimol Mathew
- University College London Medical School, Gower Street, London, United Kingdom
| | | | - Riaz Agha
- Bart's Health NHS Foundation Trust, London, United Kingdom
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9
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Wheeler M, Guterres S, Bewley AP, Thompson AR. An analysis of qualitative responses from a UK survey of the psychosocial wellbeing of people with skin conditions and their experiences of accessing psychological support. Clin Exp Dermatol 2021; 47:37-42. [PMID: 34160837 DOI: 10.1111/ced.14815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Skin conditions have a large emotional, psychological and psychiatric impact on the individual. The All-Party Parliamentary Group on Skin (APPGS) commissioned a qualitative survey to further explore this relationship alongside the experiences of those accessing services in relation to these difficulties in the UK. AIM To examine the experiences of UK individuals living with a skin condition, and their views of seeking and receiving psychological treatment. This survey formed part of the evidence collected in the preparation of the APPGS Mental Health and Skin Disease report. METHODS A free-text electronic survey was widely distributed by professional bodies and skin-related charities. Responses were analysed using descriptive thematic analysis and descriptive statistics. Data for each question were classified and labelled, leading to the development of a coding frame. Inter-rater reliability was assessed using Cohen kappa statistic. RESULTS In total, 544 participants (84% female) completed the survey. The majority of respondents had inflammatory skin diseases such as eczema (43%) or psoriasis (33%). The thematic analysis revealed five key themes associated with impact on mood; impact of intimacy; impact on activities of daily living; lack of recognition from others of the impact; and lack of accessible services. CONCLUSION The survey demonstrates that there is an urgent need to improve both awareness of the impact that skin conditions can have, and for the provision of psychological services to address this impact.
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Affiliation(s)
- M Wheeler
- South Wales Clinical Psychology Training Programme, School of Psychology, Cardiff University and Cardiff and Vale University Health Board, Cardiff, UK
| | - S Guterres
- All-Party Parliamentary Group on Skin, Niddry Lodge, London, UK
| | - A P Bewley
- The Royal London Hospital and Whipps Cross University Hospitals NHS Trust, Barts Health NHS Trust and Queen Mary University, London, UK
| | - A R Thompson
- South Wales Clinical Psychology Training Programme, School of Psychology, Cardiff University and Cardiff and Vale University Health Board, Cardiff, UK
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10
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Chen Q, Ran L, Li M, Tan X. Health-related quality of life of middle-aged and elderly people with hypertension: A cross-sectional survey from a rural area in China. PLoS One 2021; 16:e0246409. [PMID: 33529252 PMCID: PMC7853450 DOI: 10.1371/journal.pone.0246409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 01/18/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate health-related quality of life (HRQoL) of middle-aged and elderly people with hypertension in Enshi, China, and to explore the important correlates defining HRQoL. METHODS From April through July 2018, a self-monitoring intervention program for hypertension control was implemented in a remote area of central China. Participants completed a cross-sectional survey which included demographic characteristics, the Health-related Quality of Life Survey, and the Pittsburgh Sleep Quality Index Survey. Univariate analysis was performed by analysis of variance, and multiple linear regression analysis was used to analyze the influencing factors of HRQoL in middle-aged and elderly hypertensive patients. In the multivariate analysis, the variables with P≤0.05 in the single factor analysis were combined with the professional significance to establish a multiple linear regression model. RESULTS Information from 500 participants was available for analysis. Among them, the scores of PCS and MCS was 31.66 ± 9.50 and 41.38 ± 10.69, respectively. Multivariable regression analyses showed that higher education and sleep quality, and moderate physical activity (30 minutes for at least five days a week) had a positive influence on PCS scores. Higher monthly family income (3,000-5,000 ¥) and sleep quality, regular tea-drinking, having 30 minutes of moderate physical activity at least five days a week were positively associated with MCS scores. CONCLUSION The overall HRQoL for rural middle-aged and elderly hypertensive patients in Xuan'en county of Hubei province was poor. Effective relevant measures for the above factors were urgently needed to improve the quality of life for the elderly in rural areas. Awareness of these relevant factors could help health care professionals provide better supportive care.
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Affiliation(s)
- Qi Chen
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Li Ran
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Mengying Li
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Xiaodong Tan
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
- * E-mail:
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11
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Killey J, Simons M, Kimble RM, Tyack Z. Effectiveness of interventions for optimising adherence to treatments for the prevention and management of scars: protocol for a systematic review and meta-analysis. BMJ Open 2019; 9:e023904. [PMID: 30928928 PMCID: PMC6475195 DOI: 10.1136/bmjopen-2018-023904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Treatments used in the management of scarring following wounds of the skin can be complex and time consuming, and patients may experience difficulties adhering to these treatments. Therefore, the aim of this systematic review is to identify the types of interventions that have been used to optimise adherence to treatment for preventing or reducing skin scars in adults and children and to determine the effectiveness of these interventions. METHODS AND ANALYSIS Databases (PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and OTSeeker) will be searched using the developed search strategy to identify eligible randomised trials. Adults and children using scar treatments to prevent or manage scarring as a result of a dermal wound (which may occur following burn injury, surgery, lacerations, piercings, vaccinations, acne and other conditions affecting the skin) will be included. Any intervention with the potential to effect adherence will be included. Titles and abstracts located through searching will be screened by two independent reviewers. Full text of studies will also be screened to determine eligibility for final inclusion. Two reviewers will assess the quality of included studies using the Cochrane 'risk of bias' tool. Data extraction forms will be developed and two reviewers will extract the data. A third reviewer will be used at each stage to ensure consensus is achieved. Meta-analysis and meta-regression will be completed if appropriate, otherwise a narrative synthesis of results will be undertaken. ETHICS AND DISSEMINATION No ethical approval is necessary for this systematic review as no patients will be directly involved. Results of this systematic review will be disseminated through journal publications and relevant conference presentations. PROSPERO REGISTRATION NUMBER CRD42018095082.
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Affiliation(s)
- Jessica Killey
- Centre for Children's Burns and Trauma Research, Children's Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Megan Simons
- Centre for Children's Burns and Trauma Research, Children's Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
- Department of Occupational Therapy, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Children's Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Children's Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
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12
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Solman L, Lloyd‐Lavery A, Grindlay DJC, Rogers NK, Thomas KS, Harman KE. What's new in atopic eczema? An analysis of systematic reviews published in 2016. Part 1: treatment and prevention. Clin Exp Dermatol 2019; 44:363-369. [DOI: 10.1111/ced.13885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2018] [Indexed: 12/14/2022]
Affiliation(s)
- L. Solman
- Department of Paediatric Dermatology Great Ormond Street Hospital for Children London UK
| | - A. Lloyd‐Lavery
- Churchill Hospital Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - D. J. C. Grindlay
- Centre of Evidence Based Dermatology University of Nottingham King's Meadow Campus Lenton Lane Nottingham UK
| | - N. K. Rogers
- Centre of Evidence Based Dermatology University of Nottingham King's Meadow Campus Lenton Lane Nottingham UK
| | - K. S. Thomas
- Centre of Evidence Based Dermatology University of Nottingham King's Meadow Campus Lenton Lane Nottingham UK
| | - K. E. Harman
- Centre of Evidence Based Dermatology University of Nottingham King's Meadow Campus Lenton Lane Nottingham UK
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13
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Khoury LR, Møller T, Zachariae C, Correll H, Jørgensen NB, Pedersen C, Pors M, Bundy C, Skov L. A prospective, clinical, nonrandomized controlled trial of individualized, nurse-led patient-centred intervention in patients with psoriasis. Br J Dermatol 2018; 180:1244-1245. [PMID: 30585311 DOI: 10.1111/bjd.17585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L R Khoury
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T Møller
- University Hospitals Centre for Health Care Research, Rigshospitalet, University of Copenhagen, Denmark
| | - C Zachariae
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - H Correll
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - N B Jørgensen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - C Pedersen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Pors
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - C Bundy
- School of Healthcare Sciences, University of Cardiff, Cardiff, U.K
| | - L Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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14
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Heratizadeh A, Werfel T, Gieler U, Kupfer J. Neurodermitis-Erwachsenenschulung nach dem Konzept der „Arbeitsgemeinschaft Neurodermitisschulung für Erwachsene“ (ARNE). Hautarzt 2018; 69:225-231. [DOI: 10.1007/s00105-018-4125-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Effects of structured patient education in adults with atopic dermatitis: Multicenter randomized controlled trial. J Allergy Clin Immunol 2017; 140:845-853.e3. [DOI: 10.1016/j.jaci.2017.01.029] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 12/09/2016] [Accepted: 01/05/2017] [Indexed: 11/23/2022]
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16
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Nelson PA, Kane K, Pearce CJ, Bundy C, Chisholm A, Hilton R, Thorneloe R, Young H, Griffiths CEM, Cordingley L. 'New to me': changing patient understanding of psoriasis and identifying mechanisms of change. The Pso Well ® patient materials mixed-methods feasibility study. Br J Dermatol 2017; 177:758-770. [PMID: 28403510 PMCID: PMC5637913 DOI: 10.1111/bjd.15574] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 12/27/2022]
Abstract
Background Psoriasis is an inflammatory long‐term condition involving comorbidities, unhealthy lifestyle and significant life impact. Patients’ understanding of psoriasis is limited and support lacking. The Common‐Sense Model of Self‐Regulation of Health and Illness emphasizes the role of illness and treatment beliefs on coping and self‐management. New ‘Pso Well®’ patient materials informed by the model, addressed psoriasis as a long‐term condition, medication management and lifestyle behaviours. Objectives To investigate whether Pso Well® materials (i) broaden understanding of psoriasis without increasing anxiety; (ii) are acceptable; and (iii) comprise features that appear to effect change. Methods The Revised Illness Perceptions Questionnaire (IPQ‐R modified) and the Hospital Anxiety and Depression Scale (HADS) were administered in patients before and after intervention. Numerical rating scales assessed perceptions of change in understanding and anxiety resulting from engagement with the materials. Qualitative interviews explored acceptability and perceived ‘active ingredients’. Results Fifty‐five patients completed pre‐ and postintervention questionnaires (56% female; median age 59 years). Postintervention, a large effect size was indicated in two IPQ‐R domains – illness coherence [t(55) = −3·48, P = 0·001 (two‐tailed), η2 = 0·19] and personal control [t(55) = −2·98, P = 0·004 (two‐tailed), η2 = 0·14] – and a medium effect in one, treatment control [t(55) = −2·08, P = 0·042 (two‐tailed), η2 = 0·08]. HADS scores did not change. For numerical rating scales, 80% of participants reported increased understanding of psoriasis and none reported increased anxiety. Interviews with 19 patients indicated the materials were acceptable and usable. Factors reported to broaden understanding and promote engagement with self‐management included linking of related disease aspects, personally relevant content and high‐quality design. Conclusions High‐quality, theory‐based psoriasis materials are acceptable to patients and can improve understanding and sense of control without increasing anxiety. What's already known about this topic? Psoriasis is associated with comorbidities, unhealthy lifestyle and significant life impact. Patients’ understanding of psoriasis is limited, self‐management support is lacking and disengagement from healthcare services is common.
What does this study add? The new, theory‐informed Pso Well® patient materials address psoriasis as a long‐term condition; medications management and lifestyle behaviour. The Pso Well® patient materials can increase understanding of psoriasis, promote feelings of self‐worth and encourage a desire to engage in self‐management and behaviour change, without increasing anxiety or depression.
What are the clinical implications of this work? The Pso Well® patient materials could support clinical consultations by helping patients recognize the remitting–relapsing nature of psoriasis. This will help to improve understanding of the disease, as well as providing a clearer rationale for treatment adherence and lifestyle behaviour change.
Linked Comment: Prinsen. Br J Dermatol 2017; 177:616–617
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Affiliation(s)
- P A Nelson
- Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.,Manchester Academic Health Science Centre, Manchester, U.K
| | - K Kane
- Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.,Manchester Academic Health Science Centre, Manchester, U.K
| | - C J Pearce
- Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.,Manchester Academic Health Science Centre, Manchester, U.K.,Manchester Centre for Health Psychology, University of Manchester, Manchester, U.K
| | - C Bundy
- Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.,Manchester Academic Health Science Centre, Manchester, U.K.,Manchester Centre for Health Psychology, University of Manchester, Manchester, U.K
| | - A Chisholm
- Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.,Manchester Academic Health Science Centre, Manchester, U.K.,Manchester Centre for Health Psychology, University of Manchester, Manchester, U.K
| | - R Hilton
- Bridgewater Community Healthcare Trust, Wigan, U.K
| | - R Thorneloe
- Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.,Manchester Academic Health Science Centre, Manchester, U.K.,Manchester Centre for Health Psychology, University of Manchester, Manchester, U.K
| | - H Young
- Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.,Manchester Academic Health Science Centre, Manchester, U.K.,Salford Royal NHS Foundation Trust, Greater Manchester, U.K
| | - C E M Griffiths
- Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.,Manchester Academic Health Science Centre, Manchester, U.K.,Salford Royal NHS Foundation Trust, Greater Manchester, U.K
| | - L Cordingley
- Manchester Academic Health Science Centre, Manchester, U.K.,Manchester Centre for Health Psychology, University of Manchester, Manchester, U.K.,Division of Musculoskeletal and Dermatological Research, University of Manchester, Manchester, U.K
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17
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Ridd MJ, King AJL, Le Roux E, Waldecker A, Huntley AL. Systematic review of self-management interventions for people with eczema. Br J Dermatol 2017; 177:719-734. [PMID: 28432696 PMCID: PMC5637890 DOI: 10.1111/bjd.15601] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 01/25/2023]
Abstract
Eczema is a common long‐term condition, but inadequate support and information can lead to poor adherence and treatment failure. We have reviewed the international literature of interventions designed to promote self‐management in adults and children with eczema. MEDLINE, MEDLINE in process, Embase, CINAHL and the Global Resource for EczemA Trials database were searched from their inception to August 2016, for randomized controlled trials. Two authors independently applied eligibility criteria, assessed risk of bias for all included studies and extracted data. Twenty studies (3028 participants) conducted in 11 different countries were included. The majority (n = 18) were based in secondary care and most (n = 16) targeted children with eczema. Reporting of studies, including descriptions of the interventions and the outcomes themselves, was generally poor. Thirteen studies were face‐to‐face educational interventions, five were delivered online and two were studies of written action plans. Follow‐up in most studies (n = 12) was short term (up to 12 weeks). Only six trials specified a single primary outcome. There was limited evidence of effectiveness. Only three studies collected and reported outcomes related to cost and just one study undertook any formal cost‐effectiveness analysis. In summary, we have identified a general absence of well‐conducted and well‐reported randomized controlled trials with a strong theoretical basis. Therefore, there is still uncertainty about how best to support self‐management of eczema in a clinically effective and cost‐effective way. Recommendations on design and conduct of future trials are presented. What's already known about this topic? Eczema requires a high degree of self‐management by patients. Adherence to eczema treatments, and hence control of symptoms, can be poor. There is uncertainty about how best to support self‐management in a clinically effective and cost‐effective way.
What does this study add?A wide range of interventions designed to promote self‐management have been evaluated in 20 studies across 11 different countries. Reporting of the design and conduct of these studies is generally poor, and explicit theory describing how interventions are expected to improve care is uncommon. What works best for people with eczema and whether it is cost‐effective is unknown. Recommendations for future trials are made.
Linked Comment: Arents. Br J Dermatol 2017; 177:613–614 Plain language summary available online
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Affiliation(s)
- M J Ridd
- School of Social and Community Medicine, University of Bristol, Bristol, U.K
| | - A J L King
- School of Social and Community Medicine, University of Bristol, Bristol, U.K
| | - E Le Roux
- School of Social and Community Medicine, University of Bristol, Bristol, U.K
| | - A Waldecker
- School of Social and Community Medicine, University of Bristol, Bristol, U.K
| | - A L Huntley
- School of Social and Community Medicine, University of Bristol, Bristol, U.K
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Bieber T. Atopic Dermatitis 2.0: the Long and Tedious Road to Precision Medicine. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0172-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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Wallmeyer L, Dietert K, Sochorová M, Gruber AD, Kleuser B, Vávrová K, Hedtrich S. TSLP is a direct trigger for T cell migration in filaggrin-deficient skin equivalents. Sci Rep 2017; 7:774. [PMID: 28377574 PMCID: PMC5428778 DOI: 10.1038/s41598-017-00670-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/08/2017] [Indexed: 02/08/2023] Open
Abstract
Mutations in the gene encoding for filaggrin (FLG) are major predisposing factors for atopic dermatitis (AD). Besides genetic predisposition, immunological dysregulations considerably contribute to its pathophysiology. For example, thymic stromal lymphopoietin (TSLP) is highly expressed in lesional atopic skin and significantly contributes to the pathogenesis of AD by activating dendritic cells that then initiate downstream effects on, for example, T cells. However, little is known about the direct interplay between TSLP, filaggrin-deficient skin and other immune cells such as T lymphocytes. In the present study, FLG knockdown skin equivalents, characterised by intrinsically high TSLP levels, were exposed to activated CD4+ T cells. T cell exposure resulted in an inflammatory phenotype of the skin equivalents. Furthermore, a distinct shift from a Th1/Th17 to a Th2/Th22 profile was observed following exposure of T cells to filaggrin-deficient skin equivalents. Interestingly, TSLP directly stimulated T cell migration exclusively in filaggrin-deficient skin equivalents even in the absence of dendritic cells, indicating a hitherto unknown role of TSLP in the pathogenesis of AD.
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Affiliation(s)
- Leonie Wallmeyer
- Institute for Pharmacy, Pharmacology and Toxicology, Freie Universität Berlin, Berlin, Germany
| | - Kristina Dietert
- Department of Veterinary Medicine, Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Michaela Sochorová
- Faculty of Pharmacy, Charles University Prague, Hradec Kralove, Czech Republic
| | - Achim D Gruber
- Department of Veterinary Medicine, Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Burkhard Kleuser
- Institute of Nutritional Science, Department of Toxicology, University of Potsdam, Potsdam, Germany
| | - Kateřina Vávrová
- Faculty of Pharmacy, Charles University Prague, Hradec Kralove, Czech Republic
| | - Sarah Hedtrich
- Institute for Pharmacy, Pharmacology and Toxicology, Freie Universität Berlin, Berlin, Germany.
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Santer M, Muller I, Yardley L, Lewis-Jones S, Ersser S, Little P. Parents' and carers' views about emollients for childhood eczema: qualitative interview study. BMJ Open 2016; 6:e011887. [PMID: 27543590 PMCID: PMC5013451 DOI: 10.1136/bmjopen-2016-011887] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Leave-on emollients form the mainstay of eczema treatment, but adherence is poor. We aimed to explore parents'/carers' views on effectiveness and acceptability of leave-on emollients for childhood eczema through secondary analysis of data from 2 qualitative data sets. SETTING Study 1 recruited through mail-out from 6 general practices in southern England. Study 2 recruited from a feasibility trial of an intervention to support eczema self-care in 31 practices in the same area. PARTICIPANTS Study 1 included 28 interviews with carers of children aged ≤5 years with eczema. Study 2 included 26 interviews with carers of children aged ≤5 years with eczema. METHODS Interviews followed semistructured guides: study 1 explored carers' understandings around eczema treatments in order to develop a web-based self-care support intervention; study 2 explored carers' understandings of eczema and eczema treatments after using the intervention. Interviews were carried out face to face or by telephone, audio-recorded and transcribed. Secondary analysis of data from both studies focused on views and experiences of emollient use. Data were analysed using an inductive thematic approach facilitated by NVivo V.10 software. RESULTS In study 1, most participants felt emollients improved eczema but held mixed views about long-term use to prevent flare-ups. In study 2, where carers had used the web-based intervention, all participants held positive views about long-term emollient use. In both studies, participants expressed a range of preferences about emollient 'thickness'; some felt that 'thick' emollients (ointments) were most effective, while others found these difficult to use. Carers described a process of 'trial and error', trying emollients suggested by professionals, friends and family, or bought over-the-counter. Carers expressed a need for understanding differences between products and their effective use. CONCLUSIONS Providing a rationale for long-term emollient use and choice of emollients could help improve adherence and help families gain more rapid control of eczema.
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Affiliation(s)
- M Santer
- Primary Care & Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - I Muller
- Primary Care & Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - L Yardley
- Primary Care & Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - S Lewis-Jones
- Ninewells Hospital & University of Dundee, Dundee, UK
| | | | - P Little
- Primary Care & Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
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21
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Bundy C. Is education enough to improve quality of life in people with chronic inflammatory skin conditions? Br J Dermatol 2016; 174:1179. [PMID: 27317274 DOI: 10.1111/bjd.14611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C Bundy
- Centre for Dermatology Research, University of Manchester, Oxford Road, Manchester, M13 7PT, U.K.
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