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Singleton H, Hodder A, Almilaji O, Ersser SJ, Heaslip V, O'Meara S, Boyers D, Roberts A, Scott H, Van Onselen J, Doney L, Boyle RJ, Thompson AR. Educational and psychological interventions for managing atopic dermatitis (eczema). Cochrane Database Syst Rev 2024; 8:CD014932. [PMID: 39132734 PMCID: PMC11318083 DOI: 10.1002/14651858.cd014932.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
BACKGROUND Atopic dermatitis (eczema), can have a significant impact on well-being and quality of life for affected people and their families. Standard treatment is avoidance of triggers or irritants and regular application of emollients and topical steroids or calcineurin inhibitors. Thorough physical and psychological assessment is central to good-quality treatment. Overcoming barriers to provision of holistic treatment in dermatological practice is dependent on evaluation of the efficacy and economics of both psychological and educational interventions in this participant group. This review is based on a previous Cochrane review published in 2014, and now includes adults as well as children. OBJECTIVES To assess the clinical outcomes of educational and psychological interventions in children and adults with atopic dermatitis (eczema) and to summarise the availability and principal findings of relevant economic evaluations. SEARCH METHODS We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, APA PsycINFO and two trials registers up to March 2023. We checked the reference lists of included studies and related systematic reviews for further references to relevant randomised controlled trials (RCTs) and contacted experts in the field to identify additional studies. We searched NHS Economic Evaluation Database, MEDLINE and Embase for economic evaluations on 8 June 2022. SELECTION CRITERIA Randomised, cluster-randomised and cross-over RCTs that assess educational and psychological interventions for treating eczema in children and adults. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods, with GRADE to assess the certainty of the evidence for each outcome. Primary outcomes were reduction in disease severity, as measured by clinical signs, patient-reported symptoms and improvement in health-related quality-of-life (HRQoL) measures. Secondary outcomes were improvement in long-term control of symptoms, improvement in psychological well-being, improvement in standard treatment concordance and adverse events. We assessed short- (up to 16 weeks after treatment) and long-term time points (more than 16 weeks). MAIN RESULTS We included 37 trials (6170 participants). Most trials were conducted in high-income countries (34/37), in outpatient settings (25/37). We judged three trials to be low risk of bias across all domains. Fifteen trials had a high risk of bias in at least one domain, mostly due to bias in measurement of the outcome. Trials assessed interventions compared to standard care. Individual educational interventions may reduce short-term clinical signs (measured by SCORing Atopic Dermatitis (SCORAD); mean difference (MD) -5.70, 95% confidence interval (CI) -9.39 to -2.01; 1 trial, 30 participants; low-certainty evidence) but patient-reported symptoms, HRQoL, long-term eczema control and psychological well-being were not reported. Group education interventions probably reduce clinical signs (SCORAD) both in the short term (MD -9.66, 95% CI -19.04 to -0.29; 3 studies, 731 participants; moderate-certainty evidence) and the long term (MD -7.22, 95% CI -11.01 to -3.43; 3 studies, 1424 participants; moderate-certainty evidence) and probably reduce long-term patient-reported symptoms (SMD -0.47 95% CI -0.60 to -0.33; 2 studies, 908 participants; moderate-certainty evidence). They may slightly improve short-term HRQoL (SMD -0.19, 95% CI -0.36 to -0.01; 4 studies, 746 participants; low-certainty evidence), but may make little or no difference to short-term psychological well-being (Perceived Stress Scale (PSS); MD -2.47, 95% CI -5.16 to 0.22; 1 study, 80 participants; low-certainty evidence). Long-term eczema control was not reported. We don't know whether technology-mediated educational interventions could improve short-term clinical signs (SCORAD; 1 study; 29 participants; very low-certainty evidence). They may have little or no effect on short-term patient-reported symptoms (Patient Oriented Eczema Measure (POEM); MD -0.76, 95% CI -1.84 to 0.33; 2 studies; 195 participants; low-certainty evidence) and probably have little or no effect on short-term HRQoL (MD 0, 95% CI -0.03 to 0.03; 2 studies, 430 participants; moderate-certainty evidence). Technology-mediated education interventions probably slightly improve long-term eczema control (Recap of atopic eczema (RECAP); MD -1.5, 95% CI -3.13 to 0.13; 1 study, 232 participants; moderate-certainty evidence), and may improve short-term psychological well-being (MD -1.78, 95% CI -2.13 to -1.43; 1 study, 24 participants; low-certainty evidence). Habit reversal treatment may reduce short-term clinical signs (SCORAD; MD -6.57, 95% CI -13.04 to -0.1; 1 study, 33 participants; low-certainty evidence) but we are uncertain about any effects on short-term HRQoL (Children's Dermatology Life Quality Index (CDLQI); 1 study, 30 participants; very low-certainty evidence). Patient-reported symptoms, long-term eczema control and psychological well-being were not reported. We are uncertain whether arousal reduction therapy interventions could improve short-term clinical signs (Eczema Area and Severity Index (EASI); 1 study, 24 participants; very low-certainty evidence) or patient-reported symptoms (visual analogue scale (VAS); 1 study, 18 participants; very low-certainty evidence). Arousal reduction therapy may improve short-term HRQoL (Dermatitis Family Impact (DFI); MD -2.1, 95% CI -4.41 to 0.21; 1 study, 91 participants; low-certainty evidence) and psychological well-being (PSS; MD -1.2, 95% CI -3.38 to 0.98; 1 study, 91 participants; low-certainty evidence). Long-term eczema control was not reported. No studies reported standard care compared with self-help psychological interventions, psychological therapies or printed education; or adverse events. We identified two health economic studies. One found that a 12-week, technology-mediated, educational-support programme may be cost neutral. The other found that a nurse practitioner group-education intervention may have lower costs than standard care provided by a dermatologist, with comparable effectiveness. AUTHORS' CONCLUSIONS In-person, individual education, as an adjunct to conventional topical therapy, may reduce short-term eczema signs compared to standard care, but there is no information on eczema symptoms, quality of life or long-term outcomes. Group education probably reduces eczema signs and symptoms in the long term and may also improve quality of life in the short term. Favourable effects were also reported for technology-mediated education, habit reversal treatment and arousal reduction therapy. All favourable effects are of uncertain clinical significance, since they may not exceed the minimal clinically important difference (MCID) for the outcome measures used (MCID 8.7 points for SCORAD, 3.4 points for POEM). We found no trials of self-help psychological interventions, psychological therapies or printed education. Future trials should include more diverse populations, address shared priorities, evaluate long-term outcomes and ensure patients are involved in trial design.
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Affiliation(s)
- Heidi Singleton
- Bournemouth University, Department of Nursing Science, Bournemouth, UK
| | - Andrew Hodder
- Department of Dermatology, University Hospitals Dorset, Christchurch, UK
- Yell Health Centre, NHS Scotland, Shetland, UK
| | - Orouba Almilaji
- Department of Health Service Research and Policy, LSHTM, London, UK
| | - Steven J Ersser
- Bournemouth University, Department of Nursing Science, Bournemouth, UK
| | - Vanessa Heaslip
- Department of Nursing and Midwifery , University of Salford, Salford, UK
| | | | - Dwayne Boyers
- Health Economics Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, UK
| | - Helen Scott
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Julie Van Onselen
- Dermatology Education Partnership, Oxford, UK
- National Eczema Society, London, UK
| | - Liz Doney
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Robert J Boyle
- National Heart & Lung Institute, Section of Inflammation and Repair, Imperial College London, London, UK
| | - Andrew R Thompson
- South Wales Clinical Psychology Training Programme, Cardiff and Vale University Health Board & Cardiff University, Cardiff, UK
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Kling J, Billaud Feragen K. Experiences of appearance conversations among young people living with a visible difference. Body Image 2024; 49:101699. [PMID: 38489964 DOI: 10.1016/j.bodyim.2024.101699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/05/2024] [Accepted: 02/27/2024] [Indexed: 03/17/2024]
Abstract
Stigmatisation surrounding having a visible difference to the face or body may have a marked impact on how young people communicate about appearance. The aim of our study was therefore to explore the experiences of appearance conversations among young people living with a visible difference. Interviews were conducted with 32 young people (mean age 14.1 years; 67.7% girls), with a condition resulting in a visible difference (e.g., craniofacial condition or scarring). Using reflexive thematic analysis, we identified three themes. Importance of Safety and Understanding reflects the importance of feeling safe in order to be able to talk about appearance. Participants described appearance conversations as often originating in their need for emotional support or practical assistance when encountering difficulties (Conversations When in Need of Support), but appearance was also experienced as a sensitive topic that was difficult to talk about (Avoiding Appearance Conversations). Our results highlight the importance of creating spaces where young people with a visible difference feel safe to bring up the topic of appearance when in need of support. Elements that facilitate such conversations include others having knowledge about the condition and having one's feelings and experiences validated instead of minimised.
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Affiliation(s)
- Johanna Kling
- Centre for Rare Disorders, Rikshospitalet, Oslo University Hospital, Norway; Department of Psychology, University of Gothenburg, Sweden.
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Lamb D, Russell A, Morant N, Stevenson F. The challenges of open data sharing for qualitative researchers. J Health Psychol 2024; 29:659-664. [PMID: 38485917 PMCID: PMC11141072 DOI: 10.1177/13591053241237620] [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] [Indexed: 05/31/2024] Open
Abstract
'Open Science' advocates for open access to scientific research, as well as sharing data, analysis plans and code in order to enable replication of results. However, these requirements typically fail to account for methodological differences between quantitative and qualitative research, and serious ethical problems are raised by the suggestion that full qualitative datasets can or should be published alongside qualitative research papers. Aside from important ethical concerns, the idea of sharing qualitative data in order to enable replication is conceptually at odds with the underpinnings on most qualitative methodologies, which highlight the importance of the unique interpretative function of the researcher. The question of whether secondary analysis of qualitative data is acceptable is key, and in this commentary we argue that there are good conceptual, ethical and economic reasons to consider how funders, researchers and publishers can make better use of existing data.
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Artusa S, Mazzuca G, Piacentini G, Castagnoli R, Marseglia GL, Pietrobelli A, Pecoraro L. Paediatric Atopic Dermatitis: The Unexpected Impact on Life with a Specific Look at the Molecular Level. Int J Mol Sci 2024; 25:4778. [PMID: 38731996 PMCID: PMC11083669 DOI: 10.3390/ijms25094778] [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: 03/19/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Atopic dermatitis (AD) is a condition with a multifactorial aetiology that affects the skin. It most often begins at preschool age and involves the skin. The disease's main symptom is intense itching, which occurs especially at night and affects the child's sleep, negatively impacting the quality of life of affected children and, consequently, their families. The difficulty in resting during the night leads to many problems during the day, particularly behavioural disorders and difficulties in paying attention at school, which results in learning impairment. The unexpected symptoms of AD are caused by pathophysiological processes that include many molecular pathways and inflammatory cytokines such as IL-31, IL-1, IL-2, TNF-a, and IL-6. Drawing on a comprehensive review of the literature in PubMed/MedLine, our review offers an in-depth exploration of both the psychosocial impacts of AD and the molecular processes that contribute to this disorder.
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Affiliation(s)
- Silvia Artusa
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (S.A.); (G.M.)
| | - Giorgia Mazzuca
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (S.A.); (G.M.)
| | - Giorgio Piacentini
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (S.A.); (G.M.)
| | - Riccardo Castagnoli
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Angelo Pietrobelli
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (S.A.); (G.M.)
| | - Luca Pecoraro
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (S.A.); (G.M.)
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Chu DK, Schneider L, Asiniwasis RN, Boguniewicz M, De Benedetto A, Ellison K, Frazier WT, Greenhawt M, Huynh J, Kim E, LeBovidge J, Lind ML, Lio P, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Wang J, Wheeler KE, Guyatt GH, Capozza K, Begolka WS, Chu AWL, Zhao IX, Chen L, Oykhman P, Bakaa L, Golden D, Shaker M, Bernstein JA, Greenhawt M, Horner CC, Lieberman J, Stukus D, Rank MA, Wang J, Ellis A, Abrams E, Ledford D, Chu DK. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol 2024; 132:274-312. [PMID: 38108679 DOI: 10.1016/j.anai.2023.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Guidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology. OBJECTIVE To produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD. METHODS A multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group supported guideline development by performing systematic evidence reviews, facilitating guideline processes, and holding focus groups with patient and family partners. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed rating the certainty of evidence and strength of recommendations. Evidence-to-decision frameworks, subjected to public comment, translated evidence to recommendations using trustworthy guideline principles. RESULTS The panel agreed on 25 recommendations to gain and maintain control of AD for patients with mild, moderate, and severe AD. The eAppendix provides practical information and implementation considerations in 1-2 page patient-friendly handouts. CONCLUSION These evidence-based recommendations address optimal use of (1) topical treatments (barrier moisturization devices, corticosteroids, calcineurin inhibitors, PDE4 inhibitors [crisaborole], topical JAK inhibitors, occlusive [wet wrap] therapy, adjunctive antimicrobials, application frequency, maintenance therapy), (2) dilute bleach baths, (3) dietary avoidance/elimination, (4) allergen immunotherapy, and (5) systemic treatments (biologics/monoclonal antibodies, small molecule immunosuppressants [cyclosporine, methotrexate, azathioprine, mycophenolate, JAK inhibitors], and systemic corticosteroids) and UV phototherapy (light therapy).
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Affiliation(s)
- Derek K Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada.
| | - Lynda Schneider
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts.
| | | | - Mark Boguniewicz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Division of Pediatric Allergy and Clinical Immunology, National Jewish Health, Denver, Colorado
| | - Anna De Benedetto
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | | | - Winfred T Frazier
- Department of Family Medicine, UPMC St. Margaret, Pittsburgh, Pennsylvania
| | - Matthew Greenhawt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Section of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colorado
| | - Joey Huynh
- Sepulveda VA Medical Center, North Hills, California
| | | | - Jennifer LeBovidge
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Mary Laura Lind
- School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Arizona
| | - Peter Lio
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen A Martin
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Monica O'Brien
- Tufts University School of Medicine, Boston, Massachusetts
| | - Peck Y Ong
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics, USC Keck School of Medicine, Los Angeles, California
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jonathan M Spergel
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Kathryn E Wheeler
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Gordon H Guyatt
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Korey Capozza
- Global Parents for Eczema Research, Santa Barbara, California
| | | | - Alexandro W L Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Irene X Zhao
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Lina Chen
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Paul Oykhman
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Layla Bakaa
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - David Golden
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marcus Shaker
- Dartmouth Geisel School of Medicine and Dartmouth Hitchcock Medical Center, Section of Allergy, Lebanon, New Hampshire
| | | | - Matthew Greenhawt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Section of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colorado
| | - Caroline C Horner
- Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Jay Lieberman
- University of Tennessee Health Science Center and LeBonheur Children's Hospital, Memphis, Tennessee
| | - David Stukus
- Nationwide Children's Hospital and Ohio State University College of Medicine, Columbus, Ohio
| | - Matthew A Rank
- Mayo Clinic in Arizona and Phoenix Children's Hospital, Scottsdale and Phoenix, Arizona
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Anne Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Elissa Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dennis Ledford
- Morsani College of Medicine, University of South Florida and James A. Haley Veterans' Affairs Hospital, Tampa, Florida
| | - Derek K Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
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Cayci AB, Rathbone AP, Lindsey L, Richardson C. Pharmacy Students' Lived Experiences With Atopic Dermatitis Inform Perceptions of Learning in the Curriculum. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100651. [PMID: 38218340 DOI: 10.1016/j.ajpe.2024.100651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/25/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE To explore the impact of lived experiences of pharmacy students with atopic dermatitis (AD) on perceptions of learning in pharmacy curriculum. METHODS An exploratory qualitative study was conducted with pharmacy students in the United Kingdom to understand how their lived experiences affect their perception of AD in pharmacy curriculum. Semistructured interviews were conducted, and a thematic analysis method was followed. Firstly, codes were created, and then relevant codes were combined to identify themes. RESULTS Thirteen pharmacy students were interviewed. Study findings showed pharmacy students support teaching with a holistic approach to management and patient-centered care in AD in pharmacy curriculum. Although students had empathy and moral support for patients, they also described a need for teaching on the mental health effects of AD in pharmacy education. CONCLUSION This brief report explores the role of lived experience of pharmacy students in considering the provision of holistic, patient-centered care in AD teaching in pharmacy education. Participants also suggest the need within the pharmacy curriculum for training to provide mental health advice to patients with AD.
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Affiliation(s)
- Abdi Berk Cayci
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Faculty of Pharmacy, Hacettepe University, Ankara, Türkiye.
| | - Adam Pattison Rathbone
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Laura Lindsey
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Charlotte Richardson
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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Williams E, Lakkiss S. Supporting children, young people and families to self-manage atopic eczema. Nurs Child Young People 2024:e1478. [PMID: 38247728 DOI: 10.7748/ncyp.2024.e1478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 01/23/2024]
Abstract
Atopic eczema is common in childhood and can continue into adulthood. Adherence to treatment is a significant factor in its effective management, but the complexity of treatment regimens can make adherence challenging. Additionally, living with the condition can have adverse psychosocial consequences for young people in particular. This article discusses treatment regimens for moderate-to-severe atopic eczema and some of the challenges encountered by children, young people and families in self-managing the condition. The authors discuss strategies that can support families to achieve optimal self-management, namely online support tools, written action plans and nurse-led eczema clinics.
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Affiliation(s)
- Emma Williams
- School of Health and Social Care, Swansea University, Swansea, Wales
| | - Samantha Lakkiss
- Singleton Hospital, Swansea Bay University Health Board, Swansea, Wales
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Current Utilization of Qualitative Methodologies in Dermatology: A Scoping Review. JID INNOVATIONS 2023; 3:100172. [PMID: 36891031 PMCID: PMC9986021 DOI: 10.1016/j.xjidi.2022.100172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/27/2022] [Accepted: 10/03/2022] [Indexed: 11/19/2022] Open
Abstract
The focus of this review was to determine how qualitative methods are used in dermatology research and whether published manuscripts meet current standards for qualitative research. A scoping review of manuscripts published in English between January 1, 2016 and September 22, 2021 was conducted. A coding document was developed to collect information on authors, methodology, participants, research theme, and the presence of quality criteria as outlined by the Standards for Reporting Qualitative Research. Manuscripts were included if they described original qualitative research about dermatologic conditions or topics of primary interest to dermatology. An adjacency search yielded 372 manuscripts, and after screening, 134 met the inclusion criteria. Most studies utilized interviews or focus groups, and researchers predominantly selected participants on the basis of disease status, including over 30 common and rare dermatologic conditions. Research themes frequently included patient experience of disease, development of patient-reported outcomes, and descriptions of provider and caregiver experiences. Although most authors explained their analysis and sampling strategy and included empirical data, few referenced qualitative data reporting standards. Missed opportunities for qualitative methods in dermatology include examination of health disparities, exploration of surgical and cosmetic dermatology experiences, and determination of the lived experience of and provider attitudes toward diverse patient populations.
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McNiven A, Ryan S. Unsettling experiences: A qualitative inquiry into young peoples’ narratives of diagnosis for common skin conditions in the United Kingdom. Front Psychol 2022; 13:968012. [PMID: 36186350 PMCID: PMC9521611 DOI: 10.3389/fpsyg.2022.968012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/09/2022] [Indexed: 12/02/2022] Open
Abstract
Skin conditions such as eczema and psoriasis are relatively prevalent health concerns in children, adolescents and young adults. Experiences of these dermatology diagnoses in adolescence have hitherto not been the focus of research, perhaps owing to assumptions that these diagnoses are not particularly impactful or intricate processes, events or labels. We draw on a thematic secondary analysis of in-depth interviews with 42 adolescents and young people living in the United Kingdom and, influenced by the sociologies of diagnosis and time, highlight the psychological, emotional, social and temporal complexities involved in their diagnosis experiences. Firstly, we describe how participants remembered, re- and co-constructed their diagnosis experiences during the interview. Secondly, we explore the pace and rhythm of diagnosis, including mis-diagnoses, highlighting the jarring potential for adolescents on being diagnosed, even for conditions typically deemed minor. Thirdly, we consider the ways in which these diagnoses have the capacity to reformulate notions of past, present and future, including projecting into imagined futures and reinterpreting past bodily sensations. Finally, we examine how memories about and the meaning of diagnosis are revisited, revised and potentially replaced as a child or adolescent grows older, and increases their management of their condition and encounters with healthcare professionals. In unsettling an assumption that diagnosis experiences for adolescents of common skin conditions is unproblematic or straightforward, our qualitative analysis critically engages with and contribute to tenets of health research that are of interest to quantitative and qualitative researchers, clinicians and patients.
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Affiliation(s)
- Abigail McNiven
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- *Correspondence: Abigail McNiven,
| | - Sara Ryan
- Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, North West England, United Kingdom
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Ghio D, Calam R, Lee RR, Cordingley L, Ulph F. "I just want to be normal": A qualitative investigation of adolescents' coping goals when dealing with pain related to arthritis and the underlying parent-adolescent personal models. PAEDIATRIC & NEONATAL PAIN 2022; 4:96-109. [PMID: 36188161 PMCID: PMC9485820 DOI: 10.1002/pne2.12069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 11/14/2022]
Abstract
The aim of the current study was to examine adolescents' goals when coping with pain and map these goals to the cognitive and emotional profiles of both adolescent and their parent. 17 adolescents (11-16 years) and their parents participated in a cohort study of Juvenile Idiopathic Arthritis (JIA); the adolescents, took part in a two-part interview (about their pain perceptions and about a recent pain experience) and the parents completed an open-ended qualitative survey. The three datasets were analysed following a qualitative framework approach. A coping framework was developed and cognitive and emotional profiles for both adolescent and parent were mapped back to the framework. The overall goal of adolescents was to preserve social identity, by either focusing on maintaining a "normal" lifestyle (sub-coping goal one) or managing the pain (sub-coping goal two). Across these two sub-coping goals, the adolescents held similar cognitive profiles (beliefs about timeline, consequences, control) but different emotional profiles such as feeling fine/happy compared with feeling angry and frustrated. Conversely, the parents' cognitive and emotional profiles were mapped back to the two groups and found that their beliefs were different across the two sub-coping goals but had similar emotional profiles across the two groups such as worry. Both the adolescents' emotional representations and parental cognitive profiles seem to be related to how the adolescent perceives a pain event, deals with the pain, and the overall coping goal of the adolescent. Findings are suggestive that parental pain beliefs influence the adolescents' pain representations and their coping goals but are also driven by adolescents' emotions. Further work on these potential pathways is needed. Family interventions should be designed, targeting coping goals taking into consideration the importance of emotions for adolescents and parental pain beliefs.
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Affiliation(s)
- Daniela Ghio
- Division of Psychology & Mental HealthSchool of Health SciencesFaculty of Biology, Medicine and HealthManchester Academic Health Science CentreUniversity of ManchesterManchesterUK
| | - Rachel Calam
- Division of Psychology & Mental HealthSchool of Health SciencesFaculty of Biology, Medicine and HealthManchester Academic Health Science CentreUniversity of ManchesterManchesterUK
| | - Rebecca Rachael Lee
- NIHR Manchester Biomedical Research CentreManchester Academic Health Science CentreManchester University NHS Foundation TrustManchesterUK
- Versus Arthritis Centre for Musculoskeletal ResearchUniversity of Manchester UniversityManchesterUK
| | - Lis Cordingley
- NIHR Manchester Biomedical Research CentreManchester Academic Health Science CentreManchester University NHS Foundation TrustManchesterUK
- Versus Arthritis Centre for Musculoskeletal ResearchUniversity of Manchester UniversityManchesterUK
| | - Fiona Ulph
- Division of Psychology & Mental HealthSchool of Health SciencesFaculty of Biology, Medicine and HealthManchester Academic Health Science CentreUniversity of ManchesterManchesterUK
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11
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Sears AV, Ali R, O’Connor J, Baron S. Establishing and developing a paediatric psychodermatology service and our experience of a new paediatric psychodermatology clinic during the Covid 19 pandemic. SKIN HEALTH AND DISEASE 2022; 2:e151. [PMID: 36245551 PMCID: PMC9539254 DOI: 10.1002/ski2.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/06/2022]
Abstract
Children and young people (CYP) with skin and hair conditions are at an increased risk of mental health problems and vice versa. Current child and adolescent mental health services are already stretched and in our experience, this unique combination of symptoms and signs requires a multi-disciplinary approach. We report our experience of establishing a paediatric psychodermatology clinic where, at each appointment, CYP are seen by a consultant dermatologist and a clinical psychologist initially jointly and then individually to ensure all viewpoints are heard and a collaborative treatment plan can be agreed. The clinic was established one month prior to the national lockdown during the COVID-19 pandemic and the face-to-face model was converted to a virtual format. CYP are now seen either face to face or virtually according to CYP/parent/carer preference and this hybrid model increases accessibility and has reduced DNA rates. Referrals were received from primary, secondary and tertiary care settings. Thirty -six new patients were seen and followed-up over a 2 year period, age range 3-17 years old. The majority of patients presented with compulsive hair pulling (trichotillomania) and medically unexplained signs (dermatitis artefacta); other problems seen were eczema, skin picking and acne. Half of the patients required additional psychology sessions. Seventy-six percent of patients have been discharged, almost half back to the care of their general practitioner. We use pre- and post-clinic questionnaires and share these and feedback from CYP/families who have found this clinic model helpful and effective.
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Affiliation(s)
- Alison V. Sears
- St John's Institute of DermatologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Rukshana Ali
- St John's Institute of DermatologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Jane O’Connor
- St John's Institute of DermatologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Susannah Baron
- St John's Institute of DermatologyGuy's and St Thomas' NHS Foundation TrustLondonUK
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12
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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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13
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Xie QW, Liang Z. Self-stigma Among Children Living with Atopic Dermatitis in Hong Kong: a Qualitative Study. Int J Behav Med 2022; 29:775-786. [PMID: 35132539 DOI: 10.1007/s12529-022-10059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Stigma has been recently identified as a crucial factor associated with the psychosocial burden of those who have chronic skin diseases. The self-stigma experiences of children living with atopic dermatitis (AD) have yet to be fully investigated, and questions of how these children respond to public stigma and how AD symptoms further affect their self-stigma experiences remain unresolved. The current qualitative study aimed to (1) describe the main manifestations of self-stigma in children living with AD; (2) investigate factors that might influence their self-stigma experiences; and (3) explore the potential mechanisms underlying the impacts of AD on their psychosocial well-being from the self-stigma perspective. METHODS We performed a secondary analysis of the qualitative literal transcription data which were collected earlier by using the participatory, drawing-based qualitative interviews with 17 children aged 8-12 who were diagnosed with severe or moderate AD. RESULTS The qualitative findings indicated that the visible and invisible symptoms of AD and its management exerted unique influences on self-stigma in children living with AD, which manifested in cognitive, affective, and behavioral aspects and ultimately affected their psychosocial well-being. CONCLUSIONS Findings of this study allowed us to advocate for eliminating public stigma of people with skin diseases and propose recommendations for helping children living with AD relieve their self-stigma.
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Affiliation(s)
- Qian-Wen Xie
- Department of Social Welfare and Risk Management, School of Public Affairs, Zhejiang University, Hangzhou, China.,Center of Social Welfare and Governance, Zhejiang University, Hangzhou, China
| | - Zurong Liang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China.
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Singleton H, Hodder A, Boyers D, Doney L, Almilaji O, Heaslip V, Thompson AR, Boyle RJ, Axon E, Van Onselen J, O'Meara S, Roberts A, Ersser SJ. Psychological and educational interventions for managing eczema. Hippokratia 2021. [DOI: 10.1002/14651858.cd014932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Heidi Singleton
- Department of Nursing Science; Bournemouth University; Bournemouth UK
| | - Andrew Hodder
- Department of Dermatology; Royal Cornwall Hospitals NHS Trust; Truro UK
- Department of Dermatology; University Hospitals Dorset; Christchurch UK
| | - Dwayne Boyers
- Health Economics Research Unit; University of Aberdeen; Aberdeen UK
| | - Liz Doney
- Cochrane Skin, Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | - Orouba Almilaji
- Department of Medical Science and Public Health; Bournemouth University; Bournemouth UK
| | - Vanessa Heaslip
- Department of Nursing Science; Bournemouth University; Bournemouth UK
| | - Andrew R Thompson
- South Wales Clinical Psychology Training Programme; Cardiff and Vale University Health Board & Cardiff University; Cardiff UK
| | - Robert J Boyle
- Cochrane Skin, Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
- National Heart & Lung Institute, Section of Inflammation and Repair; Imperial College London; London UK
| | - Emma Axon
- Cochrane Skin, Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | | | | | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema; Nottingham UK
| | - Steven J Ersser
- Department of Nursing Science; Bournemouth University; Bournemouth UK
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Teasdale E, Sivyer K, Muller I, Ghio D, Roberts A, Lawton S, Santer M. Children's Views and Experiences of Treatment Adherence and Parent/Child Co-Management in Eczema: A Qualitative Study. CHILDREN-BASEL 2021; 8:children8020158. [PMID: 33672514 PMCID: PMC7923777 DOI: 10.3390/children8020158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 11/16/2022]
Abstract
Eczema affects one in five children and can have a substantial impact on quality of life. This qualitative study aimed to explore children's views and experiences of eczema and what may affect treatment adherence from their perspective. We conducted semi-structured, face-to-face interviews with children with eczema aged 6-12 years from March to July 2018. Interviews were transcribed verbatim and analysed using inductive thematic analysis. We found that children do not typically view eczema as a long-term condition, and topical treatments (predominately emollients) were seen to provide effective symptom relief. Uncertainty around co-managing at home was expressed as children typically felt that parental reminders and assistance with applying different types of topical treatments were still needed. For some children, eczema can be difficult to manage at school due to a lack of convenient access and appropriate spaces to apply creams and psychosocial consequences such as attracting unwanted attention from peers and feeling self-conscious. Treatment adherence could be supported by reinforcing that eczema is a long-term episodic condition, providing clear information about regular emollient use, practical advice such as setting reminders to support co-management at home, and working with schools to facilitate topical treatment use when necessary.
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Affiliation(s)
- Emma Teasdale
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (I.M.); or (D.G.); (M.S.)
- Correspondence: ; Tel.: +44-2380-591753
| | - Katy Sivyer
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton SO17 1BJ, UK; or
- Department of Psychology, University of Portsmouth, Portsmouth PO1 2UP, UK
| | - Ingrid Muller
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (I.M.); or (D.G.); (M.S.)
| | - Daniela Ghio
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (I.M.); or (D.G.); (M.S.)
- School of Health and Society, Allerton Building, University of Salford, Manchester M6 6PU, UK
| | - Amanda Roberts
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Sandra Lawton
- Department of Dermatology, Rotherham NHS Foundation Trust, Rotherham, S60 2UD, UK;
| | - Miriam Santer
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (I.M.); or (D.G.); (M.S.)
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16
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Greenwell K, Ghio D, Muller I, Roberts A, McNiven A, Lawton S, Santer M. Taking charge of eczema self-management: a qualitative interview study with young people with eczema. BMJ Open 2021; 11:e044005. [PMID: 33408215 PMCID: PMC7789449 DOI: 10.1136/bmjopen-2020-044005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To explore young people's experiences of eczema self-management and interacting with health professionals. DESIGN Secondary qualitative data analysis of data sets from two semistructured interview studies. Data were analysed using inductive thematic analysis. SETTING Participants were recruited from the UK primary care, dermatology departments and a community-based sample (eg, patient representative groups, social media). PARTICIPANTS Data included 28 interviews with young people with eczema aged 13-25 years (mean age=19.5 years; 20 female). RESULTS Although topical treatments were generally perceived as effective, young people expressed doubts about their long-term effectiveness, and concerns around the safety and an over-reliance on topical corticosteroids. Participants welcomed the opportunity to take an active role in their eczema management, but new roles and responsibilities also came with initial apprehension and challenges, including communicating their treatment concerns and preferences with health professionals, feeling unprepared for transition to an adult clinic and obtaining treatments. Decisions regarding whether to engage in behaviours that would exacerbate their eczema (eg, irritants/triggers, scratching) were influenced by young people's beliefs regarding negative consequences of these behaviours, and perceived control over the behaviour and its negative consequences. CONCLUSIONS Behavioural change interventions must address the treatment concerns of young people and equip them with the knowledge, skills and confidence to take an active role in their own eczema management.
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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
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
- Psychology, School of Health and Society, University of Salford, Manchester, UK
| | - Ingrid Muller
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Amanda Roberts
- Centre of Evidence-Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Abigail McNiven
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Sandra Lawton
- Dermatology Department, The Rotherham NHS Foundation Trust, Rotherham, UK
| | - Miriam Santer
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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