Engaging with diverse audiences to raise awareness about childhood eczema: reflections from two community events

BACKGROUND

Eczema is a common childhood condition, causing dry and itchy skin which can be difficult to manage. We have been undertaking eczema and food allergy research to address previously prioritised research questions. We obtained funding to trial novel approaches to reach diverse audiences to raise awareness of childhood eczema, research, and public involvement in research.

METHODS

This paper reflects on two public engagement events held in collaboration with stakeholders in two settings of ethnic diversity in East Bristol, UK. We invited parents and children to attend the events by public display of posters. We created novel activities related to the research and involved artists to engage parents/carers and children about eczema and the research we are doing into its management.

RESULTS

Attendance at the first event was lower than expected. Lessons learned were incorporated into the second event, to use a more structured approach and attract greater numbers of parents/carers from more diverse backgrounds. Creative approaches such as using artists at both events made the subject more accessible for diverse audiences, including children.

CONCLUSION

We successfully delivered two public engagement events. The success of the events has generated individual interest in PPI and enquiries about future events from neighbouring community groups. Reflections from the events have also been fed back to inform the research.

Test-guided dietary management of eczema in children: A randomized controlled feasibility trial (TEST)

BACKGROUND

Parents commonly ask about food allergy tests, to find a cause for their child's eczema, yet the value of routine testing is uncertain.

OBJECTIVE

To determine whether a clinical trial comparing test-guided dietary advice versus usual care, for the management of eczema, is feasible.

METHODS

Children (>3 months and <5 years) with mild-to-severe eczema, recruited via primary care, were individually randomized (1:1) to intervention or usual care. Intervention participants underwent structured allergy history and skin prick tests (SPT) with dietary advice for cow's milk, hen's egg, wheat, peanut, cashew and codfish. All participants were followed up for 24 weeks. A sample of doctors and parents was interviewed. Registration ISRCTN15397185.

RESULTS

From 1059 invitation letters sent to carers of potentially eligible children, 84 were randomized (42 per group) with mean age of 32.4 months (SD 13.9) and POEM of 8.7 (4.8). Of the 42, 6 (14%) intervention participants were advised to exclude one or more foods, most commonly egg, peanut or milk. By participant, 1/6 had an oral food challenge (negative); 3/6 were told to exclude until review in allergy clinic; and 6/6 advised a home dietary trial (exclusion and reintroduction of food over 4-6 weeks) - with 1/6 partially completing it. Participant retention (four withdrawals) and data completeness (74%-100%) were acceptable and contamination low (two usual care participants had allergy tests). There were three minor SPT-related adverse events. During follow-up, 12 intervention and 8 usual care participants had minor, unrelated adverse events plus one unrelated hospital admission.

CONCLUSIONS

It is possible to recruit, randomize and retain children with eczema from primary care into a trial of food allergy screening and to collect the outcomes of interest. Changes to recruitment and inclusion criteria are needed in a definitive trial, to ensure inclusion of younger children from more diverse backgrounds.

Parents and GPs' understandings and beliefs about food allergy testing in children with eczema: qualitative interview study within the Trial of Eczema allergy Screening Tests (TEST) feasibility trial

AIM

To explore parent and general practitioner (GP) understanding and beliefs about food allergy testing for children with eczema.

DESIGN AND SETTING

Qualitative interview study in UK primary care within the Trial of Eczema allergy Screening Tests feasibility trial.

PARTICIPANTS

Semi-structured interviews with parents of children with eczema taking part in the feasibility study and GPs at practices hosting the study.

RESULTS

21 parents and 11 GPs were interviewed. Parents discussed a range of potential causes for eczema, including a role for food allergy. They believed allergy testing to be beneficial as it could potentially identify a cure or help reduce symptoms and they found negative tests reassuring, suggesting to them that no dietary changes were needed. GPs reported limited experience and uncertainty regarding food allergy in children with eczema. While some GPs believed referral for allergy testing could be appropriate, most were unclear about its utility. They thought it should be reserved for children with severe eczema or complex problems but wanted more information to advise parents and help guide decision making.

CONCLUSIONS

Parents' motivations for allergy testing are driven by the desire to improve their child's condition and exclude food allergy as a possible cause of symptoms. GPs are uncertain about the role of allergy testing and want more information about its usefulness to support parents and help inform decision making.

TRIAL REGISTRATION NUMBER

ISRCTN15397185.

Adolescent perceptions about participating in HIV-related research studies

The rising incidence of infection among youth in sub-Saharan Africa makes HIV-related research among younger people a top priority. There remains, however, a lack of consistent and unambiguous ethical principles and guidance for researchers wishing to conduct HIV studies with adolescents. The overarching aim of our research was to better understand youths' experiences with HIV studies. The present study explored four questions: (1) What strategies are effective for recruiting youth for HIV studies? (2) What motivates youth to participate in these studies? (3) How do study participants perceive HIV testing within the context of a research study? (4) What do participants understand about the risks of study participation? These data are essential to inform guidelines for the responsible conduct of research with young people. We interviewed 82 adolescents (aged 15-19) in Kenya taking part in a study examining ethical issues pertaining to their involvement in HIV-related research. Pursuant to our research questions, we found that direct study recruitment combined with encouragement from female relatives was the greatest facilitator to study enrolment among young people. Most young participants expressed that they were motivated to join the study in order to (1) learn their HIV status (n = 49) and (2) receive HIV-related education (n = 26), even though both are already free and widely available. Participants largely preferred testing in a place they deemed "private," although both the health clinic and home were regarded by adolescents as locations with greater privacy. Adolescents largely did not accurately perceive risks of the study two months after baseline, although they could remember the benefits with great clarity. This work can inform researchers, policymakers, and ethics review committees on approaches to maximize efficiency in recruitment and data collection, and to enhance understanding of risks and benefits in HIV-related research among adolescents. While further research is needed, these data may be used by others conducting HIV research in this region to improve recruitment strategies and more effectively engage and appeal to young people.

Feasibility cluster randomised controlled trial of a within-consultation intervention to reduce antibiotic prescribing for children presenting to primary care with acute respiratory tract infection and cough

OBJECTIVE

To investigate recruitment and retention, data collection methods and the acceptability of a 'within-consultation' complex intervention designed to reduce antibiotic prescribing.

DESIGN

Primary care feasibility cluster randomised controlled trial.

SETTING

32 general practices in South West England recruiting children from October 2014 to April 2015.

PARTICIPANTS

Children (aged 3 months to <12 years) with acute cough and respiratory tract infection (RTI).

INTERVENTION

A web-based clinician-focussed clinical rule to predict risk of future hospitalisation and a printed leaflet with individualised child health information for carers, safety-netting advice and a treatment decision record.

CONTROLS

Usual practice, with clinicians recording data on symptoms, signs and treatment decisions.

RESULTS

Of 542 children invited, 501 (92.4%) consented to participate, a month ahead of schedule. Antibiotic prescribing data were collected for all children, follow-up data for 495 (98.8%) and the National Health Service resource use data for 494 (98.6%). The overall antibiotic prescribing rates for children's RTIs were 25% and 15.8% (p=0.018) in intervention and control groups, respectively. We found evidence of postrandomisation differential recruitment: the number of children recruited to the intervention arm was higher (292 vs 209); over half were recruited by prescribing nurses compared with less than a third in the control arm; children in the intervention arm were younger (median age 2 vs 3 years controls, p=0.03) and appeared to be more unwell than those in the control arm with higher respiratory rates (p<0.0001), wheeze prevalence (p=0.007) and global illness severity scores assessed by carers (p=0.045) and clinicians (p=0.01). Interviews with clinicians confirmed preferential recruitment of less unwell children to the trial, more so in the control arm.

CONCLUSION

Differential recruitment may explain the paradoxical antibiotic prescribing rates. Future cluster level studies should consider designs which remove the need for individual consent postrandomisation and embed the intervention within electronic primary care records.

TRIAL REGISTRATION NUMBER

ISRCTN 23547970 UKCRN STUDY ID: 16891.

Effect of verbal encouragement on patient question-asking behaviour during medication counselling

Context

Empowering patients to take a more active role in health-related encounters is a goal of many advocates today. This stems from evidence that patients remain rather passive during interactions with doctors and pharmacists.

Objective

The objective of this study was to examine the effect of verbal encouragement on patient question-asking. It was hypothesised that encouragement to ask questions would elicit a freer flow of questioning.

Method

The study had two arms — intervention and control. The same prescription processing steps occurred for each group except that intervention subjects were presented with a short verbal message (to invite questioning) before the prescription was handed over to a pharmacist for filling. Any questions patients raised during subsequent medication counselling were recorded. Observations took place in one Canadian community pharmacy.

Results

A total of 127 patients were observed for study purposes (60 intervention and 67 control). A total of 141 questions were asked by 59 patients; the other 68 patients had no questions when asked. Subjects in the intervention group (one outlier removed) asked an average of 1.1 questions per encounter, while the control group asked 0.9 questions. This difference was not statistically significant.

Conclusion

The hypothesis of no difference in the rate of patient question-asking between groups was retained. This method of encouraging patients to become more involved in the counselling process proved unsuccessful.

Stump ulcers and continued prosthetic limb use

Stump ulcers are common problems in amputees. Temporary discontinuation of prosthetic limb use is frequently employed to facilitate healing. Inevitably, this limits activity and may, for instance, prevent an amputee from going to work. A survey of clinical practice was carried out based on the premise that controlled continued prosthetic limb use in patients with stump ulcers will not adversely affect the ulcer nor prevent healing. The survey would also form a basis for developing future guidelines in the management of stump ulcers. All consecutive patients attending the Chapel Allerton Hospital prosthetic clinic between January 2003 and May 2004 with stump ulcers were recruited into the study. Primary outcome measures were changes in the surface area of the ulcers and in clinical photographs taken on 2 occasions 6 weeks apart. Some 102 patients with a mean age 60 years (range 18 - 88 years) were recruited. Eight patients who were established prosthetic limb users did not complete the study and were excluded from the analysis. Of the patients 52 were newly referred patients with delayed surgical wound healing while 42 were established prosthetic limb users for at least 1 year. Continued prosthetic limb was associated with a significant reduction in ulcer size (p < 0.05). Mean sizes of the ulcers at first and second observations were 3.30 cm2 (range 0.06 - 81) and 0.70 cm2 (range 0.00 - 13.00) respectively. The ulcers improved in 83 cases while two were unchanged. Deterioration was observed in nine cases. The current clinical practice is to allow most of the patients to commence or continue prosthetic limb wearing despite the presence of stump ulceration. This observational study found that, despite prosthetic use, 60 (64%) cases healed completely within the six-week study period and 23 (25%) ulcers reduced in size. The ulcers were unchanged in 2% of the cases. Deterioration was observed in nine (9%) cases. This survey suggests that the current practice of allowing patients to use their prostheses is safe. A clinical trial is now needed to establish whether this practice alters healing rate or has any other disadvantages for new or established amputees.

Indications of physical, sexual, and verbal victimization in projective tree drawings

Several facets of the Tree-Scar-Trauma hypothesis were addressed. The first inquiry was whether scars, knotholes, and/or broken branches on a drawn tree are indicative of previous victimization. A statistically significant relationship between these variables was found. The study also examined differences between mental health patients (N = 56) and control subjects (N = 215) with regard to their abuse history and tree drawings. No significant differences between these two populations were found. A modification of Buck's (1948) hypothesis with regard to the relationship between the location of traumatic indicators on projective tree drawings and age of traumatization was tested and not validated. However, the association between the duration of physical abuse and the number of indicators on the tree was statistically significant.

Compliance of the tubing compartment of lung ventilators

The compliance of three types of breathing tubing commonly used in lung ventilators was measured. The black rubber corrugated tubing commonly used in anaesthetic circuits is too compliant for use in ventilators in intensive care. It is suggested that the international draft standard of compliance for breathing tubes used in lung ventilators should be amended.