Studies have shown that managing eczema in children has many challenges, including adherence to proven treatment regimens. Administering treatment can be time-consuming, the caregiver may have apprehensions regarding the use of topical corticosteroids (TCS), and some children may be resistant to the application of treatments.
The Eczema Care Online (ECO) for Families resource was developed to support caregiver management of pediatric eczema. Katy Sivyer, BA, MSc, DPhil, CPsychol, and colleagues share the process for the development of this resource through their application of a theory-, evidence-, and person-based approach with qualitative research in a study published in the British Journal of General Practice.
Five Behaviors Cited as Critical for Eczema Management
Five behaviors were identified as crucial for effective eczema care, according to Dr. Sivyer:
› Application of TCS to achieve control of inflammation
› Increased emollient use to keep skin inflammation in check
› Optimal management of irritants/triggers
› Avoidance of scratching affected areas
› Better management of emotional distress in children
Sixteen experts were recruited to ensure that the advice given through ECO for Families was medically sound, appropriate, and accessible. The resource was then developed in two stages, intervention planning and intervention optimization.
Barriers to Eczema Care Identified
Intervention planning consisted of a systematic review/qualitative synthesis of the literature as well as interviews with parents/caregivers. The literature review identified 39 papers from 32 studies and found that there was a substantial physical and emotional impact in caring for a child with eczema. Barriers to care included lack of information about treatment application, receiving negative or conflicting advice about topical treatments, the burden and time commitment of treatment as well as managing irritants/triggers, disliking topical treatments, child’s resistance to treatment, concerns about the safety of TCS, uncertainty about the proper use of treatments, and doubts about the effectiveness of treatment.
Attention Paid to Use of Parents’/ Caregivers’ Familiar Language
Interviews were conducted with 30 parents/caregivers, with the majority identified through primary care practices. For inclusion, participants needed to have a child aged 0-12 with diagnosed eczema who had one or more eczema treatments prescribed to them over the past 12 months. Each interview lasted 45-60 minutes and interviewees were compensated for their participation. The interviews were transcribed and analyzed using inductive thematic analysis.
Six key themes were cited: incomplete knowledge of eczema and its treatments, concerns about the safety of treatments, use of a trial-and-error process when administering treatment, the negative impact of eczema and its treatments on the parents/ caregivers, child’s acceptance or rejection of treatment, and reluctance to transfer to child selfmanagement.
The information gathered from the interviews was applied to the development of content for the resource. For example, the parents/caregivers’ penchant for using the term “cream” to refer to treatment was incorporated into the modules. Emollients were called “moisturizing creams” and TCS was called “flare control cream (Figure).”
Learning to Identify the Gaps in Knowledge
Participants were recruited using the same criteria as stage 1. Twenty-five parents/caregivers were identified and were asked to read sections of the website resource and recite their reactions to the content. The data collected from these think-aloud interviews were then analyzed and applied when appropriate to the improvement of the ECO for Families.
Overall, the response to the online resource was positive. Concerns raised by the interviewees included complaints that the initial content was too lengthy, repetitive, and not relevant to caregivers who were more experienced, as well as lacking quick access to main modules. Adjustments were made accordingly.
“Even parents/caregivers with extensive experience of looking after a child with eczema have gaps in knowledge around treatment, which healthcare professionals could help identify and address, particularly around why, when, and how to use emollients and topical corticosteroids,” wrote Dr. Sivyer and colleagues.