An online resource guide can help fill gaps in parent/guardian knowledge when caring for a child with eczema.
Studies have shown that managing eczema in children presents many challenges, including adherence to proven treatment regimens. The administration of the treatment may take time, the caregiver may be apprehensive about the use of topical corticosteroids (TCS), and some children may be refractory to the application of the treatments.
The Eczema Care Online The (ECO) resource for families has been developed to support carers in the management of pediatric eczema. Katy Sivyer, BA, MSc, DPhil, CPsycholand colleagues share the process of developing this resource through their application of a theory-, evidence- and people-based approach with qualitative research, in a study published in the British Journal of General Medicine.
Five behaviors cited as critical for managing eczema
According to Dr. Sivyer, five behaviors have been identified as crucial for effective eczema management:
- Application of TCS to control inflammation
- Increased use of emollients to control skin inflammation
- Optimal management of irritants/triggers,
- Avoid scratching the affected areas
- Better management of emotional distress in children.
Sixteen experts were recruited to ensure that the advice given by ECO for Families was medically valid, 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/guardians. The literature review identified 39 articles from 32 studies and found that there was 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, treatment burden and time commitment as well as managing irritants/triggers, dislike of topical treatments, child’s resistance to treatment, concerns about the safety of TCS, uncertainty about the proper use of treatments, doubt about the effectiveness of treatments.
Attention to the use of colloquial parent/guardian language
Interviews were conducted with 30 parents/guardians, the majority of whom were identified through primary care practices. To be included, participants had to have a child aged 0-12 with diagnosed eczema who had been prescribed one or more eczema treatments in the past 12 months. Each interview lasted 45 to 60 minutes and interviewees were paid 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, negative impact of eczema and its treatments on parents/guardians, child’s acceptance or rejection of treatment, and reluctance to transition to child self-management.
The information gathered during the interviews was applied to the development of the content of the resource. For example, the penchant of parents/guardians to use the term ‘cream’ to refer to the treatment has been incorporated into the modules. Emollients were called “moisturizers” and TCS was called “flare cream.” (Figure).”
Learn to identify knowledge gaps
Participants were recruited using the same criteria as in Stage 1. Twenty-five parents/guardians were identified and were asked to read sections of the website resource and recite their reactions to the content. The data gathered from these think-aloud interviews was then analyzed and applied, where appropriate, to improving CEO for families.
Overall, the response to the online resource has been positive. Concerns raised by interviewees included complaints that the initial content was too long and repetitive, not relevant for more experienced caregivers, and the need for quick access to key modules. Adjustments have been made accordingly.
“A key finding of this research is that even parents/caregivers with extensive experience caring for a child with eczema have knowledge gaps about treatment, which healthcare professionals could help to address. identify and fill, especially on why, when and how to use emollients and topical corticosteroids