This update has incorporated five new RCTs using educational interventions as an adjunct to conventional treatment for children with atopic eczema. We did not identify any further studies using psychological interventions. The inclusion of new studies has not substantially altered the conclusions from the original review. The educational studies in both the original review and this update lack detail about intervention design and do not use a complex interventions framework. Few use an explicit theoretical base, and the components of each intervention are not sufficiently well described to allow replication. A relative lack of rigorously designed trials provides limited evidence of the effectiveness of educational and psychological interventions in helping to manage the condition of atopic eczema in children. However, there is some evidence from included paediatric studies using different educational intervention delivery models (multiprofessional eczema interventions and nurse-led clinics) that these may lead to improvements in disease severity and quality of life. Educational and psychological interventions require further development using a complex interventions framework. Comparative evaluation is needed to examine their impact on eczema severity, quality of life, psychological distress, and cost-effectiveness. There is also a need for comparison of educational interventions with stand-alone psychosocial self-help.
Background: The systematic support of parents of children with eczema is essential to their effective management. The few existing support models have a limited evidence base. This paper reports the outcome-orientated service evaluation of an original, extensive social learning theory based, nurse-led Eczema Education Programme (EEP).Objectives: To evaluate the EEP using specified child and parental outcomes and service impact data.Methods: From a sample of 257 parent-child dyads attending the EEP, a pretest-posttest design evaluated its child impact using health related quality of life measures (Infant's Dermatitis Quality of Life index, IDQOL, which includes a small dermatitis severity element; Children's Dermatology Life Quality Index, CDLQI), severity measures (Patient Orientated Eczema Measure, POEM), a new parental measure (Parental Self-Efficacy in Eczema Care Index, PASECI) and service impact data based on General Practice (GP) attendance patterns pre-post intervention.Results: Statistically significant impacts were observed, compared to baseline, on infant quality of life (p<0.001), child quality of life (p=0.027), disease severity (p<0.001) and parental self-efficacy (p<0.001). Improvements in child quality of life, parental efficacy and service impact were also evident from qualitative data. The cumulative total of all GP visits for selected participants post EEP reduced by 62%. Conclusions:The EEP appears to be an effective model of delivering structured education to parents of children with eczema and one generalizable to other multi-ethnic metropolitan populations. As a non-controlled study, this rigorous service evaluation highlights the model's significance and the case for an evaluative multi-centre randomised controlled trial of this educational intervention to inform a nurse-led programme of care.
It was feasible to provide the EEP as an adjunct to normal clinical care on a large scale, achieving a high level of patient/parent satisfaction and access within an urban area of multiple deprivation and high mobility. The intervention is transferable and the results are generalizable to other ethnically diverse child eczema populations within metropolitan areas in Britain. A multicentre RCT is required to test the effectiveness of this intervention on a larger scale.
Summary Background Effective parental management of childhood eczema requires education and support to reduce disease severity and improve the child's quality of life. Self‐efficacy is a key factor influencing effective chronic disease management, yet there are no published scales to measure parental self‐efficacy in managing childhood eczema. The Parental Self‐Efficacy with Eczema Care Index (PASECI) was designed to measure parental self‐efficacy in managing childhood eczema as a pre‐ and postintervention tool in the evaluation of a structured Eczema Education Programme (EEP). Objectives To develop and test the validity, reliability and sensitivity of a new outcome measure (PASECI) designed to assess parental self‐efficacy in managing their child's eczema to determine pre‐ vs. postintervention changes in educational intervention evaluation studies. Methods PASECI was developed from the literature, expert consultation and piloting of a 40‐item prototype. The final 29‐item scale is arranged in four subscales. Parents of children with eczema aged 0–16 years (n = 242) attending the EEP were assessed at 1 week pre‐EEP and 4 weeks postintervention. Cronbach's α and factor analyses were undertaken. Results PASECI has face, content and construct validity. It is reliable, with high item internal consistency (α > 0·87 in all domains). Factor analysis revealed four viable domains. It was sensitive to change for postintervention measures using sign tests (P < 0·001). Conclusions PASECI is a useful, valid, reliable and sensitive evaluative outcome measure of self‐efficacy in parents managing childhood eczema.
Developing opportunities for preregistration nursing students to learn to support children with complex needs and their families is possible and potentially beneficial.
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