‘New to me’: changing patient understanding of psoriasis and identifying mechanisms of change. The Pso Well^®patient materials mixed‐methods feasibility study

Abstract

SummaryBackgroundPsoriasis is an inflammatory long‐term condition involving comorbidities, unhealthy lifestyle and significant life impact. Patients’ understanding of psoriasis is limited and support lacking. The Common‐Sense Model of Self‐Regulation of Health and Illness emphasizes the role of illness and treatment beliefs on coping and self‐management. New ‘Pso Well®’ patient materials informed by the model, addressed psoriasis as a long‐term condition, medication management and lifestyle behaviours.ObjectivesTo investigate whether Pso Well® materials (i) broaden understanding of psoriasis without increasing anxiety; (ii) are acceptable; and (iii) comprise features that appear to effect change.MethodsThe Revised Illness Perceptions Questionnaire (IPQ‐R modified) and the Hospital Anxiety and Depression Scale (HADS) were administered in patients before and after intervention. Numerical rating scales assessed perceptions of change in understanding and anxiety resulting from engagement with the materials. Qualitative interviews explored acceptability and perceived ‘active ingredients’.ResultsFifty‐five patients completed pre‐ and postintervention questionnaires (56% female; median age 59 years). Postintervention, a large effect size was indicated in two IPQ‐R domains – illness coherence [t(55) = −3·48, P = 0·001 (two‐tailed), η2 = 0·19] and personal control [t(55) = −2·98, P = 0·004 (two‐tailed), η2 = 0·14] – and a medium effect in one, treatment control [t(55) = −2·08, P = 0·042 (two‐tailed), η2 = 0·08]. HADS scores did not change. For numerical rating scales, 80% of participants reported increased understanding of psoriasis and none reported increased anxiety. Interviews with 19 patients indicated the materials were acceptable and usable. Factors reported to broaden understanding and promote engagement with self‐management included linking of related disease aspects, personally relevant content and high‐quality design.ConclusionsHigh‐quality, theory‐based psoriasis materials are acceptable to patients and can improve understanding and sense of control without increasing anxiety.

Changing patients’ understanding of psoriasis is promising

“…Patient education is considered to be an important aspect in patient management and should be considered as an adjunct to treatment to enhance patients’ overall health perception. The results of this study show that targeting illness beliefs improves patients’ motivation to change . In addition, it may facilitate doctor–patient communication and shared decision‐making.…”

“…Nelson and colleagues have developed Pso Well ® patient materials and evaluated whether these improve illness coherence (defined by the authors as ‘broaden patients’ understanding of psoriasis without increasing anxiety’), improve understanding of psoriasis treatments and identify mechanisms of action (i.e. aspects that patients perceive as motivating them to change).…”

Does message framing affect changes in behavioural intentions in people with psoriasis? A randomized exploratory study examining health risk communication

“…We demonstrate a clear need for condition-specific health information for people with psoriasis (Keyworth, Nelson, Chew-Graham et al, 2015;Nelson et al, 2017). …”

“…Condition-specific information may improve risk perceptions and promote more informed decision-making about behaviour change (Nelson et al, 2017;Waldron et al, 2011). To date, no studies have examined the effectiveness of psoriasis-specific health information in prompting changes in behavioural intentions.…”

Medication non‐adherence: the hidden problem in clinical practice

“…Improving medication adherence requires more than simply ‘giving advice’ especially in the Internet age of readily accessible but potentially conflicting recommendations. So where should clinicians and researchers go from here?…”