Experiences of carers managing childhood eczema and their views on its treatment: a qualitative study

Santer, Miriam; Burgess, Hana; Yardley, Lucy; Ersser, Steven J.; Lewis-Jones, Sue; Müller, Ingrid; Hugh, Catherine; Little, Paul

doi:10.3399/bjgp12x636083

Cited by 63 publications

(111 citation statements)

References 20 publications

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“…As with other studies, primary care consultations were often considered unsatisfactory by lay people (patients or parents) who commonly felt that the condition was being trivialised by practitioners16 52 53 and who perceived that practitioners lacked knowledge 50. The notion of a group who are self-managing by default has parallels with the involuntary autonomy described by Noerreslet and colleagues54 in which patients thought they ‘had to’ be responsible for their care.…”

Section: Discussionmentioning

confidence: 90%

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Knowledge mobilisation: an ethnographic study of the influence of lay mindlines on eczema self-management in primary care in the UK

Cowdell

2018

BMJ Open

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ObjectiveTo investigate the way in which mindlines, ‘collectively reinforced, internalised tacit guidelines’, are constructed among lay people with eczema in primary care.DesignEthnographic study.SettingObservation in one general practice in the UK and interviews across central England.ParticipantsIn observation, patients in the participating general practice regardless of presenting complaint and in interviews, people with eczema or parents of children with eczema (n=16).ResultsObservation of over 250 hours and interview data were combined and analysed using an ethnographic approach through the lenses of mindlines and self-management. Four themes were identified: doctor knows best; not worth bothering the doctor; I need to manage this myself; and how I know what to do. Themes were set within the context of four broad typologies of lay people’s approach to self-management: content to self-manage; content to accept practitioner management; self-managing by default; and those referred to secondary care.ConclusionsThis study is the first to examine how lay eczema mindlines are developed and to recognise typologies of people with different need for, and receptiveness to, information. Lay eczema mindlines are constructed in many ways. The outstanding challenge is to find strategies to revise or modify these mindlines by adding reliable and useful knowledge and by erasing outdated or inaccurate information.

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Section: Discussionmentioning

confidence: 90%

“…Eczema is treated in primary care in 97% of cases15 and has a high self-management demand. The mainstay of treatment is regular and consistent application of topical medication,16 predominantly emollients and steroid preparations. Treatment failure is common17 18 and wastage of prescribed preparations high 19.…”

Section: Introductionmentioning

confidence: 99%

Knowledge mobilisation: an ethnographic study of the influence of lay mindlines on eczema self-management in primary care in the UK

Cowdell

2018

BMJ Open

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“…8 It is important that the education provided to parents of children suffering with pAD acknowledges the impact of the pAD and pays particular attention to addressing carers' treatment beliefs. 19 Community pharmacists play a role in educating patients about the management of dermatology conditions. 20,21 The pharmacists' code of ethics requires that they offer information on the use of medications but that this information should never conflict with the prescriber's recommendation.…”

Section: Discussionmentioning

confidence: 99%

Pharmacists' knowledge about use of topical corticosteroids in atopic dermatitis: Pre and post continuing professional development education

et al. 2015

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“…Study 2 was a qualitative study among carers who had used the web-based intervention, as part of its evaluation. We previously reported findings from study 1 showing that some carers did not believe emollients to be effective and that a minority viewed emollients as ‘unnatural’ and potentially harmful if used long term 7. We also previously reported that carers described mixed feelings about the process of ‘trial and error’,7 a process that is often necessary to find an emollient that suits the child.…”

Section: Introductionmentioning

confidence: 99%

Parents' and carers' views about emollients for childhood eczema: qualitative interview study

et al. 2016

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ObjectiveLeave-on emollients form the mainstay of eczema treatment, but adherence is poor. We aimed to explore parents’/carers' views on effectiveness and acceptability of leave-on emollients for childhood eczema through secondary analysis of data from 2 qualitative data sets.SettingStudy 1 recruited through mail-out from 6 general practices in southern England. Study 2 recruited from a feasibility trial of an intervention to support eczema self-care in 31 practices in the same area.ParticipantsStudy 1 included 28 interviews with carers of children aged ≤5 years with eczema. Study 2 included 26 interviews with carers of children aged ≤5 years with eczema.MethodsInterviews followed semistructured guides: study 1 explored carers' understandings around eczema treatments in order to develop a web-based self-care support intervention; study 2 explored carers' understandings of eczema and eczema treatments after using the intervention. Interviews were carried out face to face or by telephone, audio-recorded and transcribed. Secondary analysis of data from both studies focused on views and experiences of emollient use. Data were analysed using an inductive thematic approach facilitated by NVivo V.10 software.ResultsIn study 1, most participants felt emollients improved eczema but held mixed views about long-term use to prevent flare-ups. In study 2, where carers had used the web-based intervention, all participants held positive views about long-term emollient use. In both studies, participants expressed a range of preferences about emollient ‘thickness’; some felt that ‘thick’ emollients (ointments) were most effective, while others found these difficult to use. Carers described a process of ‘trial and error’, trying emollients suggested by professionals, friends and family, or bought over-the-counter. Carers expressed a need for understanding differences between products and their effective use.ConclusionsProviding a rationale for long-term emollient use and choice of emollients could help improve adherence and help families gain more rapid control of eczema.

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Experiences of carers managing childhood eczema and their views on its treatment: a qualitative study

Cited by 63 publications

References 20 publications

Knowledge mobilisation: an ethnographic study of the influence of lay mindlines on eczema self-management in primary care in the UK

Knowledge mobilisation: an ethnographic study of the influence of lay mindlines on eczema self-management in primary care in the UK

Pharmacists' knowledge about use of topical corticosteroids in atopic dermatitis: Pre and post continuing professional development education

Parents' and carers' views about emollients for childhood eczema: qualitative interview study

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