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

Abstract

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is to find strategies to revise or modify these mindlines by adding reliable and useful knowledge and by erasing outdated or inaccurate information.

The content and conduct of GP consultations for dermatology problems: a cross-sectional study

“…[51][52][53] Other barriers identified to GPs facilitating selfmanagement include lacking confidence to share control, ability to provide ongoing support, and concerns that patients may use medications inappropriately and not seek help when needed. 51,54 The secondary care referral rate from this study of 15.7% is comparable with a cross-sectional study of Scottish primary care consultations for skin problems, where 14% of patients were referred for specialist assessment. 36 This is higher than that previously reported from national estimates in England and Wales of 6.1% in 2006/2007.…”

“…51 – 53 Other barriers identified to GPs facilitating self-management include lacking confidence to share control, ability to provide ongoing support, and concerns that patients may use medications inappropriately and not seek help when needed. 51 , 54 …”

Knowledge mobilisation: a UK co-creation study to devise strategies to amend lay and practitioner atopic eczema mindlines to improve consultation experiences and self-management practices in primary care

“…Figure 1 illustrates the fundamentals of eczema mindlines and shows the complexity of how knowledge is gained, from which sources and the inter-relationship between lay–practitioner wider society mindlines. In essence, (1) lay people gain knowledge and beliefs from many sources, for example, personal experience, family, friends and wider society, trial and error, online and from practitioners 14 ; and (2) practitioner actions are underpinned by a belief that eczema is simple to treat ‘ the recipe does not change ’ and that treatment options are limited by prescribing guidance, knowledge is accrued from early education, colleagues, practical experience and patients. 12 Further work illuminates the inter-relationship between the two and therefore the need for efforts to amend mindlines to be a shared venture which transcends lay–practitioner boundaries and instils shared and consistent understanding.…”

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

“…GP consultations are often unsatisfactory for both patient3 and practitioner4 5 with GPs dominating encounters and using avoidance tactics6 and there being significant dissonance between patient/parent and GP beliefs about assessment and treatment 6. Many GPs have limited specialist dermatology knowledge 7.…”