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Supporting self-care for families of children with eczema with a Web-based intervention plus health care professional support: pilot randomized controlled trial

Supporting self-care for families of children with eczema with a Web-based intervention plus health care professional support: pilot randomized controlled trial
Supporting self-care for families of children with eczema with a Web-based intervention plus health care professional support: pilot randomized controlled trial
Background: Childhood eczema, or childhood atopic dermatitis, causes significant distress to children and their families through sleep disturbance and itch. The main cause of treatment failure is nonuse of prescribed treatments.

Objective: The objective of this study was to develop and test a Web-based intervention to support families of children with eczema, and to explore whether support from a health care professional (HCP) is necessary to engage participants with the intervention.

Methods: We followed the PRECEDE-PROCEED model: regular emollient use was the target behavior we were seeking to promote and we identified potential techniques to influence this. LifeGuide software was used to write the intervention website. Carers of children with eczema were invited through primary care mail-out and randomized to 3 groups: (1) website only, (2) website plus HCP support, or (3) usual care. Patient-Oriented Eczema Measure (POEM) scores were measured online by carer report at baseline and at 12 weeks. Qualitative interviews were carried out with 13 HCPs (primarily practice nurses) and 26 participants to explore their experiences of taking part in the study.

Results: A total of 143 carers were recruited through 31 practices. We found a decrease of ?2 in follow-up compared with baseline POEM score in 23 of 42 (55%) participants in the website only group, 16 of 49 (33%) in the usual care group, and 18 of 47 (38%) in the website plus HCP group. Website use data showed that 75 of 93 (81%) participants allocated to the website groups completed the core modules, but less than half used other key components (videos: 35%; regular text reminders: 39%). There were no consistent differences in website use between the website only or the website plus HCP groups. Qualitative feedback showed that most HCPs had initial concerns about providing support for eczema self-care because this was not a condition that they felt expert in. However, HCPs reported productive consultations and that they found it helpful to use the website in consultations, while observing that some participants seemed to need more support than others. Qualitative interviews with participants suggested that HCP support was valued highly only by a minority, generally those who were less confident in their management of eczema or less confident using the Internet.

Conclusions: Our pilot trial demonstrated the potential for greater improvements in POEM scores in both website intervention groups and that a full-scale trial is feasible. Such a trial would quantify the effectiveness and cost-effectiveness of this intervention to determine whether it should be widely promoted to families of children with newly diagnosed eczema. In this study population, HCP support was not strongly valued by participants and did not lead to better outcomes or website use than use of the Web-based intervention alone.

Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 98560867; http://www.controlled-trials.com/ISRCTN98560867 (Archived by WebCite at http://www.webcitation.org/6NcxvMtgN).
child, primary care, randomized controlled trial, eczema, internet, self-care
1438-8871
e70
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Muller, Ingrid
2569bf42-51bd-40da-bbfd-dd4dbbd62cad
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Burgess, Hana
c103e930-9676-49d6-bbab-ca29eb7c4222
Selinger, Hannah
a0d60fdc-13f9-4fcf-92c3-2da898650065
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Muller, Ingrid
2569bf42-51bd-40da-bbfd-dd4dbbd62cad
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Burgess, Hana
c103e930-9676-49d6-bbab-ca29eb7c4222
Selinger, Hannah
a0d60fdc-13f9-4fcf-92c3-2da898650065
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777

Santer, Miriam, Muller, Ingrid, Yardley, Lucy, Burgess, Hana, Selinger, Hannah, Stuart, Beth and Little, Paul (2014) Supporting self-care for families of children with eczema with a Web-based intervention plus health care professional support: pilot randomized controlled trial. Journal of Medical Internet Research, 16 (3), e70. (doi:10.2196/jmir.3035). (PMID:24594972)

Record type: Article

Abstract

Background: Childhood eczema, or childhood atopic dermatitis, causes significant distress to children and their families through sleep disturbance and itch. The main cause of treatment failure is nonuse of prescribed treatments.

Objective: The objective of this study was to develop and test a Web-based intervention to support families of children with eczema, and to explore whether support from a health care professional (HCP) is necessary to engage participants with the intervention.

Methods: We followed the PRECEDE-PROCEED model: regular emollient use was the target behavior we were seeking to promote and we identified potential techniques to influence this. LifeGuide software was used to write the intervention website. Carers of children with eczema were invited through primary care mail-out and randomized to 3 groups: (1) website only, (2) website plus HCP support, or (3) usual care. Patient-Oriented Eczema Measure (POEM) scores were measured online by carer report at baseline and at 12 weeks. Qualitative interviews were carried out with 13 HCPs (primarily practice nurses) and 26 participants to explore their experiences of taking part in the study.

Results: A total of 143 carers were recruited through 31 practices. We found a decrease of ?2 in follow-up compared with baseline POEM score in 23 of 42 (55%) participants in the website only group, 16 of 49 (33%) in the usual care group, and 18 of 47 (38%) in the website plus HCP group. Website use data showed that 75 of 93 (81%) participants allocated to the website groups completed the core modules, but less than half used other key components (videos: 35%; regular text reminders: 39%). There were no consistent differences in website use between the website only or the website plus HCP groups. Qualitative feedback showed that most HCPs had initial concerns about providing support for eczema self-care because this was not a condition that they felt expert in. However, HCPs reported productive consultations and that they found it helpful to use the website in consultations, while observing that some participants seemed to need more support than others. Qualitative interviews with participants suggested that HCP support was valued highly only by a minority, generally those who were less confident in their management of eczema or less confident using the Internet.

Conclusions: Our pilot trial demonstrated the potential for greater improvements in POEM scores in both website intervention groups and that a full-scale trial is feasible. Such a trial would quantify the effectiveness and cost-effectiveness of this intervention to determine whether it should be widely promoted to families of children with newly diagnosed eczema. In this study population, HCP support was not strongly valued by participants and did not lead to better outcomes or website use than use of the Web-based intervention alone.

Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 98560867; http://www.controlled-trials.com/ISRCTN98560867 (Archived by WebCite at http://www.webcitation.org/6NcxvMtgN).

Full text not available from this repository.

More information

e-pub ahead of print date: 4 March 2014
Published date: March 2014
Keywords: child, primary care, randomized controlled trial, eczema, internet, self-care
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 363401
URI: https://eprints.soton.ac.uk/id/eprint/363401
ISSN: 1438-8871
PURE UUID: 26f209c7-9da2-4ecd-bdd1-ba09d1b1accc
ORCID for Miriam Santer: ORCID iD orcid.org/0000-0001-7264-5260
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

Catalogue record

Date deposited: 25 Mar 2014 10:31
Last modified: 15 Oct 2019 00:49

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