Greenwell, Kate, Becque, Taeko, Sivyer, Katy, Steele, Mary, Denison-Day, James, Steele, Mary, Howells, Laura M., Ridd, Matthew J., Roberts, Amanda, Lawton, Sandra, Langan, Sinéad M., Hooper, Julie, Wilczynska, Sylvia, Griffiths, Gareth, Sach, Tracey H., Little, Paul, Williams, Hywel, Thomas, Kim S, Yardley, Lucy, Muller, Ingrid, Santer, Miriam and Stuart, Beth (2024) Online behavioural interventions for children and young people with eczema: quantitative evaluation. The British journal of general practice : the journal of the Royal College of General Practitioners. (doi:10.3399/BJGP.2023.0411).
Abstract
Background: two online behavioural interventions (Eczema Care Online; one website for parents/carers of children with eczema; one for young people with eczema) have been shown in randomised controlled trials to facilitate a sustained improvement in eczema severity.
Aim: to describe intervention use and examine potential mediators of intervention outcomes and contextual factors that may influence intervention delivery and outcomes.
Design and setting: quantitative process evaluation; UK primary care.
Method: parents/carers and young people were recruited through primary care. Intervention use was recorded and summarised descriptively. Logistic regression explored socio-demographic and other factors associated with intervention engagement. Mediation analysis investigated whether patient enablement (ability to understand and cope with health issues), treatment use, and barriers to adherence were mediators of intervention effect. Subgroup analysis compared intervention effects among pre-specified participants subsets.
Results: 340 parents/carers and 337 young people were recruited. 87% (148/171) parent/carers and 91% (153/168) young people in the intervention group completed the core introduction. At 24 weeks, users spent approximately 20 minutes on average on the interventions. Among parents/carers, greater intervention engagement was associated with higher education levels, uncertainty about carrying out treatments, and doubts about treatment efficacy at baseline. Among young people, higher intervention use was associated with higher baseline eczema severity. Patient enablement accounted for approximately 30% of the intervention effect among parents/carers and 50% among young people.
Conclusion: findings demonstrated that positive intervention outcomes depended on a modest time commitment from users. They provide further support that the wider implementation of Eczema Care Online is justified.
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