Views and Experiences of Managing Eczema

Systematic Review and Thematic Synthesis of Qualitative Studies

E. Teasdale; I. Muller; K. Sivyer; D. Ghio; K. Greenwell; S. Wilczynska; A. Roberts; M.J. Ridd; N. Francis; L. Yardley; K.S. Thomas; M. Santer

Disclosures

The British Journal of Dermatology. 2021;184(4):627-637. 

In This Article

Abstract and Introduction

Abstract

Background: The number of qualitative studies on eczema has increased rapidly in recent years. Systematically reviewing these can provide greater understandings of people's perceptions of eczema and eczema treatments.

Objectives: We sought to systematically review and thematically synthesize qualitative studies exploring views and experiences of people with eczema and parents/carers of children with eczema.

Methods: We searched MEDLINE, EMBASE, PsycINFO and CINAHL from the earliest date available to February 2019. We selected papers focusing on views and experiences of eczema and eczema treatments, and barriers/facilitators to eczema self-management. We excluded papers focusing on health service provision models or health professionals' views.

Results: We synthesized 39 papers (reporting 32 studies) from 13 countries. We developed four analytical themes: (1) Eczema not viewed as a long-term condition; (2) Significant psychosocial impact not acknowledged by others; (3) Hesitancy (patient/carer uncertainty) about eczema treatments; and (4) Insufficient information and advice. Our findings suggest that people with eczema and their carers experience frustration at having to manage a condition that is often seen by others as mundane but has significant psychosocial impact and is difficult to manage due to concerns about, and burden of, treatment. This frustration can be exacerbated by experiences of conflicting and/or insufficient information and advice from health professionals, family and others.

Conclusions: Effective self-management of eczema could be supported by addressing beliefs and concerns about treatments; seeking positive ways to promote a 'control not cure' message; acknowledging psychosocial impacts of eczema and treatment burden; and providing clear consistent advice or signposting towards reliable information.

Introduction

Eczema is common and can have substantial impact on quality of life due to itch and sleep disturbance.[1] Eczema management involves applying topical treatments and avoiding triggers (e.g. soap).[2] National Institute for Health and Care Excellence guidance[2] suggests the main cause of treatment failure is due to the underuse of topical treatments.[3] Treatment usage is related to people's understanding of their condition and its treatment, as well as their perceived need for treatments and concerns about any negative effects.[4] Surveys have found that people with eczema worry about using topical corticosteroids,[5,6] yet relatively little is known about the reasons behind this.

Qualitative research seeks to gain a comprehensive understanding of people's lived experiences of a condition. Greater understanding of their perspectives on treatments may help to promote a 'shared understanding' and identify narratives that could mitigate against increasingly polarized views about eczema treatments that have emerged between patients/carers and health professionals.[7,8]

Synthesizing the results from existing qualitative research studies helps to generate new valuable insights into people's beliefs and concerns, and their support and information needs.[9,10] We aimed to synthesize existing qualitative studies exploring the views and experiences of eczema and eczema management among people with eczema and parents/carers of children with eczema.

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