Supporting self-care for eczema in the community

Aims Our aim is to improve the lives of people with eczema by developing and testing digital interventions (websites/apps) that will support self-care and address common barriers to eczema self-care, including concerns around topical corticosteroids. Research questions What are the self-care support needs of children with eczema and their parents/carers, teenagers and young adults with eczema? What are patients and parents/carers beliefs and concerns around the use of eczema treatments, and how do these views differ between different groups (by age or severity)? What is the current best evidence on the safety of topical corticosteroids? What is the clinical and cost-effectiveness of digital interventions (websites/apps) to support eczema self-care through behaviour change? How can we implement and integrate digital self-care interventions for eczema into routine care? Background and rationale Eczema is a common condition with significant impact on quality of life. The main cause of treatment failure is non-use of prescribed treatments for reasons including: treatments are time-consuming to apply; they may sting when first applied to inflamed skin; there are concerns about the safety of some treatments; and because patients often receive conflicting advice about how and when to use them. Concerns about topical corticosteroid phobia and addiction are prevalent and patients and parents/carers urgently need better information to interpret conflicting advice about how best to use eczema treatments. We will explore and seek to address these concerns within this programme of research, leading to the development and evaluation of digital interventions (websites/apps) that use behaviour change techniques to support behaviours relevant to eczema self-care. Research Plan We propose the following closely linked workstreams: Workstream 1 Understand facilitators and barriers to effective self-care amongst people with eczema (children with eczema and their families, teenagers and young adults managing their own eczema). Methods: Systematic review of qualitative literature and qualitative study with people with eczema and parents/carers. Workstream 2 Review the evidence base regarding safety of topical corticosteroids and develop knowledge tools aimed at patients, parents/carers and clinicians. Methods: Systematic reviews of RCTs and observational studies, combine with qualitative findings from workstream 1 to create knowledge tools. Workstream 3 Develop two digital interventions to support eczema self-care: one for parents/carers of children with eczema and one for teenagers and young adults managing their own eczema. Methods: Iterative development of interventions including think aloud interviews with users of prototype interventions. Workstream 4 Determine the clinical and cost-effectiveness of digital self-care interventions compared to standard clinical care. Methods: Two feasibility RCTs, two full-scale RCTs, and nested health economic evaluations of the digital self-care interventions for (1) parents/carers of children with eczema and (2) teenagers and young adults managing their own eczema, each compared to standard care. Workstream 5 Explore how to integrate interventions into clinical practice and to facilitate their uptake should they prove clinically and cost-effective. Methods: Process evaluation and implementation planning. Workstreams 1, 2 and 3 will be carried out concurrently, so that interventions are developed iteratively based on evidence from the systematic reviews and qualitative interviews prior to the RCTs in workstream 4. Workstream 5 will continue throughout the duration of the programme. Projected outputs and dissemination plan We will produce: A clear summary of current best evidence on the safety of topical corticosteroids plus knowledge tools to facilitate dissemination. Two new fully evaluated self-care support interventions for (1) parents/carers of children with ec