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

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Resumo

CKGROUND: 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).

Resumo Limpo

ckground childhood eczema childhood atop dermat caus signific distress children famili sleep disturb itch main caus treatment failur nonus prescrib treatmentsobject object studi develop test webbas intervent support famili children eczema explor whether support health care profession hcp necessari engag particip interventionmethod follow precedeproce model regular emolli use target behavior seek promot identifi potenti techniqu influenc lifeguid softwar use write intervent websit carer children eczema invit primari care mailout random group websit websit plus hcp support usual care patientori eczema measur poem score measur onlin carer report baselin week qualit interview carri hcps primarili practic nurs particip explor experi take part studyresult total carer recruit practic found decreas followup compar baselin poem score particip websit group usual care group websit plus hcp group websit use data show particip alloc websit group complet core modul less half use key compon video regular text remind consist differ websit use websit websit plus hcp group qualit feedback show hcps initi concern provid support eczema selfcar condit felt expert howev hcps report product consult found help use websit consult observ particip seem need support other qualit interview particip suggest hcp support valu high minor general less confid manag eczema less confid use internetconclus pilot trial demonstr potenti greater improv poem score websit intervent group fullscal trial feasibl trial quantifi effect costeffect intervent determin whether wide promot famili children newli diagnos eczema studi popul hcp support strong valu particip lead better outcom websit use use webbas intervent alonetri registr intern standard random control trial number isrctn httpwwwcontrolledtrialscomisrctn archiv webcit httpwwwwebcitationorgncxvmtgn

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