Optimisation of Eczema Care Online (ECO) a web-based intervention to support self-management: a qualitative think aloud interview study with parents or carers of children with eczema

Talk Code: 
Mary Steele
Emma Teasdale, Katy Sivyer, Kate Greenwell, Miriam Santer, Daniela Ghio, Sylvia Wilczynska, Amanda Roberts, Lucy Yardley, Ingrid Muller
Author institutions: 
University of Southampton, PPI representative Nottingham


Eczema is an inflammatory skin condition that affects approximately 1 in 5 children. Inadequate support for self-managing eczema can lead to poor adherence to treatments and poor control of eczema. An intervention designed to provide this support requires an in-depth understanding of the needs of the user.


This study aimed to optimise ECO (Eczema Care Online), a web-based intervention to support eczema self-management for parents/carers of children with eczema (aged 0-12 years). We recruited 24 parents/carers from primary care to take part in a qualitative think-aloud interview where they were asked to express their thoughts about the intervention as they used it. Participants were purposively sampled, based on child’s age and eczema severity. Interviews were audio-recorded and transcribed. Analysis was carried out using a table of changes approach which provided a systematic method of assessing and addressing user feedback. Agreed modifications were tested in further think aloud interviews until no further significant problems occurred.


Early interviews identified issues with the usability and acceptability of the intervention. For example, information that was identified as unclear, repetitive or not relevant to many participants was either re-written or placed on an optional ‘click-through’ page. Participants who had been managing their child’s eczema for longer did not think the intervention would be useful to them because they believed that they already knew a lot of the information. Participants also stated they wished to hear more from other parents/carers about their experiences of managing eczema so further quotes were added, adapted from previous interview data.In later interviews, after changes had been made, feedback was increasingly positive. Participants welcomed quotes from other parents/carers, saying this addressed feelings of isolation. Barriers such as a lack of time, and dislike of reading lengthy text were overcome with design including: allowing participants to immediately access content directly relevant to them; interactive pages with ‘pop-up’ boxes; short concise answers; and important information appearing in bold text. Persuasive information designed to engage participants early on improved expectations.


This approach allowed us to gain an in-depth understanding of the perspectives of the participants. It was therefore possible to accommodate these to maximise intervention acceptability and feasibility. Participant feedback enabled us to improve the structure, length and navigation of the intervention. Content likely to enhance motivation and engagement, such as quotes, was added or emphasised. Some of these findings could be generalisable for digital interventions across a range of health conditions. The findings also suggest that the intervention could be a useful adjunct to clinical advice. Participants indicated that the intervention gave them a more complete understanding of managing eczema than would be possible during a short GP appointment.

Submitted by: 
Mary Steele
Funding acknowledgement: 
On behalf of the ECO team