Views and experiences of managing eczema: systematic review and thematic synthesis of qualitative studies
Eczema is a common skin condition that has a substantial impact of quality of life. The main cause of treatment failure is under-usage of topical treatments. Increasingly, qualitative approaches have been adopted to explore people’s perceptions of eczema and eczema treatment. Synthesising qualitative studies can provide a comprehensive overview of existing literature, greater understanding of people’s perspectives and experiences and can inform clinical practice. We sought to synthesise existing qualitative studies exploring the views and experiences of people with eczema and parents/carers of children with eczema about the condition and its treatment.
We systematically searched four databases (MEDLINE, PsycINFO, CINAHL and EMBASE) from the earliest date available to February 2019. Papers were selected that primarily focused on views and experiences of eczema and eczema treatments, and barriers / facilitators to eczema self-management. We excluded papers that focused solely on models of health service provision or the views and experiences of health professionals. No language restrictions or date limits were placed on the search. Reference lists of selected papers were searched for additional relevant papers. Two authors and two additional research assistants performed assessment of study quality and data extraction. A thematic synthesis approach was followed to synthesise the findings.
We identified and synthesised 39 papers (reporting 32 studies) from 13 countries that had explored the views and experiences of 1,007 participants including 405 parents of children with eczema, 252 people with eczema and 350 online forum users. Four main analytical themes were highlighted 1) Eczema not viewed as a long-term condition, 2) Hesitancy about eczema treatments, particularly topical corticosteroids 3) Significant psychosocial impact of eczema not acknowledged by others and 4) Eczema information and advice perceived as insufficient, inconsistent and conflicting. Our findings suggest that people with eczema and parents of children with eczema experience frustration at having to manage a condition that is seen as mundane and insignificant but that has a significant psychosocial impact and is difficult to manage (due to hesitancy about treatment, especially in the long-term and misperceptions about the chronic nature of eczema). This frustration appears to be exacerbated by experiences of conflicting and inconsistent information and advice, from both health professionals or friends, family and others.
To our knowledge there has been no previous synthesis of qualitative studies in this area. Our novel work suggests that clinicians need to address eczema treatment beliefs and concerns, and emphasise the ‘control not cure’ message to support effective ongoing self-management. There is also a need for health professionals to acknowledge the significant psychosocial impacts of eczema and provide clear consistent information and advice or signpost towards credible information. This may address people’s concerns that distress caused by the condition is not taken seriously.