What are the barriers to treatment use amongst parents/carers of children with eczema and young people with eczema: questionnaire survey in primary care, secondary care and social media

Problem

Eczema is very common in childhood and often persists into adulthood. The main treatments are emollients and topical corticosteroids, although low adherence is a common cause of treatment failure. Previous research has focused on concerns about topical corticosteroids but there may be other barriers to treatment adherence. This study aimed to explore prevalence of barriers and concerns around using both emollients and topical corticosteroids amongst parents/carers of children with eczema and young people with eczema.

Approach

Parents/carers of children aged 12 or less with eczema (N=259) and young people aged 13 to 25 with eczema (N=103) completed a cross-sectional survey through primary care mail-out (N=331), secondary care opportunistic recruitment (N= 20) and through social media (N=11). The survey comprised self-report measures assessing: eczema severity; medication use; sociodemographics; concerns and beliefs about the necessity of treatments (Beliefs about Medicines Questionnaire; BMQ) and common barriers to using treatments (Problematic Experiences of Therapy Scales; PETS). The PETS has four subscales measuring: barriers related to symptoms (e.g. symptoms aggravated by treatment); uncertainty about how to use treatment; doubts about treatment efficacy; and practical problems (e.g. forgetting). The BMQ and PETS assessed both topical corticosteroids and emollients.

Findings

EmollientsPreliminary analysis suggested that for parents/carers and young people with eczema the biggest barrier to using emollients was practical (e.g. lack of time, or forgetting): with 61% of parents/carers and 84% of young people reporting some practical difficulties. In both groups, the overall belief that emollients are necessary outweighed concerns about emollients; mean=3.80 (SD:0.82) versus mean=2.43 (SD:0.89) for parents/carers, and mean=3.71 (SD:0.86) versus mean=2.63 (SD:0.94) for young people. Topical corticosteroidsAmongst parents/carers the biggest barrier to using topical corticosteroids were doubts, e.g. 55% reported some doubts that the treatment was right for their child. However, overall beliefs about the necessity of topical corticosteroids and concern scores were equal; mean=3.04 (SD:1.12) versus mean=3.04 (SD:0.95). Compared to emollients, topical corticosteroids were rated as less necessary and concerns were rated more highly.In contrast, young people rated practical difficulties as their biggest barrier to using topical corticosteroids e.g. 87% reported some practical problems (e.g. lack of opportunity). Amongst young people, overall necessity score for topical corticosteroids marginally outweighed concerns about using them; mean=3.32 (SD:0.92) versus mean=3.00 (SD:0.99).

Consequences

These results suggest differences between parents/carers and young people in how they perceive topical treatments for eczema and experience barriers to their use, leading to implications for support needs. Future analyses will examine differences between parents/carers and young people, and how different beliefs/barriers and eczema severity are related to use of emollients and topical corticosteroids.