Can online interventions supporting eczema self-management for young people and parents/carers of children with eczema lead to improved outcomes? Two randomised-controlled trials with process evaluations.

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

2A.1

Presenter:

Miriam Santer

Twitter:

@me_steele

Co-authors:

Mary Steele, Ingrid Muller, Julie Hooper, Beth Stuart, Taeko Becque, Tracey Sach, Sylvia Wilczynska, Kate Greenwell, Lucy Yardley, Matthew J Ridd, Amanda Roberts, Paul Little, Kim S Thomas, Miriam Santer and the rest of the ECO team

Author institutions:

University of Southampton, University of Nottingham, University of East Anglia, University of Bristol,

Problem

Eczema is common and has significant impact on quality of life. The main cause of treatment failure is under-use of prescribed treatments for reasons including insufficient or conflicting advice about how to use treatments. We aimed to develop and evaluate the Eczema Care Online interventions to support self-management amongst young people with eczema and parents/carers of children with eczema.

Approach

Using theory, evidence, and person-based approaches we developed two online behavioural interventions for eczema self-management: one for young people aged 13-25 years (YP) and one for parents/carers of children aged 0-12 years (PC). Two RCTs were carried out to evaluate the interventions. Participants were recruited through primary care and randomised to either: usual care plus access to the intervention; or usual care only. Participants completed 4-weekly questionnaires online for a year. The primary outcome for both trials was eczema severity over 24 weeks measured by Patient-Oriented Eczema Measure (POEM). Secondary outcomes included: quality of Life, long-term eczema control, enablement, service use and medication use.

Findings

677 participants (337 YP/340 PC) were recruited between Dec 2019 and Dec 2020. Follow-up rates were excellent (90.2% YP/92.4% PC at 24 weeks). Engagement with core content of interventions was excellent with most participants completing the key module (86.5% PC/ 92.8% YP). After controlling for baseline severity and confounders, eczema severity (POEM) amongst young people in the intervention group compared with usual care group at 24 weeks were -1.8 (95% CI -3.4 to -0.2), and amongst parents/carers in intervention group -1.5 (95% CI -2.5 to -0.5), with benefit maintained through until 52 weeks. In the RCT for young people there was a significant treatment-time interaction, with effectiveness developing over several weeks, whereas in the RCT for parents/carers the treatment effect was realised more quickly and was constant over time.Amongst young people, 39% in the usual care group and 56% in the intervention group achieved the minimal clinically important difference (MCID) of 2.5 points at 24 weeks (OR 2.0, 95% CI 1.2 to 3.5; NNT 6), with a similar effect among amongst parents/carers (39% vs 58% respectively; OR 2.1, 95% CI 1.2 to 3.6; NNT 6). Enablement showed an important difference in favour of the intervention group in both trials. (Adjusted mean difference in score between groups at 24 weeks -0.9 (95% CI -1.3 to -0.6) for young people and -0.7 (95% CI -1.0 to -0.4) for parents/carers).

Consequences

Online interventions for eczema self-management enable both young people and parents/carers of children to manage their eczema and provide a useful, sustained benefit in eczema severity over 12 months. Health economic and process evaluations are underway.

Submitted by:

Mary Steele

Funding acknowledgement:

This study presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (grant ref No RP-PG-0216-20007). Eczema Care Online (ECO) interventions were developed using LifeGuide software, which was partly funded by the NIHR Southampton Biomedical Research Centre (BRC). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.