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.
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.