PITCH: Development of a web-based behavioural intervention to support self-management of acne vulgaris

Problem

Acne vulgaris is a common skin condition with the potential for substantial physical and psychological impact. First and second line treatments for acne are topical preparations but non-adherence is common. A substantial proportion of patients progress to taking long courses of oral antibiotics, associated with antibiotic resistance. A behavioural web-based intervention was developed to promote self-management of acne in particular promoting the appropriate use of topicals. This study describes the intervention planning process demonstrating how the Person-Based Approach (PBA) was combined with theory and evidence to develop an intervention that was acceptable, persuasive, engaging, and easy to implement.

Approach

Intervention planning and development was informed by extensive qualitative research to ensure the intervention is grounded in the perspectives of people with acne. A systematic review and synthesis of qualitative data was carried out to understand the existing literature on people’s experiences of acne and its treatments. A secondary analysis of 24 interviews with young people with acne carried out by HealthTalk.org sought to identify likely barriers and facilitators to appropriate use of topical treatments. These studies enabled identification of key features which should be incorporated into the intervention. The next stage involved developing guiding principles and mapping behaviour change techniques in the intervention onto the Behaviour Change Wheel and the Extended Common Sense Model of Illness. Once developed, the draft intervention was further refined through qualitative think aloud interviews with 17 young people to explore user reactions to the intervention content. A table of changes was developed documenting the positive and negative comments for further modification.

Findings

Findings from the synthesis of qualitative data highlighted the importance of building a feeling of control over treatment choice and/or illness as well as the difficulty dealing with and presenting psychological problems to health care professionals (HCP). We proposed key intervention features to help overcome these, including offering user choice to promote autonomy and providing advice on how people can effectively communicate with their HCP. The secondary analysis of qualitative data also highlighted key barriers to effective self-management, including people’s concerns about the side effects of topical treatments and their limited knowledge about acne and its management. Key intervention features to help them overcome these included providing compelling information/rationale supported by scientific evidence and supporting patients to formulate a personal goal/action plan. The mapping of behaviour change techniques enabled us to identify key behavioural determinants for the intervention.

Consequences

The PBA along with theory and research evidence ensured that the intervention was comprehensive and that it acknowledged and understood the barriers and facilitators expressed by the target population. This web-based intervention will potentially improve adherence to topical treatments, support young people in managing their acne and reduce the burden on healthcare services.