Views and experiences of managing eczema: systematic review and thematic synthesis of qualitative studies
Problem
Eczema is a common skin condition that has a substantial impact on quality of life. 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.
Approach
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 used to synthesise the findings.
Findings
We identified and synthesised 39 papers (reporting 32 studies) from 13 countries exploring the views and experiences of 1,007 participants. Four key themes were identified 1) Eczema not viewed as a long-term condition, 2) Significant psychosocial impact of eczema not acknowledged by others, 3) Hesitancy (patient uncertainty) about eczema treatments and 4) Insufficient eczema information and advice. Our findings suggest that people with eczema and parents of children with eczema experience frustration at having to manage a condition that is seen by others as mundane but has significant psychosocial impact and treatment burden and concerns. This frustration appears to be exacerbated by experiences of conflicting and inconsistent information and advice, from both health professionals or friends, family and others.
Consequences
Our synthesis suggests that effective self-management of eczema could be supported by addressing beliefs and concerns about treatments and seeking positive ways to promote a ‘control not cure’ message. Acknowledging the significant psychosocial impacts of eczema and burdensome nature of treatment as well as providing clear consistent information and advice or signposting towards reliable information, may address people’s concerns that distress caused by the condition is not taken seriously.