Carers' views of topical corticosteroid use in childhood eczema: a qualitative study of online discussion forums. (3rd February 2017)

• Record Type: Journal Article
• Authors: Teasdale, E.J.; Muller, I.; Santer, M.
• Is Part Of: British journal of dermatology. Volume 176:Number 6(2017)
• Page Start: 1500
• Page End: 1507
• Publication Date: 2017-02-03
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.15130
• Languages: English
• ISSNs: 0007-0963

Abstract

Abstract : What's already known about this topic? The main reason for treatment failure in childhood eczema is thought to be nonadherence to treatments, mainly topical corticosteroids and emollients. Despite expert consensus about the effectiveness and safety of topical corticosteroids (if used correctly), previous research has revealed concern about their use among parents and carers. What does this study add? We found diverse concerns around the use of topical corticosteroids among posts on online forums. There was widespread confusion, particularly around the potency of different products, duration of use and safety, for instance of use on the face. Carers value the experiential advice and support of online forum users to try to resolve offline knowledge deficits after consultation or confusion following conflicting offline advice. What are the clinical implications of this work? This study highlights that people seeking eczema information in online forums are likely to find advice with potentially both negative and positive impacts. Widespread confusion expressed online suggests the need for clear, consistent advice about topical corticosteroids, including signposting parents and carers towards reliable, evidence‐based resources. Further research is needed to find effective ways of communicating with carers and to develop resources to support them if questions arise after consultation. Respond to this article Linked Comment:Swallow. Br J Dermatol 2017; 176:1430 Plain language summary available online Summary: Background: Childhood eczema is very common and can have substantial impact on quality of life. One of the main treatments is topical corticosteroids, but these are often underused by parents and carers for reasons that include concerns about safety. Objectives: To explore understandings and concerns about topical corticosteroids among parents and carers of children with eczema who had posted messages in online forums. Methods: A qualitative study of messages and their resultant discussions about topical corticosteroids for childhood eczema posted by parents and carers on two U.K.‐based discussion forums. Results: Ninety‐five forum users involved in 27 discussions relating to topical corticosteroid use in childhood eczema were identified dating from 2003 to 2015. Analysis of discussions highlighted three themes: (i) diverse beliefs about the use of topical corticosteroids; (ii) uncertainty and confusion about using and applying topical corticosteroids; and (iii) seeking to resolve conflicting advice received offline and advice on navigating health services. People expressed a general sense of cautiousness about topical corticosteroids, wide‐ranging concerns and considerable confusion, for instance about potency or safe duration of use. They sought advice from other forum users who they perceived as having experiential expertise. Some posts attempted to reassure that topical corticosteroids were safe if used correctly, but overall the discussions seemed likely to amplify existing concerns. Conclusions: Given the prevalence of concerns and uncertainties about topical corticosteroids, signposting parents and carers of children with eczema towards detailed, credible information about how to use topical corticosteroids safely would be beneficial. In the absence of such information, parents and carers are likely to turn to online discussion forums where, although much useful support and advice can be found, the credibility of advice cannot be assured.