'New to me': changing patient understanding of psoriasis and identifying mechanisms of change. The Pso Well® patient materials mixed‐methods feasibility study. (17th August 2017)

• Record Type: Journal Article
• Authors: Nelson, P.A.; Kane, K.; Pearce, C.J.; Bundy, C.; Chisholm, A.; Hilton, R.; Thorneloe, R.; Young, H.; Griffiths, C.E.M.; Cordingley, L.
• Is Part Of: British journal of dermatology. Volume 177:Number 3(2017)
• Page Start: 758
• Page End: 770
• Publication Date: 2017-08-17
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.15574
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Background: Psoriasis is an inflammatory long‐term condition involving comorbidities, unhealthy lifestyle and significant life impact. Patients' understanding of psoriasis is limited and support lacking. The Common‐Sense Model of Self‐Regulation of Health and Illness emphasizes the role of illness and treatment beliefs on coping and self‐management. New 'Pso Well ® ' patient materials informed by the model, addressed psoriasis as a long‐term condition, medication management and lifestyle behaviours. Objectives: To investigate whether Pso Well ® materials (i) broaden understanding of psoriasis without increasing anxiety; (ii) are acceptable; and (iii) comprise features that appear to effect change. Methods: The Revised Illness Perceptions Questionnaire (IPQ‐R modified) and the Hospital Anxiety and Depression Scale (HADS) were administered in patients before and after intervention. Numerical rating scales assessed perceptions of change in understanding and anxiety resulting from engagement with the materials. Qualitative interviews explored acceptability and perceived 'active ingredients'. Results: Fifty‐five patients completed pre‐ and postintervention questionnaires (56% female; median age 59 years). Postintervention, a large effect size was indicated in two IPQ‐R domains – illness coherence [ t (55) = −3·48, P = 0·001 (two‐tailed), η 2 = 0·19] and personal control [ t (55) = −2·98, P = 0·004 (two‐tailed), η 2 = 0·14] – and a medium effect in one, treatment control [ t (55) = −2·08, P = 0·042 (two‐tailed), η 2 = 0·08]. HADS scores did not change. For numerical rating scales, 80% of participants reported increased understanding of psoriasis and none reported increased anxiety. Interviews with 19 patients indicated the materials were acceptable and usable. Factors reported to broaden understanding and promote engagement with self‐management included linking of related disease aspects, personally relevant content and high‐quality design. Conclusions: High‐quality, theory‐based psoriasis materials are acceptable to patients and can improve understanding and sense of control without increasing anxiety. Abstract : What's already known about this topic? Psoriasis is associated with comorbidities, unhealthy lifestyle and significant life impact. Patients' understanding of psoriasis is limited, self‐management support is lacking and disengagement from healthcare services is common. What does this study add? The new, theory‐informed Pso Well ® patient materials address psoriasis as a long‐term condition; medications management and lifestyle behaviour. The Pso Well ® patient materials can increase understanding of psoriasis, promote feelings of self‐worth and encourage a desire to engage in self‐management and behaviour change, without increasing anxiety or depression. What are the clinical implications of this work? The Pso Well ® patient materials could support clinical consultations by helping patients recognize the remitting–relapsing nature of psoriasis. This will help to improve understanding of the disease, as well as providing a clearer rationale for treatment adherence and lifestyle behaviour change. Linked Comment: Prinsen. Br J Dermatol 2017; 177 :616–617