Managing childhood eczema: qualitative study exploring carers' experiences of barriers and facilitators to treatment adherence

Authors


Correspondence to M. Santer: e-mail: m.santer@soton.ac.uk

Abstract

Aim

To explore parents and carers' experiences of barriers and facilitators to treatment adherence in childhood eczema

Background

Childhood eczema is common and causes significant impact on quality of life for children and their families, particularly due to sleep disturbance and itch. Non-adherence to application of topical treatments is the main cause of treatment failure.

Design

Qualitative interview study.

Methods

Qualitative interviews were carried out with 31 carers from 28 families of children with eczema. Participants were recruited through primary care and included if they had a child aged 5 or less with a diagnosis of eczema. Interviews were carried out between December 2010–May 2011. Data were analysed using a constant comparative approach.

Findings

Barriers to treatment adherence included carer beliefs around eczema treatment, the time consuming nature of applying topical treatments, and child resistance to treatment. Families employed a range of strategies in an attempt to work around children's resistance to treatment with varying success. Strategies included involving the child in treatment, distracting the child during treatment, or making a game of it, using rewards, applying treatment to a sleeping child or, in a few cases, physically restraining the child. Some carers reduced frequency of applications in an attempt to reduce child resistance.

Conclusions

Regular application of topical treatments to children is an onerous task, particularly in families where child resistance develops. Early recognition and discussion of resistance and better awareness of the strategies to overcome this may help carers to respond positively and avoid establishing habitual confrontation.

Ancillary