A Qualitative Exploration of the Impact, Management, and Existing Psychological Support Available for Adults Living with Skin Conditions
DOI:
https://doi.org/10.2340/actadv.v104.40657Keywords:
psychodermatology, qualitative research, self managementAbstract
Skin conditions carry a significant physical, psychological, and social burden. People with skin conditions often engage in health-threatening behaviours that can worsen symptoms and increase cardiovascular disease risk. However, access to dedicated psychological and behaviour-change support is limited. The impact, management, and existing psychological support available to adults living with skin conditions was qualitatively explored to inform the development of a psychologically supportive digital intervention. Qualitative research involving a hybrid inductive– deductive approach was performed. Data collection and analysis were theoretically informed by the Common-Sense Model of Self-Regulation. Eight synchronous online group interviews with 43 English-speaking adults (≥ 18 years) with a range of skin conditions were conducted. Data were analysed using Reflexive Thematic Analysis. Three superordinate themes are outlined: (i) visibility underpinning life course impairment, (ii) seeking control amid uncertainty, and (iii) existing support for people with skin conditions. Skin conditions carry a substantial psychological burden, yet dermatology service provision is sub-optimal and patients often resort to seeking support from unreliable sources. Psychological support can have benefits, but barriers exist. This study reinforces the need for high-quality psychological support, and that patients wanted digital means to support effective self- management.
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References
Flohr C, Hay R. Putting the burden of skin diseases on the global map. Br J Dermatol 2021; 184: 189-190.
https://doi.org/10.1111/bjd.19704
Basra MKA, Shahrukh M. Burden of skin diseases. Expert Rev Pharmacoecon Outcomes Res 2009; 9: 271-283.
https://doi.org/10.1586/erp.09.23
Pattinson R, Hewitt RM, Trialonis-Suthakharan N, Chachos E, Courtier N, Austin J, et al. Development of a conceptual framework for a Patient-Reported Impact of Der-matological Diseases (PRIDD) measure: a qualitative concept elicitation study. Acta Derm Venereol 2022; 102: adv00823.
https://doi.org/10.2340/actadv.v102.2401
Von Stülpnagel CC, Augustin M, Düpmann L, Da Silva N, Sommer R. Mapping risk factors for cumulative life course impairment in patients with chronic skin diseases: a systematic review. J Eur Acad Dermatol 2021; 35: 2166-2184.
https://doi.org/10.1111/jdv.17348
Kimball A, Gieler U, Linder D, Sampogna F, Warren R, Augustin M. Psoriasis: is the im-pairment to a patient's life cumulative? J Eur Acad Dermatol 2010; 24: 989-1004.
https://doi.org/10.1111/j.1468-3083.2010.03705.x
All-Party Parliamentary Group on Skin. Mental Health and Skin Disease. British Skin Foundation, 2020. Available from: https://www.britishskinfoundation.org.uk/news/all-party-parliamentary-group-on-skin-report-mental-health-skin-disease
Massoud SH, Alassaf J, Ahmed A, Taylor RE, Bewley A. UK psychodermatology services in 2019: service provision has improved but is still very poor nationally. UK Clin Exp Dermatol 2021; 46: 1046-1051.
https://doi.org/10.1111/ced.14641
Al‐Jefri K, Newbury‐Birch D, Muirhead CR, Gilvarry E, Araújo‐Soares V, Reynolds NJ, et al. High prevalence of alcohol use disorders in patients with inflammatory skin dis-eases. Br J Dermatol 2017; 177: 837-844.
https://doi.org/10.1111/bjd.15497
Zanesco S, Hall W, Gibson R, Griffiths C, Maruthappu T. Approaches to nutrition interven-tion in plaque psoriasis, a multi-system inflammatory disease: the Diet and Pso-riasis Project (DIEPP). Nutr Bull 2022; 47: 524-537.
https://doi.org/10.1111/nbu.12580
Sawada Y, Saito-Sasaki N, Mashima E, Nakamura M. Daily lifestyle and inflammatory skin diseases. Int J Mol Sci 2021; 22: 5204.
https://doi.org/10.3390/ijms22105204
Hu S, Anand P, Laughter M, Maymone MBC, Dellavalle RP. Holistic dermatology: an evi-dence-based review of modifiable lifestyle factor associations with dermatologic disorders. J Am Acad Dermatol 2022; 86: 868-877.
https://doi.org/10.1016/j.jaad.2020.04.108
Public Health England. Action plan for cardiovascular disease prevention, 2017-2018. London: Public Health England, 2017.
Trettin B, Feldman S, Andersen F, Danbjørg DB, Agerskov H. Improving management of psoriasis patients receiving biological treatment: a qualitative approach. Nurs-ing Open 2021; 8: 1283-1291.
https://doi.org/10.1002/nop2.745
Thimbleby H. Technology and the future of healthcare. J Public Health Res 2013; 2: jphr.2013.e28.
https://doi.org/10.4081/jphr.2013.e28
van Gemert-Pijnen L, Kip H, Kelders SM, Sanderman R. Introducing eHealth. In: van Ge-mert-Pijnen L, editor. eHealth research, theory and development: a multidiscipli-nary approach. London, New York: Routledge; 2018: p. 344.
https://doi.org/10.4324/9781315385907
Pfaeffli Dale L, Dobson R, Whittaker R, Maddison R. The effectiveness of mobile-health behaviour change interventions for cardiovascular disease self-management: a systematic review. Eur J Prev Cardiol 2020; 23: 801-817.
https://doi.org/10.1177/2047487315613462
McLean G, Murray E, Band R, Moffat KR, Hanlon P, Bruton A, et al. Interactive digital inter-ventions to promote self-management in adults with asthma: systematic review and meta-analysis. BMC Pulm Med 2016; 16: 83.
https://doi.org/10.1186/s12890-016-0248-7
Hewitt RM, Ploszajski M, Purcell C, Pattinson R, Jones B, Wren GH, et al. A mixed methods systematic review of digital interventions to support the psychological health and well-being of people living with dermatological conditions. Front Med (Lau-sanne) 2022; 9: 1024879.
https://doi.org/10.3389/fmed.2022.1024879
Gudmundsdóttir SL, Ballarini T, Ámundadóttir ML, Mészáros J, Eysteinsdóttir JH, Thor-leifsdóttir RH, et al. Clinical efficacy of a digital intervention for patients with atopic dermatitis: a prospective single-center study. Dermatol Ther (Heidelb) 2022; 12: 2601-2611.
https://doi.org/10.1007/s13555-022-00821-y
Santer M, Muller I, Becque T, Stuart B, Hooper J, Steele M, et al. Eczema Care Online behavioural interventions to support self-care for children and young people: two independent, pragmatic, randomised controlled trials. BMJ 2022; 379: e072007.
https://doi.org/10.1136/bmj-2022-072007
Cline A, Unrue EL, Cardwell LA, Alinia H, Tull R, Feldman SR, et al. Internet-based survey intervention improves adherence to methotrexate among psoriasis patients. J Dermatolog Treat 2022; 33: 2784-2789.
https://doi.org/10.1080/09546634.2022.2071821
Walburn J, Foster L, Araújo‐Soares V, Sarkany R, Weinman J, Sainsbury K, et al. Accepta-bility and influence of a complex personalized intervention on changes in pho-toprotection behaviours among people with xeroderma pigmentosum. Br J He-alth Psychol 2023; 28: 1113-1131.
https://doi.org/10.1111/bjhp.12675
Foster J, Teske NM, Zigler CK, Hamilton A, Jacobe H. Current utilization of qualitative methodologies in dermatology: a scoping review. JID Innov 2022; 10.1016/j.xjidi.2022.100172: 100172.
https://doi.org/10.1016/j.xjidi.2022.100172
Hewitt RM, Bundy C. New technology use needs patient input. Br J Dermatol 2021; 185: 880-881.
https://doi.org/10.1111/bjd.20634
Leventhal H, Benyamini Y, Brownlee S, Diefenbach M, Leventhal EA, Patrick-Miller L, et al. Illness representations: theoretical foundations. In: Weinman, JA, editor. Per-ceptions of health and illness: current research and applications. Amsterdam: Harwood Academic Publishers; 1997: p. 19-45.
Braun V, Clarke V. Conceptual and design thinking for thematic analysis. Wilmington, DE: Educational Publishing Foundation, 2022: p. 3-26.
https://doi.org/10.1037/qup0000196
Larsen MH, Hagen KB, Krogstad AL, Wahl AK. Shared decision making in psoriasis: a sys-tematic review of quantitative and qualitative studies. Am J Clin Invest 2019; 20: 13-29.
https://doi.org/10.1007/s40257-018-0390-5
Nelson PA, Kane K, Chisholm A, Pearce CJ, Keyworth C, Rutter MK, et al. 'I should have taken that further' - missed opportunities during cardiovascular risk assess-ment in patients with psoriasis in UK primary care settings: a mixed-methods study. Health Expect 2016; 19: 1121-1137.
https://doi.org/10.1111/hex.12404
Petukhova TA, Wilson BN, Gadjiko M, Lee EH, Wang J, Rossi AM, et al. Utilization of Fa-cebook for support and education by patients with skin cancer. Dermatol Online J 2020; 26: 13030/qt27k6w5b2.
https://doi.org/10.5070/D3263047973
Sivyer K, Teasdale E, Greenwell K, Steele M, Ghio D, Ridd MJ, et al. Supporting families managing childhood eczema: developing and optimising eczema care online using qualitative research. Br J Gen Pract 2022; 72: e378-e389.
https://doi.org/10.3399/BJGP.2021.0503
Greenwell K, Ghio D, Sivyer K, Steele M, Teasdale E, Ridd MJ, et al. Eczema Care Online: development and qualitative optimisation of an online behavioural intervention to support self-management in young people with eczema. BMJ Open 2022; 12: e056867.
https://doi.org/10.1136/bmjopen-2021-056867
Pascual MG, Morris MA, Kohn LL. Publication trends of qualitative research in dermato-logy: a scoping review. JAMA Dermatol 2023; 159: 648-658.
https://doi.org/10.1001/jamadermatol.2023.0839
Yardley L, Ainsworth B, Arden-Close E, Muller I. The person-based approach to enhan-cing the acceptability and feasibility of interventions. Pilot Feasibility Stud 2015; 1: 37.
https://doi.org/10.1186/s40814-015-0033-z
Coulson N. Online research methods for psychologists. London: Palgrave, 2015.
Hewitt RM, Purcell C, Bundy C. Safeguarding online research integrity, concerns from re-cent experiences. Br J Dermatol 2022; 10.1111/bjd.21765.
https://doi.org/10.1111/bjd.21765
Weatherhead S, Robson SC, Reynolds NJ. Eczema in pregnancy. BMJ 2007; 335: 152-154.
https://doi.org/10.1136/bmj.39227.671227.AE
Greenblatt DT, Pillay E, Snelson K, Saad R, Torres Pradilla M, Widhiati S, et al. Recommen-dations on pregnancy, childbirth and aftercare in epidermolysis bullosa: a con-sensus‐based guideline. Br J Dermatol 2022; 186: 620-632.
https://doi.org/10.1111/bjd.20809
Heng AHS, Chew FT. Systematic review of the epidemiology of acne vulgaris. Scientific Reports 2020; 10.
https://doi.org/10.1038/s41598-020-62715-3
Chisholm A, Nelson PA, Pearce CJ, Littlewood AJ, Kane K, Henry AL, et al. Motivational in-terviewing‐based training enhances clinicians' skills and knowledge in psoria-sis: findings from the Pso Well® study. Br J Dermatol 2017; 176: 677-686.
https://doi.org/10.1111/bjd.14837
Hewitt R, Pattinson R, Cordingley L, Griffiths C, Kleyn E, McAteer H, et al. Implementation of the PsoWell™ model for the management of people with complex psoriasis. Acta Derm Venereol 2021; 101: adv00445.
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Copyright (c) 2024 Rachael M. Hewitt, Carys Dale, Catherine Purcell, Rachael Pattinson, Chris Bundy
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