title: Managing childhood eczema: qualitative study exploring carers' experiences of barriers and facilitators to treatment adherence.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: Primary Care and Population Sciences, University of Southampton, UK.
authors.forename: Miriam
authors.initials: M
authors.lastname: Santer
authors.forename: Hana
authors.initials: H
authors.lastname: Burgess
authors.forename: Lucy
authors.initials: L
authors.lastname: Yardley
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Ersser
authors.forename: Sue
authors.initials: S
authors.lastname: Lewis-Jones
authors.forename: Ingrid
authors.initials: I
authors.lastname: Muller
authors.forename: Catherine
authors.initials: C
authors.lastname: Hugh
authors.forename: Paul
authors.initials: P
authors.lastname: Little
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D002675:Child, Preschool; D004485:Eczema / Q000188:drug therapy* / Q000523:psychology; D004643:Emollients / Q000008:administration & dosage*; D004739:England; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology*; D036301:Qualitative Research
chemical_list: D004643:Emollients
keywords: adherence; atopic eczema; children; concordance; dermatitis; dermatology nursing; qualitative research