title: Adopting a Sustainable Community of Practice Model when Developing a Service to Support Patients with Epidermolysis Bullosa (EB): A Stakeholder-Centered Approach.
abstract: OBJECTIVE
  Epidermolysis bullosa (EB) is a rare, genetic skin condition that is complicated, distressing, and painful and permeates every aspect of patients' lives. Support services are essential for meeting the primary needs of patients and families living with EB; however, provision is challenged by many complex issues. In collaboration with the patient organization DEBRA Ireland, this research conducted an in-depth analysis of Irish healthcare support services for EB, with a view to moving towards an improved and sustainable care pathway.
  
  
  METHODS
  A sustainable community of practice model (SCOP), as a core construct provided a simplified framework when studying this complex system. The research utilized mixed methods, comprising individual interviews, questionnaires, and a participatory action research workshop based on a soft systems approach. The study engaged patients, family members, service providers, and policy developers.
  
  
  RESULTS
  Findings emphasized that the complexities of life with EB are more than 'skin deep'. The lived experience of stakeholders revealed many levels of emotion, both positive and heart-rending. Despite the positive efforts of specialists in this field, inadequacies to meet the primary needs of people with EB, such as bandages-fundamental for survival-were highlighted. Participants reported challenges relating to understanding patients' needs, access to consistent services within hospitals and the community, time constraints, and the strong emotions evoked by this severe and rare disease.
  
  
  CONCLUSIONS
  The study identified several areas that can be targeted to bring about improvements in meeting primary needs. Education and research at public, policy, and practice levels need to be prioritized. It is imperative that citizens move beyond an awareness that EB exists and demonstrate a consciousness about the importance of advocating and enabling seamless and sustainable support services through collective action.
authors.affiliation: University of Limerick, Limerick, Ireland, rosie.gowran@ul.ie.
authors.forename: Rosemary Joan
authors.initials: RJ
authors.lastname: Gowran
authors.forename: Avril
authors.initials: A
authors.lastname: Kennan
authors.forename: Siobhán
authors.initials: S
authors.lastname: Marshall
authors.forename: Irene
authors.initials: I
authors.lastname: Mulcahy
authors.forename: Sile
authors.initials: S
authors.lastname: Ní Mhaille
authors.forename: Sarah
authors.initials: S
authors.lastname: Beasley
authors.forename: Mark
authors.initials: M
authors.lastname: Devlin
mesh_terms: D003153:Community Health Services / Q000600:supply & distribution; D004820:Epidermolysis Bullosa / Q000628:therapy*; D005380:Financing, Government; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D007494:Ireland; D017146:Models, Organizational; D036301:Qualitative Research; D012944:Social Support; D011795:Surveys and Questionnaires