title: An exploratory study using framework analysis to investigate health-seeking behaviour in patients with psoriasis.
abstract: BACKGROUND
  Psoriasis is a long-term inflammatory skin disorder, with negative effects on employment, relationships and social function, frequently causing reduced quality of life. People with psoriasis often present to secondary care late into their condition but the reasons for this are unknown.
  
  
  OBJECTIVE
  To examine the patient pathway, health-seeking behaviour and drivers for referral to secondary care in patients with psoriasis.
  
  
  METHODS
  Sixteen patients with mild-to-severe psoriasis, newly referred to secondary care participated in a semi-structured interview. Scripts were analysed by a thematic framework.
  
  
  RESULTS
  The median duration of time living with psoriasis was 15 years at referral. Drivers of secondary care referral included rapid deterioration or extremis, development of comorbidities, knowledge of treatment options, and influence of partners and friends. Reasons for late presentation to secondary care include familial experience of psoriasis, lack of follow-up after the initiation of treatments, beliefs that psoriasis is incurable and must be tolerated, and that psoriasis is not life threatening and therefore not worthy of medical help and difficulty in obtaining a secondary care referral. A common pathway from seeking help at psoriasis onset, evolving into the development of delayed health seeking later in the pathway, was identified.
  
  
  CONCLUSIONS
  Identifying the causes of delay in presentation to secondary care and effective treatment ascertains key areas to target. Health seeking early in the disease pathway provides a 'window of opportunity' for intervention, which may enable people with psoriasis to obtain early, effective treatment and achieve their full life potential.
authors.affiliation: Department of Dermatology, Royal Free London NHS Foundation Trust, London, U.K.
authors.forename: J K
authors.initials: JK
authors.lastname: Simpson
authors.affiliation: Department of Clinical Psychology, Royal Free London NHS Foundation Trust, London, U.K.
authors.forename: M
authors.initials: M
authors.lastname: Wilson
authors.affiliation: Department of Clinical Psychology, Royal Free London NHS Foundation Trust, London, U.K.
authors.forename: A A
authors.initials: AA
authors.lastname: Ahmed
authors.affiliation: Department of Dermatology, Royal Free London NHS Foundation Trust, London, U.K.
authors.forename: A
authors.initials: A
authors.lastname: Mizara
authors.affiliation: Department of Clinical Psychology, Royal Free London NHS Foundation Trust, London, U.K.
authors.forename: A
authors.initials: A
authors.lastname: Clarke
authors.affiliation: Department of Dermatology, Royal Free London NHS Foundation Trust, London, U.K.
authors.forename: S R
authors.initials: SR
authors.lastname: McBride
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005190:Family; D005260:Female; D033062:Friends / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D017060:Patient Satisfaction; D011565:Psoriasis / Q000523:psychology / Q000628:therapy*; D012017:Referral and Consultation; D063127:Secondary Health Care; D012747:Sexual Partners / Q000523:psychology; D013997:Time Factors