title: 'New to me': changing patient understanding of psoriasis and identifying mechanisms of change. The Pso Well®patient materials mixed-methods feasibility study.
abstract: BACKGROUND
  Psoriasis is an inflammatory long-term condition involving comorbidities, unhealthy lifestyle and significant life impact. Patients' understanding of psoriasis is limited and support lacking. The Common-Sense Model of Self-Regulation of Health and Illness emphasizes the role of illness and treatment beliefs on coping and self-management. New 'Pso Well®' patient materials informed by the model, addressed psoriasis as a long-term condition, medication management and lifestyle behaviours.
  
  
  OBJECTIVE
  To investigate whether Pso Well®materials (i) broaden understanding of psoriasis without increasing anxiety; (ii) are acceptable; and (iii) comprise features that appear to effect change.
  
  
  METHODS
  The Revised Illness Perceptions Questionnaire (IPQ-R modified) and the Hospital Anxiety and Depression Scale (HADS) were administered in patients before and after intervention. Numerical rating scales assessed perceptions of change in understanding and anxiety resulting from engagement with the materials. Qualitative interviews explored acceptability and perceived 'active ingredients'.
  
  
  RESULTS
  Fifty-five patients completed pre- and postintervention questionnaires (56% female; median age 59 years). Postintervention, a large effect size was indicated in two IPQ-R domains - illness coherence [t(55) = -3·48, P = 0·001 (two-tailed), η2= 0·19] and personal control [t(55) = -2·98, P = 0·004 (two-tailed), η2= 0·14] - and a medium effect in one, treatment control [t(55) = -2·08, P = 0·042 (two-tailed), η2= 0·08]. HADS scores did not change. For numerical rating scales, 80% of participants reported increased understanding of psoriasis and none reported increased anxiety. Interviews with 19 patients indicated the materials were acceptable and usable. Factors reported to broaden understanding and promote engagement with self-management included linking of related disease aspects, personally relevant content and high-quality design.
  
  
  CONCLUSIONS
  High-quality, theory-based psoriasis materials are acceptable to patients and can improve understanding and sense of control without increasing anxiety.
authors.affiliation: Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.|Manchester Academic Health Science Centre, Manchester, U.K.
authors.forename: P A
authors.identifier: http://orcid.org/0000-0003-4162-4736
authors.initials: PA
authors.lastname: Nelson
authors.affiliation: Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.|Manchester Academic Health Science Centre, Manchester, U.K.
authors.forename: K
authors.initials: K
authors.lastname: Kane
authors.affiliation: Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.|Manchester Academic Health Science Centre, Manchester, U.K.|Manchester Centre for Health Psychology, University of Manchester, Manchester, U.K.
authors.forename: C J
authors.initials: CJ
authors.lastname: Pearce
authors.affiliation: Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.|Manchester Academic Health Science Centre, Manchester, U.K.|Manchester Centre for Health Psychology, University of Manchester, Manchester, U.K.
authors.forename: C
authors.initials: C
authors.lastname: Bundy
authors.affiliation: Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.|Manchester Academic Health Science Centre, Manchester, U.K.|Manchester Centre for Health Psychology, University of Manchester, Manchester, U.K.
authors.forename: A
authors.initials: A
authors.lastname: Chisholm
authors.affiliation: Bridgewater Community Healthcare Trust, Wigan, U.K.
authors.forename: R
authors.initials: R
authors.lastname: Hilton
authors.affiliation: Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.|Manchester Academic Health Science Centre, Manchester, U.K.|Manchester Centre for Health Psychology, University of Manchester, Manchester, U.K.
authors.forename: R
authors.initials: R
authors.lastname: Thorneloe
authors.affiliation: Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.|Manchester Academic Health Science Centre, Manchester, U.K.|Salford Royal NHS Foundation Trust, Greater Manchester, U.K.
authors.forename: H
authors.initials: H
authors.lastname: Young
authors.affiliation: Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.|Manchester Academic Health Science Centre, Manchester, U.K.|Salford Royal NHS Foundation Trust, Greater Manchester, U.K.
authors.forename: C E M
authors.initials: CEM
authors.lastname: Griffiths
authors.affiliation: Manchester Academic Health Science Centre, Manchester, U.K.|Manchester Centre for Health Psychology, University of Manchester, Manchester, U.K.|Division of Musculoskeletal and Dermatological Research, University of Manchester, Manchester, U.K.
authors.forename: L
authors.initials: L
authors.lastname: Cordingley
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology; D032882:Comprehension; D005240:Feasibility Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010465:Perception; D011565:Psoriasis / Q000523:psychology* / Q000628:therapy; D011569:Psychiatric Status Rating Scales; D012648:Self Care / Q000379:methods; D012649:Self Concept; D011795:Surveys and Questionnaires