Parents’ and carers’ views about emollients for childhood eczema: qualitative interview study

Objective: Leave-on emollients form the mainstay of eczema treatment but adherence is poor. We aimed to explore parents/carers’ views on effectiveness and acceptability of leave-on emollients for childhood eczema through secondary analysis of data from two qualitative datasets. Setting: Study 1 recruited through mail-out from 6 general practices in southern England. Study 2 recruited from a feasibility trial of an intervention to support eczema self-care in 31 practices in the same area. Participants: Study 1 included 28 interviews with carers of children aged 5 or less with eczema. Study 2 included 26 interviews with carers of children aged 5 or less with eczema. Methods: Interviews followed semi-structured guides: Study 1 explored carers’ understandings around eczema treatments in order to develop a web-based self-care support intervention; Study 2 explored carers’ understandings of eczema and eczema treatments after using the intervention. Interviews were carried out face-to-face or by telephone, audio-recorded and transcribed. Secondary analysis of data from both studies focused on views and experiences of emollient use. Data were analysed using an inductive thematic approach facilitated by NVivo 10 software. Results: In Study 1, most participants felt emollients improved eczema but held mixed views about long-term use to prevent flare-ups. In Study 2, where carers had used the web-based intervention, all participants held positive views about long-term emollient use. In both studies, participants expressed a range of preferences about emollient ‘thickness’; some felt ‘thick’ emollients (ointments) were most effective while others found these difficult to use. Carers described a process of ‘trial and error’, trying emollients suggested by professionals, friends, and family, or bought over-the-counter. Carers expressed a need for understanding differences between products and their effective use. Conclusions: Providing a rationale for long-term emollient use and choice of emollients could help improve adherence and help families gain more rapid control of eczema.