Improving the self-management of atopic dermatitis: the efficacy of a pictorial patient education tool

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Authors
Wilken, Bethany
Keyword
patient education , atopic dermatitis , eczema , self-perceived knowledge , quality of life , attitudes , self-management , chronic disease
Abstract
Background: Atopic dermatitis (AD) is a chronic relapsing skin condition that requires persistent self-management. Patient education is a key component in the self-management of many chronic diseases as it facilitates disease understanding and patient empowerment. Objective: The purpose of this study was to investigate the efficacy of an AD pictorial education tool in an outpatient setting on quality of life (QoL), disease severity and patients’ self-perceived knowledge and attitudes. In order to measure self- perceived knowledge and attitudes, a novel AD self-perceived knowledge and attitudes questionnaire was developed, and its construct validity was explored. The study also sought to capture healthcare providers (HCPs) perception of the pictorial education tool to help determine its practicality. Methods: AD patients (and caregivers <18yrs) were recruited from an out-patient dermatology clinic at a single academic hospital site. Participating HCPs presented and discussed the pictorial education tool with patients during their appointment. The knowledge and attitudes questionnaire was administered to participants before, immediately after and 2 to 6 months after receiving education. QoL and disease severity scores were taken at the time of study enrolment and 2 to 6 months post-education. QoL and disease severity were measured using the Dermatology Life Quality Index (DLQI) and the Eczema Area and Severity Index (EASI), respectively. HCPs were invited to complete a short questionnaire prior to and after using the pictorial education tool with their AD patients. Results: Forty-seven patients participated in education and completed the self-perceived knowledge and attitudes questionnaire. Immediately after use of the pictorial education tool, significant changes were observed in participants’ perceived knowledge and attitudes score. Most of these significant changes remained 2 to 6 months later. The questionnaire items that did not differ significantly from baseline were related to food allergies and topical steroids/medicated creams. Also, at follow-up 2 to 6 months after the initial visit, QoL and disease severity scores were significantly improved from baseline. Upon analysis of baseline responses, the questionnaire showed good construct validity. The three participating HCPs rated the accuracy, usability, applicability and likability of the education tool highly. Conclusions: The pictorial education tool showed significant beneficial effects on patients’ self-perceived knowledges and attitudes, QoL and disease severity while being a feasible and appealing tool to busy clinicians. After further investigations, the questionnaire could be useful for clinicians to illustrate gaps in patients’ perceived knowledge and attitudes which could be limiting clinical outcomes in AD. Although further research is warranted with a control group and in a primary care setting, the pictorial education tool is likely to be an effective, widely distributable resource that can improve the self-management of AD.
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