Uncertainty about cellulitis and unmet patient information needs: a mixed methods study in primary and secondary care

Background: Cellulitis is a painful infection of the skin and underlying tissues, commonly affecting the lower leg: approximately a third of people experience recurrence. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.Aim: To explore patients’ perceptions of cellulitis and their information needs.Design and Setting: Mixed methods study comprising semi‐structured, face‐to‐face interviews and a cross‐sectional survey, recruiting through primary care, secondary care and advertising.Methods: Adults aged 18 or over with a history of cellulitis were invited to take part in a survey, qualitative interview, or both.Results: Thirty interviews were conducted between August 2016 and July 2017. Qualitative data highlighted: (1) low awareness of cellulitis prior to first episode, 2) uncertainty around the time of diagnosis, 3) concern/surprise at the severity of cellulitis, 4) perceived insufficient information provision. People were surprised they had never heard of cellulitis and that they had not received advice or leaflets giving self‐care information. Some sought information from the internet and found this confusing. Two hundred and forty surveys were completed (response rate 17%). These showed that, while many participants had received information on the treatment of cellulitis (60.0%, n=144), they often reported receiving no information about causes (60.8%, n=146) or prevention of recurrence (73.3%, n=176).Conclusions: There is a need to provide information for people with cellulitis, particularly around (1) the name of their condition, (2) managing acute episodes and (3) reducing risk of recurrences

Parents and carers' experiences of seeking health information and support online for long-term physical childhood conditions: A systematic review and thematic synthesis of qualitative research

© BMJ Publishing Group Limited 2020. Objective To systematically review and synthesise qualitative research exploring parents/carers' experiences of seeking online information and support for long-term physical childhood conditions. Design Systematic review and thematic synthesis of qualitative research. Data sources Medline, CINAHL, Embase, PsycINFO and the International Bibliography of the Social Sciences were searched from inception to September 2019. We used thematic synthesis to analyse findings. Eligibility criteria Primary research papers presenting qualitative data collection and analysis, focusing on parents/carers' experiences of seeking health information and support from online resources for long-term physical childhood health conditions. No language restrictions were placed. Results 23 studies from seven countries met inclusion criteria and were included in the synthesis. Included studies presented data collected through interviews/focus groups with 559 parents/carers; free-text surveys and essays with 26 parents/carers and 2407 messages from online support groups. Parents/carers developed a variety of strategies to obtain information and support online, based on personal preferences, appraisal of trustworthiness, perceived needs and previous experiences online. Many parents sought the benefits of online information and support, which included reassurance and validation from online communities, and feeling they had greater knowledge about their children's conditions. Some concerns and perceived risks were discussed, which often stemmed from prior unsatisfactory experiences of seeking information and support online, consultations with health professionals and seeing distressing stories online. Conclusion Most parents/carers were successful in obtaining information and support online. Many continued to share experiences with other parents/carers online. The need for information was particularly apparent early after diagnosis of the condition, whereas the need for peer support continued. The potential concerns and perceived risks with information and support online were especially apparent among parents/carers of children with life-limiting long-term conditions. Findings may be useful for health professionals to facilitate discussions regarding use of online resources, and researchers designing online health resources for parents/carers. PROSPERO registration number CRD42018096009

Parental experiences of eczema advice in online parenting forums: a qualitative interview study

Background: Parents of children with eczema are increasingly turning to online parenting forums for advice about how to manage it. Little is known about how parents make sense of advice about eczema treatments in online forums, and how it affects their management of childhood eczema.Aim: To explore how parents of children with eczema make sense of and act on advice about eczema treatments exchanged in online parenting forums.Design & setting: Qualitative interviews with parents of children with eczema from the UK.Method: Fifteen parents were recruited through online advertisements and snowball sampling. Semi-structured interviews were carried out face to face or by telephone, and analysed inductively using reflexive thematic analysis.Results: When seeking advice from online parenting forums about eczema treatments, parents described appraising the credibility of advice and considering the potential suitability of treatments that were recommended in the forum. Parents proceeded to make sense of online advice through either reading advice and not engaging in online discussions, or actively engaging in online discussions to direct topics and seek most relevant advice. Parents discussed advice received online in subsequent consultations with their GP and requested prescriptions of recommended treatments. Some parents described trying new treatments without consulting their GP

Food insecurity in adults with severe mental illness living in Northern England: Peer research interview findings

Food insecurity means that a person does not have access to sufficient nutritiousfood for normal growth and health. Food insecurity can lead to many healthproblems such as obesity, heart disease, diabetes, and other long term healthconditions. People living with a severe mental illness are more likely to experiencefood insecurity than people without mental illness. Peer-ledin-depthinterviewswere conducted with adults with severe mental illness from Northern England,during which their experiences of food insecurity and strategies to tackle foodinsecurity were discussed. Interviews took place between March and December2022, with interviews being transcribed and analysed using deductive andinductive thematic analysis. Thirteen interviews were conducted, finding that foodinsecurity in adults with severe mental illness was often a long-standingissue.Unemployment, the cost-of-livingcrisis and fuel poverty impacted on experiencesof food insecurity. Difficulties accessing food banks such as transport, stigma,and the limited selection of available food was also discussed. Strategies to tacklefood insecurity centred on making food banks more accessible and improving thequality of available food. Future research should aim to eradicate food insecurityfor adults with severe mental illness, as limited research and action focuses onthis population group over and above ‘mental illness’ or ‘poor mental health’.Removing barriers to accessing food such as lack of transport, and providing foodwhich is of adequate nutritional quality, should be prioritised, as well as tacklingthe stigma and accessibility issues surrounding food banks use

Views and experiences of seeking information and help for vitiligo: a qualitative study of written accounts

Objectives: Vitiligo is a relatively common autoimmune condition causing loss of skin pigment. Around 1 in 100 people in the UK develop vitiligo. It can have a significant impact on quality of life for many of those affected. How people access information and help for vitiligo may influence how they manage such impact. We aimed to explore people’s views and experiences of seeking health information and help for vitiligo.Design: Qualitative analysis of free-text responses to four open-ended questions in an online survey.Setting: Online survey conducted in the UK between February and March 2016.Participants: A survey link was emailed to 675 members of The Vitiligo Society, a UK-based charity providing information and support for people with vitiligo. One hundred and sixty-one members responded to the survey (24%).Results: Many participants wrote extensive free text, often reporting frustration with help-seeking. They perceived general practitioners (GP) as their primary source of advice but felt that GPs had low awareness of available treatments. Where GPs appeared sympathetic or signposted towards further information this was appreciated, even where people felt their GP had not seemed knowledgeable. Many felt that vitiligo was dismissed by health professionals including GPs and dermatologists as ‘cosmetic’, which upset those who experienced substantial impact. Participants expressed concerns about the credibility of online information on vitiligo and the need for reliable, detailed information, as well as a desire for support with managing its psychosocial impact.Conclusions: Information and help-seeking needs of people with vitiligo currently appear to be poorly met, even among members of The Vitiligo Society, who are likely to have received more information than others. People with vitiligo would welcome greater health professional awareness of available vitiligo treatments. Acknowledging the psychosocial impacts of vitiligo and signposting towards credible information are also welcomed

Supporting families managing childhood eczema:Developing and optimising Eczema Care Online using qualitative research

Background: childhood eczema is often poorly controlled due to under-use of emollients and topical corticosteroids. Parents/carers report practical and psychosocial barriers to managing their child’s eczema, including child resistance. Online interventions could potentially support parents/carers; however, rigorous research developing such interventions has been limited. Aim: to develop an online behavioural intervention to help parents/carers manage and co-manage their child’s eczema. Design and setting: Intervention development using a theory-, evidence- and Person-Based Approach with qualitative research. Methods: a systematic review and qualitative synthesis (32 studies) and interviews with parents/carers (N=30) were used to identify barriers and facilitators to effective eczema management, and a prototype intervention was developed. Think-aloud interviews with parents/carers (N=25) were then used to optimise the intervention to increase its acceptability and feasibility. Results: qualitative research identified that parents/carers had concerns about using emollients and topical corticosteroids; incomplete knowledge and skills around managing eczema; and reluctance to transitioning to co-managing eczema with their child. Think-aloud interviews highlighted that while experienced parents/carers felt they knew how to manage eczema, some information about how to use treatments was still new. Techniques for addressing barriers included: providing a rationale explaining how emollients and topical corticosteroids work; demonstrating how to use treatments; and highlighting that the intervention provided new, up-to-date information. Conclusions: parents/carers need support in effectively managing and co-managing their child’s eczema. The key output of this research is Eczema Care Online (ECO) for Families; an online intervention for parents/carers of children with eczema, which is being evaluated in a randomised trial

Food insecurity in adults with severe mental illness living in Northern England: A co-produced cross-sectional study

This study aimed to explore food insecurity prevalence and experiences of adults with severe mental illness living in Northern England.MethodsThis mixed-methods cross-sectional study took place between March and October 2022. Participants were adults with self-reported severe mental illness living in Northern England. The survey included demographic, health, and financial questions. Food insecurity was measured using the US Department of Agriculture Adult Food Security measure. Quantitative data were analysed using descriptive statistics and binary logistic regression; and qualitative data using content analysis.ResultsIn total, 135 participants completed the survey, with a mean age of 44.7 years (SD: 14.1, range: 18–75 years). Participants were predominantly male (53.3%), white (88%) and from Yorkshire (50.4%). The food insecurity prevalence was 50.4% (n = 68). There was statistical significance in food insecurity status by region (p = 0.001); impacts of severe mental illness on activities of daily living (p = 0.02); and the Covid pandemic on food access (p < 0.001). The North West had the highest prevalence of food insecurity (73.3%); followed by the Humber and North East regions (66.7%); and Yorkshire (33.8%). In multivariable binary logistic regression, severe mental illness' impact on daily living was the only predictive variable for food insecurity (odds ratio = 4.618, 95% confidence interval: 1.071–19.924, p = 0.04).ConclusionThe prevalence of food insecurity in this study is higher than is reported in similar studies (41%). Mental health practitioners should routinely assess and monitor food insecurity in people living with severe mental illness. Further research should focus on food insecurity interventions in this population

Capturing goats: documenting two hundred years of mitochondrial DNA diversity among goat populations from Britain and Ireland

The domestic goat (Capra hircus) plays a key role in global agriculture, being especially prized in regions of marginal pasture. However, the advent of industrialized breeding has seen a dramatic reduction in genetic diversity within commercial populations, while high extinction rates among feral herds have further depleted the reservoir of genetic variation available. Here, we present the first survey of whole mitochondrial genomic variation among the modern and historical goat populations of Britain and Ireland using a combination of mtDNA enrichment and high throughput sequencing. Fifteen historical taxidermy samples, representing the indigenous 'Old Goat' populations of the islands, were sequenced alongside five modern Irish dairy goats and four feral samples from endangered populations in western Ireland. Phylogenetic and network analyses of European mitochondrial variation revealed distinct groupings dominated by historical British and Irish samples, which demonstrate a degree of maternal genetic structure between the goats of insular and continental Europe. Several Irish modern feral samples also fall within these clusters, suggesting continuity between these dwindling populations and the ancestral 'Old Goats' of Ireland and Britain

Eczema Care Online: development and qualitative optimisation of an online behavioural intervention to support self-management in young people with eczema.

OBJECTIVES: To describe the development of Eczema Care Online (ECO), an online behaviour change intervention for young people with eczema (phase I); and explore and optimise the acceptability of ECO among this target group using think-aloud interviews (phase II). METHODS: Theory-based, evidence-based and person-based approaches to intervention development were used. In phase I, a qualitative systematic review and qualitative interviews developed an in-depth understanding of the needs and challenges of young people with eczema. Guiding principles highlighted key intervention design objectives and features to address the needs of this target group to maximise user engagement. Behavioural analysis and logic modelling developed ECO's hypothesised programme theory. In phase II, qualitative think-aloud interviews were carried out with 28 young people with eczema and the intervention was optimised based on their feedback. RESULTS: The final intervention aimed to reduce eczema severity by supporting treatment use (emollients, topical corticosteroids/topical calcineurin inhibitors), management of irritants/triggers, emotional management and reducing scratching. Generally, young people expressed positive views of intervention content and design in think-aloud interviews. Quotes and stories from other young people with eczema and ECO's focus on living with eczema (not just topical treatments) were valuable for normalising eczema. Young people believed ECO addressed knowledge gaps they had from childhood and the safety information about topical corticosteroids was reassuring. Negative feedback was used to modify ECO. CONCLUSIONS: A prototype of the ECO intervention was developed using rigorous and complementary intervention development approaches. Subsequent think-aloud interviews helped optimise the intervention, demonstrated ECO is likely to be acceptable to this target group, and provided support for our guiding principles including key design objectives and features to consider when developing interventions for this population. A randomised controlled trial and process evaluation of the intervention is underway to assess effectiveness and explore user engagement with the intervention's behavioural goals