Title: Action PlAns for CHildren with Eczema (APACHE): a study to develop written action plans for children with eczema and explore how best to evaluate them
Funder: Department of Health and Social Care

Abstract: BACKGROUND Eczema is a common, long-term condition that usually starts in infancy. It is characterised by dry and itchy skin and is associated with considerable physical, psychological and social morbidity. In the UK, the majority of children are diagnosed and managed exclusively by their General Practitioner (GP). The mainstays of treatment are emollients to improve the hydration of the skin and topical corticosteroids/calcineurin inhibitors to treat or prevent exacerbations or flares. Adherence to treatments is poor however. The reason for this is probably multifactorial, but importantly includes parent/carer knowledge and confidence around the use of creams and ointments. Guidelines advocate the use of individualised, self-management plans or Written Action Plans (WAPs). WAPs have been the subject of a significant amount of research in children with asthma and have been shown to be beneficial. There are many similarities between the eczema and asthma, and limited research into eczema WAPs is promising.However, there has been no systematic review of eczema WAPs and they have not been subject to rigorous development or evaluation. OBJECTIVES There are three phases to the proposed research project, with the following objectives: To systematically review and synthesise the qualitative literature on written action plans in primary care for children with long term conditions To systematically review the quantitative literature on written action or self-management plans in adults or children with eczema To produce a WAP for children with eczema and materials to support its implementation To identify barriers and facilitators to the use of an eczema WAP by clinicians and parents in primary care To identify the components of the intervention (including their inter-relationships) and the underlying mechanisms by which they will influence outcomes To refine a model for the implementation and evaluation of eczema WAPs To optimise the eczema WAP and supporting materials To optimise the study design of a randomised controlled trial comparing eczema WAPs with usual care To demonstrate the feasibility of a randomised controlled trial comparing eczema WAPs with usual care DESIGN The programme of work is based on the MRC complex intervention framework and will be informed by Normalisation Process Theory (NPT). In phase 1, qualitative and quantitative systematic reviews of the published literature relevant to eczema WAPs will be performed and the findings will inform subsequent phases. In phase 2, qualitative work (in-depth interviews and focus groups) with healthcare professionals, parents/carers/children and key informants will determine what the eczema WAP and materials to support its use should comprise. During this phase a model for the implementation and evaluation of eczema WAPs will be refined. The resulting eczema WAP package will be evaluated in phase 3, an exploratory pragmatic randomised controlled trial of eczema WAPs in primary care. The findings of this study will be used to optimise the eczema WAP package and to determine and the feasibility and design of the definitive trial. EXPECTED OUTCOMES AND ANTICIPATED BENEFITS This project will produce important systematic reviews of eczema WAPs that will guide future research in this area. These findings will be extended by a novel programme of work establishing, from both user and theoretical perspectives, how and why eczema WAPs in primary care might work. The results of the exploratory study will support the successful development and funding of a definitive trial investigating clinical and cost effectiveness of eczema WAPs.

Lay abstract: A personalised guide on how to look after your skin (Written Action Plan, WAP) may be a helpful way to improve the care of children with eczema. First, I will do a thorough search for relevant research, to see what is already known about the topic. I will then interview parents/carers of children with eczema, older children themselves, healthcare professionals and other key people to find out what they think eczema WAPs should contain and how to make them useable. I will then do an exploratory study to decide how to evaluate their value further.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: SKIN