PS05 Exploring factors influencing implementation of an itch–scratch intervention for people with eczema: the END-ITCH study
Authors: Sanjula Arora, Ruth Taylor, Ratna Sohanpal, Stephanie J C Taylor, Anthony Bewley, Padma Mohandas, Liz Steed
Journal: British Journal of Dermatology (2024)

Abstract The combined approach (TCA) is a biopsychosocial approach to treating eczema. It includes optimizing medical treatment including steroids and emollients, as well as supporting individuals to understand and manage the itch–scratch cycle, through monitoring and behaviour substitution. Although this approach has been around since the 1980s, implementation in clinical practice is variable. Differing views of acceptability and only small-scale studies of effectiveness may contribute to this. A definitive trial is needed to formally evaluate this approach; however, first we must determine whether implementation barriers are surmountable and what strategies are required to address them. This study aimed to better understand the implementation of TCA for eczema from the perspectives of both people living with eczema and healthcare professionals (HCPs). The study used a mixed-methods approach. In phase one an online survey, with recruitment through social media, and professional and charity mailing lists, was used to elicit understanding, use and attitudes towards TCA. HCPs included both primary- and secondary-care providers, and people living with eczema who were &amp;gt; 16 years of age with a clinical diagnosis. In phase two, semistructured interviews were conducted with purposively sampled individuals to understand implementation issues in greater depth. Survey responses from 106 patients diagnosed with atopic dermatitis and 54 HCPs indicated there was limited knowledge of TCA. Few respondents had either delivered or received TCA; however, on brief description the majority (63% of HCPs, 55% of people living with eczema) felt positively towards the intervention. Interviews among HCPs identified concerns around capability and capacity in implementing TCA, although there was an openness to future training. Equating TCA to habit reversal was common in both groups, suggesting a lack of understanding of the importance of combining behavioural and medical strategies. There was also concern around terminology, with reference to habits as ‘somewhat blaming’. A clear theme among people living with eczema was apprehension about steroids, including fear of withdrawal, uncertainty about benefits and inconsistent treatment advice. There was a desire for holistic care, including better understanding of eczema triggers and causes. TCA was felt to meet some of this need. The significant impact of scratch on people living with eczema was clearly specified, with themes such as impact on social, emotional and sleeping behaviours apparent throughout interviews. In conclusion, there was positivity among stakeholders for further evaluation of TCA; however, there was evidence that there is a need for greater clarity around content and branding and consideration of more efficient models of delivery needed before evaluation should be attempted. This project is funded by the National Institute for Health and Care Research (NIHR) under its Research for Patient Benefit (RfPB) programme.