Development of eczema care online, a digital intervention to support eczema self-management in young people

Background: This research aimed to develop Eczema Care Online (ECO), a digital intervention to support eczema self-management in young people (13-25 years). Methods: Theory-, evidence- and person-based approaches to intervention development were used. In Phase 1, interviews (primary research and secondary analysis) with young people (n=28), and a systematic review of qualitative studies developed an in-depth understanding of this target group’s psychosocial context. In Phase 2, guiding principles were created to address key behavioural issues, needs, and challenges identified in Phase 1. Behavioural analysis and logic modelling described the intervention and its hypothesised mechanisms, and mapped intervention content onto behaviour change theory (COM-B, Theoretical Domains Framework). Finally, think-aloud interviews explored young people’s (n=25) reactions to an intervention prototype. Optimisation was iterative, moving between data collection, analysis, and modifying the intervention. Findings: Think-aloud interview findings provided support for the importance and acceptability of the intervention features highlighted in the guiding principles. ECO addressed young people’s information gaps, treatment concerns, and unhelpful beliefs, thus providing them with a more complete understanding of managing their eczema in the context of their everyday lives. Young people valued the design features intended to engage this group, mainly the interactive quiz, quotes from peers, and videos delivering key behaviour-focused messages. Behaviour change content that was confusing or misinterpreted was identified and re-written. Discussion: Findings demonstrated that ECO was acceptable and engaging to young people with eczema. The person-based approach allowed us to understand and accommodate the perspectives of young people with eczema to maximise intervention acceptability