Supporting the parents of children with atopic eczema

Liberating parents from guilt: a grounded theory study of parents' internet communities for the recognition of ADHD

PURPOSE

This study presents a qualitative analysis of information posted on the Internet by two communities of French parents promoting the recognition of ADHD in the context of current health and school practices.

METHOD

Grounded Theory (Strauss & Corbin's approach) was applied to the posted messages, with the aim to discover the main concern and common theme through a constant comparison analysis.

RESULTS

Liberating parents from feeling responsible for their child's misconduct was found to be the core category. From this perspective, we account for the commitment of the digital communities to formalize the child's conduct as a consequence of a neurodevelopmental disorder. This approach helps to account for the promotion of behavioural expertise and conditioning strategies (e.g., positive reinforcement) for handling the child's so-called disorder as appropriate parental responses. Giving evidence for parenting struggles was the third main concern of the communities, in the face of perceived skepticism from professionals towards ADHD as a medical condition.

CONCLUSIONS

By using examples from countries that are found to have a more pro-medical approach to ADHD, the communities aim at improving such medical practices in France. Issues surrounding the claim that ADHD would require a specific style of parenting are also discussed.

Psychological and educational interventions for atopic eczema in children

BACKGROUND

Psychological and educational interventions have been used as an adjunct to conventional therapy for children with atopic eczema to enhance the effectiveness of topical therapy. This is an update of the original Cochrane review.

OBJECTIVES

To assess the effect of psychological and educational interventions for atopic eczema in children.

SEARCH METHODS

We updated our searches of the following databases to January 2013: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2012, Issue 12), MEDLINE (from 1946), EMBASE (from 1974), OpenGrey, and PsycINFO (from 1806). We also searched six trials registers and checked the reference lists of included and excluded studies for further references to relevant randomised controlled trials (RCTs).

SELECTION CRITERIA

Randomised controlled trials of psychological or educational interventions, or both, used to assist children and their carers in managing atopic eczema.

DATA COLLECTION AND ANALYSIS

Three authors independently applied eligibility criteria, assessed trial quality, and extracted data. A lack of comparable data prevented data synthesis, and we were unable to conduct meta-analysis because there were insufficient data.

MAIN RESULTS

We included 10 RCTs, of which 5 were new to this update; all interventions were adjuncts to conventional therapy and were delivered in primary- and secondary-care settings. There were 2003 participants in the 9 educational interventions and 44 participants in the 1 psychological study. Some included studies had methodological weaknesses; for example, we judged four studies to have high risk of detection bias, attrition bias, or other bias. Our primary outcomes were participant-rated global assessment, reduction in disease severity (reported as objective SCORAD (SCORing Atopic Dermatitis)), and improvement in sleep and quality of life. No study reported participant-rated global assessment or improvement of sleep.The largest and most robust study (n = 992) demonstrated significant reduction in disease severity and improvement in quality of life, in both nurse- and dermatologist-led intervention groups. It provided six standardised, age-appropriate group education sessions. Statistically significant improvements in objective severity using the SCORAD clinical tool were recorded for all intervention groups when compared with controls. Improvements in objective severity (intervention minus no intervention) by age group were as follows: age 3 months to 7 years = 4.2, 95% confidence interval (CI) 1.7 to 6.8; age 8 to 12 years = 6.7, 95% CI 2.1 to 11.2; and age 13 to 18 years = 9.9, 95% CI 4.3 to 15.5. In three of five studies, which could not be combined because of their heterogeneity, the objective SCORAD measure was statistically significantly better in the intervention group compared with the usual care groups. However, in all of the above studies, the confidence interval limits do not exceed the minimum clinically important difference of 8.2 for objective SCORAD.The largest study measured quality of life using the German 'Quality of life in parents of children with atopic dermatitis' questionnaire, a validated tool with five subscales. Parents of children under seven years had significantly better improvements in the intervention group on all five subscales. Parents of children aged 8 to 12 years experienced significantly better improvements in the intervention group on 3 of the 5 subscales.

AUTHORS' CONCLUSIONS

This update has incorporated five new RCTs using educational interventions as an adjunct to conventional treatment for children with atopic eczema. We did not identify any further studies using psychological interventions. The inclusion of new studies has not substantially altered the conclusions from the original review. The educational studies in both the original review and this update lack detail about intervention design and do not use a complex interventions framework. Few use an explicit theoretical base, and the components of each intervention are not sufficiently well described to allow replication. A relative lack of rigorously designed trials provides limited evidence of the effectiveness of educational and psychological interventions in helping to manage the condition of atopic eczema in children. However, there is some evidence from included paediatric studies using different educational intervention delivery models (multiprofessional eczema interventions and nurse-led clinics) that these may lead to improvements in disease severity and quality of life. Educational and psychological interventions require further development using a complex interventions framework. Comparative evaluation is needed to examine their impact on eczema severity, quality of life, psychological distress, and cost-effectiveness. There is also a need for comparison of educational interventions with stand-alone psychosocial self-help.  

Parenthood, information and support on the internet. A literature review of research on parents and professionals online

BACKGROUND

The aim of this article was to address questions on how parents use the internet to find information and support regarding children, health and family life. Another aim was to find out how professionals use the internet to provide support and information to parents. This was done by a literature review.

METHODS

Articles were searched for in five databases with a search strategy called "building block" approach.

RESULTS

The review showed that the majority of today's parents search for both information and social support on the internet. However, there are considerable differences due to gender, age and socio-economic differences. First time middle class mothers aged 30-35 are most active in looking up health and parent information on the internet. In the same time, several studies report diminishing class differences on parent web sites. An important reason to the increasing number of parents who turn to the internet for information and interaction has shown to be the weakened support many of today's parents experience from their own parents, relatives and friends. Professionals have recognized the parents' great interest for going online and offer both information and support on the net.

CONCLUSION

Many benefits are reported, for example the possibility to reach out to a wider audience and to increase access to organisations without an increase in costs. Other benefits include the possibility for parents to remain anonymous in their contacts with professionals and that parents' perceived need for information can be effectively met around the clock. Interventions for wider groups of parents, such as parent training on the net, are still very rare and more research is needed to evaluate different types of interventions on the net. However, most studies were empirical and lacked theoretical frameworks which leave questions on how we can more fully understand this phenomenon unanswered.

Psychological and educational interventions for atopic eczema in children

BACKGROUND

Psychological and educational interventions have been used as an adjunct to conventional therapy for children with atopic eczema to enhance the effectiveness of topical therapy. There have been no relevant systematic reviews applicable to children.

OBJECTIVES

To assess the effectiveness of psychological and educational interventions in changing outcomes for children with atopic eczema.

SEARCH STRATEGY

We searched the Cochrane Skin Group Specialised Register (to September 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2005), MEDLINE (from 1966-2005), EMBASE (from 1980 to week 3, 2005 ), PsycINFO (from 1872 to week 1, 2005). On-line: National Research Register, Meta-register of Controlled Trials, ZETOC alerts, SIGLE (August 2005).

SELECTION CRITERIA

RCTs of psychological or educational interventions, or both, used to manage children with atopic eczema.

DATA COLLECTION AND ANALYSIS

Two authors independently applied eligibility criteria, assessed trial quality and extracted data. A lack of comparable data prevented data synthesis.

MAIN RESULTS

Five RCTs met the inclusion criteria. Some included studies required clearer reporting of trial procedures. Rigorous established outcome measures were not always used. Interventions described in all 5 RCTs were adjuncts to conventional therapy. Four focused on intervention directed towards the parents; data synthesis was not possible. Psychological interventions remain virtually unevaluated by studies of robust design; the only included study examined the effect of relaxation techniques (hypnotherapy and biofeedback) on severity. Three educational studies identified significant improvements in disease severity between intervention groups. A recent German trial evaluated long term outcomes and found significant improvements in both disease severity (3 months to 7 years, p=0.0002, 8 to 12 years, p=0.003, 13 to 18 years, p=0.0001) and parental quality of life (3 months to 7 years, p=0.0001, 8 to 12 years p=0.002), for children with atopic eczema. One study found video-based education more effective in improving severity than direct education and the control (discussion) (p<0.001). The single psychological study found relaxation techniques improved clinical severity as compared to the control at 20 weeks (t=2.13) but this was of borderline significance (p=0.042).

AUTHORS' CONCLUSIONS

A lack of rigorously designed trials (excluding one recent German study) provides only limited evidence of the effectiveness of educational and psychological interventions in helping to manage the condition of children with atopic eczema. Evidence from included studies and also adult studies indicates that different service delivery models (multi-professional eczema school and nurse-led clinics) require further and comparative evaluation to examine their cost-effectiveness and suitability for different health systems.