Topical corticosteroid adherence among caregivers of children with atopic eczema

Abstract

Atopic eczema (AE) is a chronic inflammatory skin disorder and poor adherence to topical treatment regimens is linked to treatment failure in AE. Treatment adherence depends on the knowledge, motivation and ability of caregivers of children with AE to follow recommendations provided. This study aims to determine the predictors, facilitators and barriers of adherence to TCS among caregivers of children with AE for the development of a validated list of recommendations to aid pharmacists during counselling of caregivers to encourage adherence to TCS via three phases. All phases of study were conducted at dermatology clinics of two major hospitals in Malaysia. In Phase 1, 121 caregivers were recruited using convenience sampling to complete a selfreported survey on the child’s eczema severity, caregivers’ degree of TCS phobia using TOPICOP© and caregivers’ adherence to TCS using the 12-item medication adherence score. Multiple linear regression was utilised to determine the predictors of the caregivers’ adherence. Severe eczema was a positive predictor of TCS adherence (B=4.330, CI 1.907 to 6.754, p<0.001). Topical corticosteroid phobia was a negative predictor of TCS adherence (B= -0.300, CI -0.449 to -0.510, p<0.001). Seventeen caregivers from phase 1 were recruited into phase 2 to undergo in-depth semi-structured interviews. Facilitators of TCS adherence were having good insight on the child’s AE, adequate knowledge on TCS and AE, having support in managing child’s AE and awareness on the side effects of TCS, whereas barriers were misinformation on TCS, perception that TCS is not efficacious, having TCS phobia, child resistance during TCS application and use of traditional and complementary medicine. In phase 3, the triangulation of findings from phase 1 and 2 were used to develop six validated recommendations to aid pharmacists during counselling of these caregivers. The recommendations focused on reinforcement of education on TCS, role of health care practitioners and encouraging caregivers to co-manage AE with their children. It is envisioned that these recommendations will empower caregivers in managing their child’s AE with the appropriate use of the TCS.