Educational resources and strategies

It is important to maintain awareness of the range of educational resources available for supporting those living with chronic conditions and their quality. Some key sources are illustrated in Table 7.2.

Table 7.2 Educational resources related to managing chronic skin care: examples.   Websites Dermatology professionals: British Association of Dermatologists information sheets www.bad.org.uk/public/leaflets/ Dermatology sites (advanced): www.dermnet.org.nz/ Generic sites: NHS Direct www.nhsdirect.nhs.uk/ Condition specific sites: National Eczema Society*: www.eczema.org/abouteczema.html Psoriasis Association*: www.psoriasisassociation. org.uk/ National Psoriasis Foundation: www.psoriasis.org/home/ Ichthyosis: www.ichthyosis.org.uk/   Printed materials Dermatology professionals: American Academy of Dermatology: www.aad. org/forms/pamphlets/default.aspx Patient groups: materials can be ordered from many organisations (see above *) Pharmaceutical companies: these make some materials and so may have commercial influences; as such, these require careful review before use. However, useful unbiased resources can still be found, e.g. Dermol produce some useful tear off pads depicting and explaining the maintenance of the skin barrier using emollients.   Audiovisual materials These are limited. Again, pharmaceutical companies make some materials and so may have commercial influences. Podcasts – these are under-developed at present; however, they are likely to expand: e.g. now available from the Psoriasis Association: www.psoriasisassociation. org.uk/ (November 2008)

The task of identifying reliable information sources of quality information is a challenge for patients who can become bombarded with information sources. This may include sources such as internet sites originating from patients, voluntary groups and health professionals as structured educational information of widely varying quality to social networking exchange. A systematic review of studies reviewing health-related websites found that 70% concluded that quality of information was a problem (Eysenbach and Till, 2001). Information also comes in the form of pamphlets from charities and industry, articles in magazines, the media and friends and family. Indeed, Surridge’s ongoing study (Surridge, 2005) highlighted the complexity of the process by which parents need to establish whether the source of information is reliable and beneficial or not in helping them to manage their child’s eczema.

On account of the high volumes of educational material of variable quality, careful attention is needed to the ways in which patients are guided to information sources and how best to utilise resources. This should be based upon an assessment of their educational needs, preferred methods of learning and the means of access (e.g. internet) and the level and complexity of information required. Indiscriminate handing out of generic information leaflets is invariably ineffective and may well be misleading since it may lack necessary modification for the individual. There is a need to assess the effectiveness of the source material given and evaluate it as part of a package of care. This may be done in follow-up clinics or possibly telephone consultations to review learning, remaining areas of help needed and changing educational needs.

Educational opportunities need to be planned and tailored to individuals; however, consideration needs to be given to common learning needs that can be efficiently delivered in a group context. This can provide the added benefit of group support and vicarious learning from others and how they adapt to their condition and treatment. Group support and learning may apply to adults with a chronic skin condition, teenagers with severe acne and those with special needs, such as people living with psoriatic arthropathy or to carers, including parents of children with eczema. To ensure time is used efficiently, learning needs should be identified. Educational aids require consideration, such as the appropriate use of a DVD, discussion time and time for practical demonstrations and for questions.

Systematic methods of education and psychological support have received limited attention in dermatology, although there are a growing number of studies developing and testing interventions to support the management of specific dermatology conditions – some of which are subject to systematic reviews. One such example is a Cochrane review of psychological and educational interventions to manage childhood atopic eczema (Ersser et al., 2007). For the purposes of this section, the findings will be briefly summarised related to educational intervention. Following a highly systematic search of the literature and the exclusion of studies which failed to meet quality criteria for effective randomised controlled trial (RCT) methodology, only four educational studies met the inclusion criteria. RCTs’ meeting the inclusion criteria included: Chinn et al. (2002); Niebel et al. (2000); Staab et al. (2002) and Staab et al. (2006). In each case, the intervention was an adjunct to conventional therapy, not a substitute for it. It was not possible to synthesise the data due to the variation in the type of data available (heterogeneity). However, it was possible to provide an extensive critical appraisal of the included studies.


In summary, the studies by Niebel et al. (2000) and Staab et al. (2002, 2006) identified that education can lead to an improvement in clinical severity and in parental quality of life (Staab et al., 2006), but only marginal improvement was seen in the latter within the study of Chinn et al. (2002). In each case, a systematic approach to education was implemented using one of two models of service delivery: (1) eczema schools – multi-disciplinary approach (more typical in Germany) and (2) nurse-led clinics (more typical in the UK). Each of the four educational studies was directed towards parental education. It was observed in the Cochrane review that the Eczema School model was more resourceintensive compared to the nurse-led clinic model (Ersser et al., 2007), although no comparative studies have been undertaken as yet of their relative effectiveness. Delivery of education was demonstrated in both hospital outpatient settings (Niebel and Staab studies) and in primary care (Chinn) and with and without the use of technology. For example, Niebel’s study revealed that video-assisted education was more effective in improving severity than direct education and the control (discussion) (p < 0.001). The most rigorous study found to date was that of Staab et al. (2006), which evaluated long-term outcomes. This found significant improvements in both disease severity (3 months to 7 years, p = 0.0002; 8–12 years, p = 0.003; 13–18 years, p = 0.0001) and parental quality of life (3 months to 7 years, p = 0.0001; 8–12 years, p = 0.002), for children with atopic eczema.

Protecting the skin and preventing breakdown outlines specific methods of psychological intervention which have an educational basis, such as the use of behavioural management (habit reversal) to manage problematic symptoms, for those living with eczema.