Working with children with eczema : a report of mixed methods research

Abstract

Background and objectives: The voices of children have been rarely heard in re-search on, and practice related to, pediatric eczema. Few efforts have been made to address the psychosocial needs of children living with eczema. This study aimed to (1) describe the subjective experiences of children living with eczema, and (2) assess the impacts of an Integrative Body-Mind-Spirit (IBMS) intervention on children living with eczema. Methods: This study employed a mixed-methods research design. To achieve the first research objective, semi-structured interviews and drawing were conducted with 17 children in Hong Kong aged between 8 and 12 years who had been diagnosed with eczema. Interviews were transcribed, coded, and described using a phenomenological approach. Thirteen participants out of the 17 children were interviewed again after they received an IBMS Intervention. Their verbal expressions and visual artworks were analyzed and compared to explore the impacts of the IBMS intervention on the subjective experiences of children living with eczema. To assess the effectiveness of the IBMS intervention on physical and psychosocial outcomes of children living with eczema, a 2 (intervention vs. wait list control) X 3 (time: preintervention [T0], postintervention [T1], six-week follow-up [T2]) designed randomized controlled trial (RCT) was conducted at nine social service centers of two non-governmental organi-zations (NGOs) in Hong Kong. Following intention-to-treat principles, data from 113 participating children (aged 6-12 years; 58 in the intervention vs. 55 in the control group) were analyzed. Results: (1) The study found that primary school children living with eczema faced a variety of challenges and crises. The synergistic interaction of individual, environ-mental, and cultural factors contributed to shaping an incapable and wounded “self” living with eczema. How the children in our study coped with the challenges caused by eczema appeared to depend on whether or not they received adequate and useful support in specific contexts. Active and successful coping experiences of children might encourage their personal growth. (2) Results of the RCT found that children in the IBMS intervention group displayed significantly decreased severity of eczema, less generalized anxiety and social phobia, and an improved capacity to regulate their emotions compared with the control group. There was no significant difference in children’s self-esteem, the quality of their rela-tionships with their parents, and overall disease-related quality of life between the two groups. The findings of the pre-post designed qualitative research indicated that IBMS services might induce positive impacts on children living with eczema by developing a new disease identity and self-identity, improving physical symptoms and psycholog-ical functioning, and empowering spiritual transformation. Conclusions: The impact of eczema on the physical, psychological, and social well-being of children is extensive and pervasive. The holistic IBMS psychosocial service model might have the potential to positively influence the lived experiences of chil-dren who have eczema, and was significantly effective in improving their somatic and psychosocial outcomes in our study as well. Future research is needed to customize the IBMS service model to other developmental stages of children living with eczema in different geographical and cultural contexts.