Stress and wellbeing of parents of children with eczema : a prospective randomized controlled trial on psychosocial intervention

Abstract

Background: Eczema is a chronic skin disease with pruritic inflammation. The outbreak of the disease is unpredictable, but is thought to be interplay between the external environment and a personal genetic problem. Current statistics suggest that more than 10% of the global population are affected by the disease, and the lifetime prevalence for childhood eczema can rise to 30%. Moreover, around one-third of children suffer from physical and psychological disturbance due to eczema in Hong Kong. Their parents also experience various kinds of emotional distress in the caregiving process, which eventually affects their wellbeing and quality of life. Although some educational training programmes have been developed for the parents of children with eczema, most of them only focus on treatment compliances and disease management. Their psychosocial needs in the eczema caregiving process have generally been neglected. In addition, the outcomes of these training programmes are inconclusive, while empirical evidence on the effectiveness of these programmes remains limited.

Research Focus: The current research study aims to fill existing research gaps using a three-phase approach, a) conduct a qualitative study to understand the eczema caregiving challenges and wellbeing of the parents, b) develop a psychosocial intervention programme for the parents by customizing an existing holistic intervention protocol and c) perform an efficacy study on the intervention programme using the Randomized Controlled Trial methodology.

Methodology: Semi-structured interviews were first arranged with 25 parents of children with eczema. Based on the conceptualization of the interview findings, an intervention programme that focused on Acceptance, Appreciation, Support and Transformation (AAST) was developed for the parent-child dyads. Twenty-eight social workers from two Non-Governmental Organizations were trained to implement the AAST programme, and eventually 91 families attended the intervention programme in nine groups in different localities in Hong Kong.

Key Findings: Analysis of the outcome measurements has provided concrete evidence that the AAST programme can significantly improve the holistic wellbeing of the parents in terms of their non-attachment attitude, afflictive ideation awareness, and general vitality dimension. Their stress and depression levels have also been significantly reduced.

Contribution: In terms of theoretical contributions, the qualitative component of this study revealed the meaning reconstruction mechanism in the eczema caregiving experience of the parents. The Dynamic Balancing Model of parent caregivers has delineated a realistic situation of the parents from both the attitudinal and behavioural view, and the Growth Model of parent caregivers has identified a transformation pathway for parents to cope with adversities. The AAST protocol provided a theoretical framework and practical guidelines for future psychosocial intervention research studies and community health programme development. Finally, the quantitative component of this study has successfully provided concrete empirical evidence of the effectiveness of the AAST programme for the parent-child dyads, which identified theory-based and evidence-based psychosocial therapeutic direction in addition to the conventional pharmacological approaches.