CREATIVE PIECE: Living well with childhood eczema

“Eczema mindlines” is a short film documenting the process of co-creating and imaginatively sharing five key, consistent, messages across practitioner-patient-wider society boundaries to improve care of childhood eczema.     

As practitioners, we know we should be delivering evidence-based care. There are dozens of strategies to support moving evidence-to-practice, but we have no magic bullet to get this knowledge into day-to-day care. NICE provides guidance for managing childhood eczema1, but I have witnessed the misery of the condition for child and family alike, the challenges of self-management and the heart-sink nature of some consultations. This inspired me to look for new ways to improve care.    

Knowledge Mobilisation (KMb) is about sharing knowledge between different communities to catalyse change. Some knowledge mobilisation literature can be dense and seem removed from the real world. I had an “aha” moment when I read “Practice-based Evidence for Healthcare: Clinical Mindlines”2. Mindlines offer a grounded understanding of how practitioner’s thoughts and actions are constructed and therefore, a new opportunity to explore innovative methods of KMb. Mindlines go beyond explicit guidelines, they combine evidence from many sources to generate rich internalised evidence for real world practice. They are developed, refined and modified through social interactions. If practitioners have mindlines, it seems reasonable to think that patients, parents and wider society have an equivalent in “lay lines”.    

My aim was to find novel, simple and pragmatic methods of modifying eczema mindlines. Co-creation workshops with practitioners, parents, young people and researchers identified how care of childhood eczema may be improved. We need to share five key, consistent messages across practitioner-patient-wider society boundaries   

1. Eczema is more than just dry skin 

2. Eczema doesn’t just go away 

3. Moisturisers are for every day 

4. Steroid creams are okay when you need them  

5. You know your child’s eczema best   

These messages have been shared using different media across one locality through events in for example, shopping centres, places of worship, schools, primary care practices and community pharmacies.   Now, working with the orchestra Sinfonia Viva, we have written “The Dragon in my Skin”, to share five key messages with primary school children.  In online sessions children with eczema created and recorded their own song inspired by the story and their own experiences.  Children’s songs, the illustrations and the story have been brought together to create an animated movie. We will share the movie together with curriculum-linked resources for primary school teachers, to help spread messages more widely.    

This film shows how simple but important “knowledge nuggets” can be widely and creatively delivered to increase shared understanding and offer clear and consistent approaches to improving eczema care.  Screening will be followed by conversation about possibilities of using KMb more widely in primary care.         

References  

1. NICE 2007. Atopic eczema in under 12s: diagnosis and management Clinical guideline CG57]  

2. Gabbay J, Le May A. 2010. Practice-based evidence for healthcare: clinical mindlines. Routledge.