Developing Acne Care Online: early insights from developing a digital behaviour change intervention to support effective treatment of acne in young people
Problem
Acne is very common, affecting more than 90% of teenagers, and persisting in up to 60% of young adults in their twenties. It is often associated with physical discomfort, and frequently negatively impacts on individuals’ mental wellbeing. Topical treatments for mild-to-moderate acne are effective, but many young people are unaware of appropriate treatment options. This leads to reliance on ineffective off-the-shelf products, and/or potentially avoidable treatment with oral antibiotics. Amongst those who do access topical treatments, adherence is often low due to slow onset of action, or lack of advice on how to manage side effects. The Acne Care Online programme aims to develop a digital behaviour change intervention to support young people to access and effectively use topical treatments to improve acne outcomes. The primary aim of this development work was to understand beliefs and expectations about acne and acne treatments, as well as help-seeking and adherence-related behaviours amongst young people with acne and their parents/carers, to guide content development.
Approach
Employing the Person-Based Approach to intervention development, we conducted semi-structured qualitative interviews with a diverse sample of 24 people with acne aged 13-25 years (9 aged 13-15, 15 aged 16-25; 14 who had previously consulted, 10 who had not; 9 White/White British, 7 Asian/Asian British, 4 Black/ Black British, 2 other ethnic group, 2 undisclosed), and 8 of their parents/carers. Interviews were audio-recorded and transcribed. Field notes documented immediately after interview were triangulated with the intervention’s draft logic model and key publication findings to rapidly identify key context-specific behavioural issues relevant to developing intervention content to support this group.
Findings
These insights highlighted the importance of drafting intervention content that would clearly communicate several core messages to address the beliefs and experiences of teenagers and young adults about acne symptoms and treatments. Firstly, that there is a distinction between proven acne treatments and general skincare products and that the latter should not be relied upon to treat acne. It also appeared important to emphasise that acne is a medical condition that warrants medical help-seeking and is not wasting clinicians’ time. Finally, it seemed important to communicate that individuals should take action in treating their acne if it is impacting on their physical and/or mental health, rather than because of a need to change the way their skin appears.
Consequences
Alongside insights from patient and public contributors, published literature, and relevant theory, these insights were vital to informing the provisional ‘guiding principles’ and ‘behavioural analysis’ processes which underpinned the person-based development of early Acne Care Online structure and content. Qualitative think aloud interviews are currently ongoing to iteratively optimise Acne Care Online content in preparation for a feasibility trial beginning in late 2023.