Acne Care Online: optimising a digital behaviour change intervention to support self-management of acne in young people.
Problem
Acne is common and can have substantial impacts on quality of life. Despite evidence of effectiveness, adherence to topical treatments is sub-optimal, and oral antibiotics are commonly over-used. Young people often delay contacting health professionals, increasing risks of worsening acne or scarring. This study sought to maximise the acceptability, usability, and persuasiveness of a prototype digital intervention, Acne Care Online, that aims to support people with acne to obtain and use topical acne treatments appropriately.
Approach
Qualitative think-aloud interviews were conducted with a diverse group of young people with acne (13-25 years) to obtain in-depth, initial responses to behavioural techniques within Acne Care Online. Participants were recruited via mail-outs from six primary care practices and social media adverts on Facebook. Longitudinal interviews were also conducted to provide opportunity for independent use of the intervention for one week, to gain deeper insights into users’ understanding of key messaging. Key stakeholders were also consulted for feedback, including public contributors and health professionals. A Person Based Approach was taken to modify the intervention between interviews. Interviews were recorded and transcribed, and a table of changes was used to record feedback and decisions. Changes were prioritised by their likelihood to influence key issues that behaviour change techniques should target. Interviews continued until no new concerns were being raised.
Findings
Fifty-three participants took part (69% female, 31% 13-15 years/69% 16-25 years, 62% white ethnicity). Overall, positive feedback was received, and intervention content and style were perceived as relatable. Participants valued the depth of information provided and the credibility of a resource developed by health professionals alongside shared experiences given by young people. Issues observed included lack of clarity around key messages, confusing navigation, and not knowing where to start within the website. This prompted changes such as the addition of: 'pop-ups' clarifying complex terms, personalised tailoring directing participants to relevant information, and improved navigation with the toolkit and main menu always accessible on each page. Other changes included adding information such as advice on maintenance treatment to prevent acne returning and increasing the use of visual boxes to highlight important messaging. Subsequent interviews indicated that these changes were beneficial.
Consequences
This extensive interview study provided insights into key psychosocial issues and preferences of young people with acne, including a need for easily accessible information. Findings have resulted in an optimised intervention, which is ready to be assessed for feasibility and effectiveness in a randomised trial. A process evaluation will further explore optimisation of the resource as well as dissemination plans to encourage wide use and uptake from young people across the UK. If effective, it is anticipated that various platforms will host the intervention to help improve acne management.