Introducing Eczema Care Online into routine use: lessons learnt in developing an implementation strategy for a digital health intervention
Problem
Eczema management can be challenging for people with eczema, or parents of children with eczema, as it involves regular topical treatment use and avoidance of triggers. It can be difficult for health professionals explain eczema treatments and resolve concerns within time-limited consultations and previous research has found that patients often find advice confusing or insufficient. Eczema Care Online is a web-based behavioural intervention to support people with eczema and parents of children with eczema, developed following the Person-Based Approach by researchers, clinicians and people with eczema. The website includes videos, advice from others with eczema and all content is evidence-based. The website (www.EczemaCareOnline.org.uk) has been shown in two large RCTs to improve eczema outcomes for children with eczema and young people at 6 and 12 months. Implementation requires adoption at patient/family, clinician and organisational levels. We sought to learn lessons from developing and delivering an implementation strategy for the intervention.
Approach
Data from stakeholder consultation meetings, interviews with trial participants, and intervention usage data, informed our implementation plan. A scoping search of existing eczema websites helped identify the ‘unique selling points’ of Eczema Care Online. Drawing on a theoretical framework (Normalization Process Theory), we developed an action plan for implementation, and monitored website use and sources of referrals.
Findings
Eczema Care Online has been used by over 40,000 people in its first year. Key features of the website valued by stakeholders were that it is: evidence informed, created in partnership, comprehensive, independent, accessible and proven to improve eczema. Barriers to implementation included the subtle distinctions from other eczema resources and potentially adding further ‘noise’ to existing resources, where conflicting messages can be found. Facilitators included perceptions of ease-of-use and trustworthiness. The action plan included involving clinical champions, guideline authors, providers of continuing professional development for GPs and pharmacists, GP clinical software providers and direct social media advertising. All routes have met with successes and challenges. Key lessons learnt include 1) start implementation work early 2) maintain flexibility to explore multiple routes to implementation 3) plan early for longer-term maintenance beyond the life of the research project.
Consequences
Implementation planning ensures that effective health interventions are used in everyday practice. Implementation requires a flexible approach, and while available data and theoretical frameworks can inform implementation strategy, this may then have to adapt over time. We reflect on key challenges and successes in implementing Eczema Care Online.