Understanding treatment adherence and help-seeking behaviours, and their relationship to outcomes in acne vulgaris: a mixed-methods systematic review

Problem

Acne is highly prevalent and often substantially impacts physical and/or mental health. Limited knowledge of evidence-based treatments alongside treatment adherence challenges can hinder effective acne management amongst young people. Understanding experiences of managing acne is vital for supporting effective treatment-seeking and adherence-related behaviours. This mixed-methods systematic review aims to collate existing evidence to inform interventions to address this. The qualitative aspect will update an existing qualitative synthesis of acne treatment experiences among 13-25 year-olds, caregivers, and health-professionals to identify the most salient issues. The quantitative element aims to synthesise evidence on factors associated with treatment adherence and help-seeking behaviours and how these relate to outcomes, to understand mechanisms through which these behaviours can be optimised.

Approach

Medline, EMBASE, PubMed, PsychINFO and CINAHL databases were searched between 2019 and present for the qualitative literature update, and with no date restrictions for quantitative literature. Inclusion criteria were qualitative or quantitative studies that included 13-25 year-olds with acne, their caregivers or health professionals, or studies of multiple skin conditions if acne data could be extracted separately. Title and abstracts were independently screened by two reviewers, with subsequent full text screening completed by at least one reviewer, with a second independently reviewing at least 20% of records. Data were extracted, and quality appraisal completed using the Mixed Methods Appraisal Tool and checked by an independent reviewer. Qualitative and quantitative findings are being thematically synthesised - initially separately, then together if appropriate.

Findings

6 additional qualitative studies and 112 quantitative studies were identified for inclusion. Data extraction and synthesis is ongoing and will be complete by the time of the conference. Preliminary review of the additional qualitative studies highlights experiences of frustration in consultation and treatment-seeking, and the perceived importance of communicative and respectful patient-professional interaction. Findings also strongly reflect the common negative psychological consequences of acne and their impact on interactions with others, commonly leading to avoidance behaviours further exacerbating social challenges. Extraction of quantitative data is at earlier stages, but included studies are predominantly cross-sectional survey studies, with a smaller number of observational studies and randomised controlled trials.

Consequences

Alongside evidence from qualitative interviews with young people, their caregivers and health professionals, these findings inform the content of Acne Care Online, a digital intervention to support self-management for people with acne. Early insights highlight the importance of: tools and strategies for effective communication in acne consultations; support for managing the psychological consequences of acne to reduce potential negative impacts; and raising awareness around effective acne treatments. Furthermore, the findings provide insights into current behaviours and practices in the context of acne treatment-seeking that could shape recommendations for clinical practice, and will also inform how to effectively implement Acne Care Online within existing systems.