BACKGROUND
Atopic dermatitis (AD) has been related to poorer health-related quality of life (HRQoL) in adults, but no qualitative research has been published to explore in depth how this long-term condition affects the lives of adults. Interviews with AD patients provide the opportunity to uncover issues that may not be addressed in quantitative research and allow a more in-depth exploration of the impact this condition has on patients’ lives. The purpose of this study was to explore the impact of AD on HRQoL of adults.
DESIGN
The study used a qualitative design using semi-structured interviews.
METHODS
Adults with a clinical diagnosis of AD were recruited by advertising on a university campus and through social media sites. All participants completed a screening questionnaire on AD diagnosis, treatment, duration, and severity. Semi-structured interviews were conducted, audio-taped, transcribed verbatim, and analysed using thematic analysis.1
RESULTS
Participants (N=19) consisted of 10 white and 9 black and ethnic minority participants, aged
19–52, 18 of whom were female.
Five super-ordinate themes emerged from the analysis. The first theme discussed the visibility of AD, which contributed to issues with body image and resulted in participants feeling stigmatised and judged; as a result, patients often attempted to cover their skin as much as possible. The second theme centred on threats to inner sense of self, which captured participants’ accounts of the psychological impact of AD, such as impact on mood, clinical depression and anxiety, and issues relating to self-esteem and confidence. The third theme captured the threats to physical capacity due to pain and management. Within this theme, participants spoke about
being unable to lead ‘normal’ lives due to the pain and itch of the condition. These physical symptoms affected their productivity at work, sleep, engagement in physical activity, social life, and, for many, affected them financially due to
the cost of managing their condition. The fourth theme focussed on participants developing confidence in management of AD and used different methods of coping to improve or manage their daily QoL. Some used active strategies, such as avoiding triggers and having strict maintenance regimens, whereas others
used distraction methods to cope with their condition. The fifth theme captured the contrasting reactions and support from others where most participants felt strongly that their general practitioner (GP) and primary care doctors did not understand the psychological impact that AD was having on them. There was a general idea amongst participants that their GP was not equipped to address and treat mental health issues that arose as a result of AD. There were qualitative differences in the narratives of those who were diagnosed with AD at an early age compared to a later age, and across
ethnic groups.
CONCLUSIONS
AD has a great impact on the QoL of adults. Participants in this study discussed issues that have not been reported in quantitative research, particularly the lack of understanding of the psychological impact of AD, and the stigma attached to AD. Consideration of these factors may enhance disease management and improve HRQoL. Understanding and recognition of AD as a complex long-term condition involving significant psychosocial impact is crucial. These findings suggest more integrated and accessible psychological support is required for people with AD. Men were under-represented in this study and further exploration of the impact on AD in men is needed.
