Contributions of authors
Ingrid Muller (https://orcid.org/0000-0001-9341-6133) Professor, Health Psychology. Conception of programme, academic programme manager, co-led qualitative studies, intervention development, RCTs, process evaluation, implementation.
Beth Stuart (https://orcid.org/0000-0001-5432-7437) Professor, Statistician. Conception of programme, led RCT analysis.
Tracey Sach (https://orcid.org/0000-0002-8098-9220) Professor, Health Economics. Conception of programme, led health economic evaluations.
Lucy Yardley (https://orcid.org/0000-0002-3853-883X) Professor, Health Psychology. Conception of programme, co-led intervention development and process evaluation.
Kate Greenwell (https://orcid.org/0000-0002-3662-1488) Senior Research Fellow, Health Psychology. Development of the young people intervention and process evaluation.
Taeko Becque (https://orcid.org/0000-0002-0362-3794) Senior Research Fellow, Statistician. Analysis of RCT data and quantitative process evaluation.
Paul Leighton (https://orcid.org/0000-0001-5208-0274) Associate Professor, Implementation. Led implementation workstream.
Laura Howells (https://orcid.org/0000-0003-4157-7394) Senior Research Fellow, Health Psychology. Conducted implementation studies.
Jane Harvey (https://orcid.org/0000-0003-1402-6116) Research Fellow, Systematic Reviewer. Conducted quantitative systematic reviews.
Julie Hooper (https://orcid.org/0000-0001-6580-6150) Trial Manager. Managed two RCTs.
Mary Steele (https://orcid.org/0000-0003-2595-3855) Research Fellow, Digital Health. Intervention development, trial delivery, process evaluation.
Katy Sivyer (https://orcid.org/0000-0003-4349-0102) Lecturer, Psychology. Development of intervention for parents/carers, process evaluation.
Daniela Ghio (https://orcid.org/0000-0002-0580-0205) Lecturer, Psychology. Qualitative research with young people.
Emma Teasdale (https://orcid.org/0000-0001-9147-193X) Research Fellow. Qualitative interviews with parents and children, qualitative systematic review.
Emma Axon (https://orcid.org/0000-0002-3246-9968) Research Fellow, Systematic Reviews. Conducted the reviews in workstream 2.
Stephanie Lax (https://orcid.org/0000-0002-7000-9364) Research Fellow, Systematic Reviews. Conducted the reviews in workstream 2.
Holly Clarke (https://orcid.org/0009-0001-6029-0076) Research Fellow, Health Economics. Conducted health economic analyses.
Mary Onoja (https://orcid.org/0009-0005-4792-8505) Research Fellow, Health Economics. Conducted health economic analyses.
Amina Ahmed (https://orcid.org/0000-0001-9494-742X) Public contributor.
Gareth Griffiths (https://orcid.org/0000-0002-9579-8021) Director of Southampton CTU, Statistician. Light touch oversight of RCTs.
Hayden Kirk (https://orcid.org/0000-0002-4682-9709) Solent NHS Trust. Host NHS Trust.
Sinead Langan (https://orcid.org/0000-0002-7022-7441) Professor, Dermatologist. Dermatology and methodological input in all aspects of the programme.
Sandra Lawton (https://orcid.org/0000-0002-6163-5822) Nurse Consultant, Dermatology. Dermatology and methodological input in all aspects of the programme.
Paul Little (https://orcid.org/0000-0003-3664-1873) Professor, General Practitioner. Clinical and methodological input into all aspects of the programme.
Matthew Ridd (https://orcid.org/0000-0002-7954-8823) Professor, General Practitioner. Clinical and methodological input into all aspects of the programme.
Amanda Roberts (https://orcid.org/0000-0003-0370-3695) Public contributor.
Hywel C Williams (https://orcid.org/0000-0002-5646-3093) Professor, Dermatologist. Dermatology and methodological input in all aspects of the programme.
Kim S Thomas (https://orcid.org/0000-0001-7785-7465) Professor, Clinical Trialist. Programme co-lead.
Miriam Santer (https://orcid.org/0000-0001-7264-5260) Professor, General Practitioner. Programme co-lead.
Acknowledgements
We are grateful to the young people and families, research participants, NHS staff and other stakeholders who contributed to the success of this research.
The ECO academic programme manager was Ingrid Muller. The trial manager was Julie Hooper. Administrative support was provided by Sylvia Wilczynska, Barbara Maston and Linda Pycroft.
Members of the Eczema Care Online programme steering committee: Tara Dean, Suzie Holland, Andrew Proctor, John Norrie and Gail Hayward; and former steering committee members Magali Redding and Margaret Cox.
Former ECO programme team member Jo Chalmers. Mike Birchall and Jemima Waller for their help on workstream 5. Software developers Global Initiative (www.global-initiative.com).
The team would like to thank Solent NHS Trust for hosting the research, the University of Southampton for acting as Sponsor for the research and the four CRN regions (Wessex, West of England, East Midlands, and Thames Valley and South Midlands) who helped recruit participants in workstreams 1, 3 and 4.
Data-sharing statement
All data requests should be submitted to the corresponding author for consideration. Access to anonymised data may be granted following review.
Ethics statement
This study was conducted in compliance with the ethical principles of the Declaration of Helsinki and in compliance with all International Council for Harmonisation Good Clinical Practice guidelines. Study protocols were reviewed and approved by the Institutional Review board and/or Independent Ethics Committees. All participants provided written informed consent.
Ethical approval for the trial was given by South Central-Oxford A Research Ethics Committee (19/SC/0351).
Information governance statement
The University of Southampton is committed to handling all personal information in line with the UK Data Protection Act (2018) and the General Data Protection Regulation (EU GDPR) 2016/679. Under the Data Protection legislation, the University of Southampton is the Data Controller, and you can find out more about how we handle personal data, including how to exercise your individual rights and the contact details for our Data Protection Officer here www.southampton.ac.uk/hr/services/data-protection/data-protection.page
Disclosure of interests
Full disclosure of interests: Completed ICMJE forms for all authors, including all related interests, are available in the toolkit on the NIHR Journals Library report publication page at https://doi.org/10.3310/FNHD8546.
Primary conflicts of interest: Beth Stuart was on the HTA Commissioning Committee 15 September 2020 –30 November 2024.
Tracey Sach was a member of NIHR Health Technology Assessment (HTA) Efficient Study Designs – 2 1 November 2015–31 July 2016, HTA Efficient Study Designs Board 13 October 2014–7 December 2014, HTA End of Life Care and Add-on-Studies 1 September 2015–9 February 2016, HTA Primary Care Themed Call Board and the HTA Commissioning Board between 2013 and December 2019. She is a steering committee member of the UK Dermatology Clinical Trials Network and Chair of the NIHR Research for Patient Benefit Regional Advisory Panel for the East of England, HTA General Committee 1 August 2016–31 July 2017, HTA Commissioning Committee 19 June 2017–31 January 2020. Tracey had no part in the decision-making for funding this study.
Lucy Yardley is NIHR Senior Investigator, Theme lead for NIHR ARC-West and NIHR HPRU in Behavioural Science and Evaluation and was cross-cutting theme lead for NIHR BRC at University of Southampton (2017–22). She is a member of the MRC/NIHR Better Methods Better Research funding panel and was a member of NIHR HTA Efficient Designs research 1 November 2015–31 July 2016 and NIHR Public Health Research funding panels but had no part in the decision-making for funding this study.
Laura Howells has received consultancy fees from the University of Oxford on an educational grant funded by Pfizer, unrelated to the submitted work.
Sinead Langan is on the medical advisory board for the NES.
Matthew Ridd was a member of an NIHR HTA committee (2016–9), NIHR Systematic Reviews Programme Advisory Group (2019–20) and continues on the NIHR In-Practice Fellowship Selection Committee (since February 2020).
Amanda Roberts was a member of HTA General Committee 1 June 2017–30 November 2021, and HTA fast Track Committee – June 2021 and had no part in the decision-making for funding this study.
Hywel C Williams was director of the NIHR Health Technology Assessment Programme from 2015 to 2020, and the PGfAR EOIs – HTA projects Remit meeting. HTA Commissioning Sub-Board (EOI) 1 April 2016–31 March 2017, HTA Efficient Study Designs Board 8 August 2014–7 December 2014, HTA PG Skype, NIHR Journals Library Board 1 April 2012–1 April 2018, HTA Board Recruitment, HTA Remit and Competitiveness Group 26 May 2010–30 September 2020, HTA General Committee – 1 January 2016–2 November 2020, HTA Post-Funding Committee teleconference (POC members to attend 26 May 2010–30 September 2020, HTA Funding Committee Policy Group (formerly CSG) 1 January 2010–30 September 2020, HTA Commissioning Committee 1 January 2010–30 September 2020. Hywel had no part in the decision-making for funding this study.
Miriam Santer was a panel member of NIHR Programme Grants for Applied Research 2018–23, and Academic PPIE lead and Board Member NIHR School for Primary Care Research 2022 to present day. Miriam had no part in the decision-making for funding this study.
Publications
Chalmers JR, Axon E, Harvey J, Santer M, Ridd MJ, Lawton S, et al. Different strategies for using topical corticosteroids in people with eczema. Cochrane Database Syst Rev 2019;2019. https://doi.org/10.1002/14651858.cd013356
Lloyd‐Lavery A, Solman L, Grindlay DJ, Rogers NK, Thomas KS, Harman KE. What’s new in atopic eczema? An analysis of systematic reviews published in 2016. Part 2: epidemiology, aetiology and risk factors. Clin Exp Dermatol 2019;44:370–5. https://doi.org/10.1111/ced.13853
Lloyd‐Lavery A, Solman L, Grindlay DJ, Rogers NK, Thomas KS, Harman KE. What’s new in atopic eczema? An analysis of systematic reviews published in 2016. Part 3: nomenclature and outcome assessment. Clin Exp Dermatol 2019;44:376–80. https://doi.org/10.1111/ced.13886
Muller I, Santer M, Morrison L, Morton K, Roberts A, Rice C, et al. Combining qualitative research with PPI: reflections on using the person-based approach for developing behavioural interventions. Res Involv Engagem 2019;5:34. https://doi.org/10.1186/s40900-019-0169-8
Solman L, Lloyd‐Lavery A, Grindlay DJ, Rogers NK, Thomas KS, Harman KE. What’s new in atopic eczema? An analysis of systematic reviews published in 2016. Part 1: treatment and prevention. Clin Exp Dermatol 2019;44:363–9. https://doi.org/10.1111/ced.13885
Ghio D, Greenwell K, Muller I, Roberts A, McNiven A, Santer M. Psychosocial needs of adolescents and young adults with eczema: a secondary analysis of qualitative data to inform a behaviour change intervention. Br J Health Psychol 2020;26:214–31. https://doi.org/10.1111/bjhp.12467
Ghio D, Muller I, Greenwell K, Roberts A, McNiven A, Langan SM, Santer M. ‘It’s like the bad guy in a movie who just doesn’t die’: a qualitative exploration of young people’s adaptation to eczema and implications for self‐care. Br J Dermatol 2020;182:112–8. https://doi.org/10.1111/bjd.18046
Teasdale E, Muller I, Sivyer K, Ghio D, Greenwell K, Wilczynska S, et al. Views and experiences of managing eczema: systematic review and thematic synthesis of qualitative studies. Br J Dermatol 2020;184:627–37. https://doi.org/10.1111/bjd.19299
Axon E, Chalmers JR, Santer M, Ridd MJ, Lawton S, Langan SM, et al. Safety of topical corticosteroids in atopic eczema: an umbrella review. BMJ Open 2021;11:e046476. https://doi.org/10.1136/bmjopen-2020-046476
Greenwell K, Ghio D, Muller I, Roberts A, McNiven A, Lawton S, Santer M. Taking charge of eczema self-management: a qualitative interview study with young people with eczema. BMJ Open 2021;11:e044005. https://doi.org/10.1136/bmjopen-2020-044005
Muller I, Stuart B, Sach T, Hooper J, Wilczynska S, Steele M, et al. Supporting self-care for eczema: protocol for two randomised controlled trials of ECO (Eczema Care Online) interventions for young people and parents/carers. BMJ Open 2021;11:e045583. https://doi.org/10.1136/bmjopen-2020-045583
Steele M, Howells L, Santer M, Sivyer K, Lawton S, Roberts A, et al. How has the COVID‐19 pandemic affected eczema self‐management and help seeking? A qualitative interview study with young people and parents/carers of children with eczema. Skin Health Dis 2021;1:e59. https://doi.org/10.1002/ski2.59
Teasdale E, Sivyer K, Muller I, Ghio D, Roberts A, Lawton S, Santer M. Children’s views and experiences of treatment adherence and parent/child co-management in eczema: a qualitative study. Children 2021;8:158. https://doi.org/10.3390/children8020158
Greenwell K, Ghio D, Sivyer K, Steele M, Teasdale E, Ridd MJ, et al. Eczema Care Online: development and qualitative optimisation of an online behavioural intervention to support self-management in young people with eczema. BMJ Open 2022;12:e056867. https://doi.org/10.1136/bmjopen-2021-056867
Lax SJ, Harvey J, Axon E, Howells L, Santer M, Ridd MJ, et al. Strategies for using topical corticosteroids in children and adults with eczema. Cochrane Database Syst Rev 2022;3:CD013356. https://doi.org/10.1002/14651858.cd013356.pub2
Santer M, Muller I, Becque T, Stuart B, Hooper J, Steele M, et al. Eczema Care Online behavioural interventions to support self-care for children and young people: two independent, pragmatic, randomised controlled trials. BMJ 2022;379:e072007. https://doi.org/10.1136/bmj-2022-072007
Santer M, Yardley L, Muller I, Roberts A, Thomas KS. How to make Eczema Care Online freely available. BMJ 2022;379:o2973. https://doi.org/10.1136/bmj.o2973
Sivyer K, Teasdale E, Greenwell K, Steele M, Ghio D, Ridd MJ, et al. Supporting families managing childhood eczema: developing and optimising Eczema Care Online using qualitative research. Br J Gen Pract 2022;72:e378–89. https://doi.org/10.3399/bjgp.2021.0503
Greenwell K, Sivyer K, Howells L, Steele M, Ridd MJ, Roberts A, et al. ‘Eczema shouldn’t control you; you should control eczema’: qualitative process evaluation of online behavioural interventions to support young people and parents/carers of children with eczema. Br J Dermatol 2023;188:506–13. https://doi.org/10.1093/bjd/ljac115
Harvey J, Lax SJ, Lowe A, Santer M, Lawton S, Langan SM, et al. The long‐term safety of topical corticosteroids in atopic dermatitis: a systematic review. Skin Health Dis 2023;3:e268. https://doi.org/10.1002/ski2.268
Greenwell K, Becque T, Sivyer K, Steele M, Denison-Day J, Howells L, et al. Online behavioural interventions for children and young people with eczema: a quantitative evaluation. Br J Gen Pract 2024;74:e379–86. https://doi.org/10.3399/bjgp.2023.0411
Sach TH, Onoja M, Clarke H, Santer M, Muller I, Becque T, et al. Cost-effectiveness of two online interventions supporting self-care for eczema for parents/carers and young people. Eur J Health Econ 2024;25:1165–76. https://doi.org/10.1007/s10198-023-01649-9
Howells L, Thomas KS, Santer M, Muller I, Greenwell K, Roberts A, et al. Evidence to practice – lessons learnt in developing an implementation strategy for an online digital health intervention (Eczema Care Online). BMC Health Serv Res 2025 Jan 31;25:187. https://doi.org/10.1186/s12913-024-12179-2
Disclaimers
This article presents independent research funded by the National Institute for Health and Care Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, CCF, PGfAR or the Department of Health and Social Care. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, the PGfAR programme or the Department of Health and Social Care.