How to make Eczema Care Online freely available

Eczema management can be challenging for patients, since it involves avoiding triggers, using emollient regularly, and intermittent use of topical anti-inflammatory agents such as corticosteroids. It can be difficult for healthcare professionals to explain and resolve eczema concerns within time-limited consultations. We developed Eczema Care Online (EczemaCareOnline.org.uk), an online behavioural intervention to provide self-management support for people with eczema in response to the need for self-management support interventions that are rigorously developed, informed by theory and evidence, and co-produced with diverse users to maximise accessibility and usability. Our recent research study evaluated the effectiveness of interventions for parents, carers, and young people.1 We found that they provided a small but significant benefit in eczema severity at 24 weeks, which was sustained at 52 weeks for both parents and carers of children and for young people, at minimal cost, and with no identifiable harms. As eczema affects up to 20% of children and up to 10% of adults, use of such interventions could translate to substantial population benefit.2

Our research was funded by the National Institute of Health and Care Research (NIHR) and recruited through the NHS. We want to ensure that the interventions are freely available for families. Clearly, we must raise awareness about their existence, but we also need to implemented them in a way that secures long term sustainability and allows content, digital infrastructure, and format to be kept up to date. For this, time, skilled staff, and resources are required.

We have explored private, public, and charity sector partnerships. For the private sector, marketing potential is crucial. Self-management support for conditions such as eczema, which are lower priority to health services, may not offer sufficient security of income, unless the support is linked to marketable products. Even if a potential market for a digital product is identified, the costs of marketing and maintaining an intervention could make it prohibitively expensive to potential users or health services.

Participants in the Eczema Care Online trials reported that knowing that the intervention was free from commercial influence was important to them in trusting messages. However, non-commercialised licensing to public or charity sector organisations requires buy-in from these organisations. Public, charity, or private sector partners may wish to make changes to content and format of the intervention that could alter the effectiveness in unknown ways. Public contributors on the research team were strong advocates for not diluting or commercialising key messages.

Therefore, we have chosen to maintain “ownership” (ie, control of content) of the Eczema Care Online interventions. Our dissemination strategy is in partnership with eczema charities to raise awareness and build on links with clinical groups to embed intervention weblinks into clinical practice. This brings us back to the challenge of sustainability after the research funding is finished.

The NHS Transformation Directorate, incorporating NHSX and NHS Digital, has made rapid progress with high uptake and usage of the NHS App and NHS website. Relatively brief information on the NHS website can usefully be supplemented by detailed self-management support in Eczema Care Online, which is known to improve eczema outcomes. The interventions could also benefit the NHS by supplementing self-management support. NHS policy is to expand NHS accredited health apps that patients can use to manage their own health. However, progress on accrediting evidence based apps has been slow, and better online infrastructure is needed to signpost reliable resources.

No route to implementation is without difficulty. The NIHR funding enabled us to co-produce engaging and effective interventions. As a result, these interventions should be freely available to those who need them for as long as possible.