Introduction
Atopic Dermatitis (AD) is the most common form of
eczema.1 It is a chronic, inflammatory and relapsing
disease that causes intense itching and dry, cracked and lichenified
skin.2 Estimated to affect up to 20% of children in
high-income countries,3 it usually appears within the
first five years of life and in 50-70% of cases it clears after ten
years.4 The negative impact of AD on a child’s quality
of life (QoL) extends to parents and caregivers5,6 and
affects almost every aspect of the caregiver’s life, from physical
wellness and the mental burden to work, family and social
life.8 Caring for a child with AD can be a source of
stress,9 and frequently disturbed sleep can cause
chronic fatigue with more severe AD having a greater
impact,7 which may affect the caregiver’s ability to
administer treatments and help their child cope.10Therefore it is important to consider what may impact the caregiver’s
coping strategies and ability to manage their child’s condition, such as
caregiver self-efficacy (SE).
SE refers to an individual’s belief in their ability to perform certain
behaviours to obtain favourable outcomes.11 Research
shows that higher parent/caregiver SE is associated with more adaptive
coping methods, which are then linked to better child health
outcomes.12 In the case of parents, caregiver SE can
predict QoL in those they look after and in
themselves.13 How a caregiver views their child’s
illness may also affect their QoL. Leventhal’s Common-Sense Model of
Self-Regulation (CSM) provides a framework to understand how an
individual responds to an illness and its characteristics. Illness
perceptions are both cognitive and emotional and determine which
cognitive and behavioural coping strategies are employed. Thereby they
affect physical and psychological outcomes.14 The
Illness Perception Questionnaire-Revised (IPQ-R) provides a quantitative
measure of these concepts (see supplement table a). Negative illness
perceptions have been linked to lower caregiver and patient
QoL.15 To date, one study has looked at the impact of
caregiver illness perceptions on family QoL where a child suffers from
AD.16 Using a brief IPQ scale (B-IPQ) they found that
identity, consequences, illness concerns and emotional representations
significantly correlated with decreased QoL. However, the B-IPQ does not
measure beliefs about how recurrent the illness is which may be useful
when considering eczema flare ups.
Research shows that illness perceptions can also predict SE in diverse
populations,17–19 and SE is a recommended target in
interventions to treat AD in children,20 rather than
illness perceptions. However, different illness perceptions may
correlate with psychological outcomes for different
conditions.21,22 Furthermore, SE is behaviour specific
and different chronic illnesses require different management behaviours.
Once a child has been diagnosed with AD, the caregiver is likely
following instructions to complete several health-related tasks to
manage the symptoms. Potentially modifiable factors that can influence
caregiver ability are illness perceptions and SE. Therefore, this study
combines the Common Sense Model of Self-Regulation (CSM) and
self-efficacy theory and aims to investigate the relationships between
AD severity illness perceptions, self-efficacy and QoL in a population
of caregivers of children with AD.