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.