Barriers to and Facilitators of Treatment Adherence Among Caregivers of Children with Atopic Dermatitis: Exploring the Role of Attachment

Abstract

Atopic dermatitis (AD) or eczema is an inflammatory skin disease, usually with an onset in early childhood. The primary symptoms and signs of AD are itchy, dry, flaky skin and lichenification (thickening of the skin), which can cause severe discomfort, pain and irritation. Treatment consists of medication and specialised therapies. As children usually do not have the capacity to manage the condition themselves, the onus falls on the caregiver to provide the appropriate treatment. Caregivers are required to carefully monitor skin triggers, administer creams, and maintain diligent observation of the child. The attachment relationship between a child and caregiver may be an influential factor in treatment. In this qualitative study, we explored the barriers to and facilitators of treatment adherence for caregivers with children under the age of 12 years with AD. Twenty AD caregivers were purposively recruited at a specialist dermatology clinic at a tertiary hospital in the Western Cape, South Africa. Interviews were conducted, recorded, transcribed and analysed using thematic analysis. The participants reported that inadequate primary healthcare, the costs associated with treatment and the lack of resources at schools were barriers to treatment adherence. They also stated that specialised healthcare, their use of innovative treatment methods, responsive care and social support facilitated treatment adherence. We add that attachment may play an important role in the provision of treatment from caregivers and that innovative treatment and responsive care by caregivers specifically demonstrate how secure attachments enable caregivers to be responsive to the needs of the child patient.