The experiences of children and young people of using silk garments for the treatment of eczema: a nested qualitative study within the CLOTHES randomised controlled trial Wake E.V., Batchelor J., Lawton S., Thomas K.S., Harrison E.F., Cowdell F.C. Eileen Wake: University of Hull Fiona Cowdell: Birmingham City University Br J Dermatol. Accepted Author Manuscript. doi:10.1111/bjd.15909Journal reference

Eileen Wake Fiona Cowdell

Introduction What’s already known? Eczema affects around 20% of children and can have a detrimental effect on the child and their family Adherence with topical treatments is often poor and can lead to treatment failure Although children are often end-users of eczema treatments, they are rarely engaged in research involving these products beyond completing questionnaires

Methods Eighteen children aged 5-15, who took part in the CLOTHES trial, participated in age-appropriate individual interviews or focus groups when they had completed the trial.

Wearing ‘silks’ – mostly okay at night Results Four themes i) expectations of the garments; ii) wearing the silk garments; iii) did they help? and iv) thoughts about the garments. Expectations of the garments – eczema sore and itchy, high hopes, not often met Thoughts about the garments – don’t look nice, see through, fell apart Did they help? – kept me cool, comfortable, didn’t make much difference to eczema

Discussion What does this study add? Children and young people can be meaningfully engaged in dermatology research and add new dimensions of understanding, which would not be gained by proxy data The added value of child data is illustrated particularly in enhancing understanding of reasons for adherence and non- adherence, and in facilitating interpretation of the trial results, giving confidence that the selected objective outcome measures did not exclude factors that were important to children

Conclusions This study illustrates the need to communicate effectively with children and young people to ascertain their thoughts and beliefs about treatment regimens and assess the likelihood of concordance

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