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Acne is a common skin condition that is most prevalent in young people. It can have a substantial impact on the quality of life, which can be minimized with the appropriate use of topical treatments. Nonadherence to topical treatments for acne is common and often leads to treatment failure.
The aim of this study is to develop a web-based behavioral intervention to support the self-management of acne and to assess the feasibility of recruitment, retention, and engagement of users with the intervention.
The intervention was developed iteratively using the LifeGuide software and following the person-based approach for intervention development. The target behavior was
A total of 1193 participants were invited, and 53 young people with acne were randomized to usual care (27/53, 51%) or usual care plus intervention (26/53, 49%). The response rate for the primary outcome measure (Skindex-16) was 87% at 4 weeks, 6 weeks, and at both time points. The estimate of mean scores between groups (with 95% CI) using linear regression showed a trend in the direction of benefit for the web-based intervention group in the primary outcome measure (Skindex-16) and secondary measures (Patient Health Questionnaire-4 and the Problematic Experiences of Therapy Scale). Intervention usage data showed high uptake of the core module in the usual care plus web-based intervention group, with 88% (23/26) of participants completing the module. Uptake of the optional modules was low, with less than half visiting each (myth-busting quiz: 27%; living with spots or acne: 42%; oral antibiotics: 19%; what are spots or acne: 27%; other treatments: 27%; talking to your general practitioner: 12%).
This study demonstrated the feasibility of delivering a trial of a web-based intervention to support self-management in young people with acne. Additional work is needed before a full definitive trial, including enhancing engagement with the intervention, recruitment, and follow-up rates.
ISRCTN 78626638; https://tinyurl.com/n4wackrw
Acne is a common condition that is most prevalent among adolescents, affecting >85% of adolescents at some point [
A limited number of interventions have been developed to improve adherence to acne treatments [
There is also little information on recruiting through primary care in acne trials. One randomized controlled trial (RCT) investigating the use of supplementary patient educational materials on adherence recruited patients from primary care clinics in the United Kingdom; however, there was no calculation for sample size [
Feasibility trials are an essential part of complex intervention development [
In this study, we describe the development of a web-based behavioral intervention to support self-management of acne. We also present the results of a feasibility randomized trial delivering this intervention to young people with acne recruited through primary care.
The Template for Intervention Description and Replication (TIDieR) guideline [
The intervention was developed using the Person-Based Approach (PBA) for planning, developing, and evaluating the feasibility of the intervention [
Alongside intervention planning, guiding principles were drafted and iteratively developed throughout, identifying distinctive intervention features to address these. This method involved highlighting key objectives from qualitative research (1). to support young people in gaining autonomy and competence around acne management, (2) to support and promote autonomy in making treatment choices, and (3) to provide support and acknowledge the psychological impact of acne (see
Guiding principles.
Key intervention |
Patient characteristics | Evidence for key behavioral issues | Guiding principles | |
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Design objectives | Key (distinctive) intervention features |
To improve the lives of young people with acne To promote self-management of acne To promote the appropriate use of topical treatments |
Young people who have mild to moderate acne vulgaris |
Little knowledge about acne and its treatments (QR)a Young people can be confused with the myths and misconceptions around acne and are unaware or unwilling to acknowledge that acne requires ongoing treatment. Low motivation to engage with long-term treatment (QR) Certain beliefs about the causation of acne may affect people’s perceived necessity of treatment. Difficulty judging efficacy of topical treatments (QR) Belief that topical treatments do little and are only keeping their acne at bay may result in early abandonment of treatment. Difficulty overcoming barriers (QR) Young people can be uncertain about how to manage side effects of treatment, financial constraints, lengthy routines, and uncertainties around how to use medication. Confusion between cosmetic and medical treatments for acne (QR) Young people perceive they have tried all the topical treatments available |
To support young people in gaining autonomy and competence around acne management |
Offer users choice wherever possible Minimize disruption to lifestyle Dispel myths and misconceptions about the causes of acne Autonomy-supportive language Ensure they have a complete understanding of acne and the rationale behind their treatment To build their self-efficacy for the target behaviors (eg, 4-week challenge to support patients to formulate a personal goal or action plan, advice on how to minimize side effects including skin irritation, and a video with step-by-step instructions on how and when to apply topical treatments) Educational information or rationale supported by scientific evidence (topical treatments are equally as effective as antibiotics) Stories and testimonials to model successful management using topical therapies Addressing common concerns Provide a list of topical treatments and explain how they work |
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Need for control over treatment choice and disease (SR)b Young people want control over their treatment choice as well as their condition and this has been shown to improve adherence and psychological impact |
To support and promote autonomy for making treatment choices |
Provide advice on how people can effectively communicate with their GPc Invite, acknowledge, and value views or preferences (eg, CAMd therapies) Provide a list of topical treatments and explain how they work Offering user choice wherever possible Autonomy-supportive language throughout |
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Difficulty dealing with psychological issues (SR and QR) Young people can be unsure about how to cope with the psychological impact of acne, including depressive symptoms, stress, anxiety, and embarrassment Difficulty presenting psychological issues to HCPe (SR) Young people may be unwilling to present psychological problems to their HCP |
To provide support and acknowledge the psychological impact of acne |
Acknowledge the psychological impact of acne (eg, (1) emphasize that everyone with a skin disease can be at risk of psychological symptoms and (2) provide patient stories about how they dealt with the impact of acne) Provide advice on how people can effectively communicate with their GP Provide advice on different coping strategies |
aQR: qualitative research (barriers identified from the secondary analysis of qualitative interview data [
bSR: systematic review (barriers emerged from systematic review and synthesis of qualitative papers on acne) [
cGP: general practitioner.
dCAM: complementary and alternative medicine.
eHCP: health care practitioner.
The hypothesized outcome of the intervention was to improve QoL for young people with acne through the target behavior
Evidence from the literature and qualitative research (including the systematic review and synthesis of qualitative data [
Alongside the PBA, a behavioral analysis was carried out to map the intervention components to the behavior change taxonomy, which is a list of consensually agreed techniques for specifying interventions [
Qualitative research showed the Extended Common Sense Model of Illness [
Behavioral analysis of Spotless intervention.
Barrier or facilitator for target behaviora and intervention component | Spotless module | Target construct (BCW)b | Intervention function (BCW) | Behavior change technique (using 93 BCTTv1)c | Target construct (ECSM)d | |||||
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Provide persuasive and credible information about the side effects of topicals and their safety via scientific evidence and personal stories | Core treatments | Psychological capability, reflective motivation, and social opportunity | Education, persuasion, and modeling |
5.1. Information about health consequences 6.2. Social comparison 6.3. Information about others’ approval 9.1. Credible source |
Beliefs about necessity and concerns over its use | ||||
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Provide advice on how to choose the right topical | Core treatments | Psychological capability | Training and education | 4.1. Instructions on how to perform the behavior | Beliefs about necessity and concerns over its use | ||||
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Provide advice on how to choose the right topical | Core treatments | Psychological capability | Training and education | 4.1. Instructions on how to perform the behavior | Curability or controllability | ||||
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Provide information about different topicals (eg, most common or least common topicals and how they work) | Core treatments | Psychological capability | Education | 5.1. Information about health consequences | Curability or controllability | ||||
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Provide persuasive and credible information about the effectiveness of topicals via scientific evidence and personal stories Provide rationale for how topicals control acne Explain via personal stories or video that it can take time for topical treatments to work |
Core treatments | Psychological capability, reflective motivation, and social opportunity | Education, persuasion, and modeling |
5.1. Information about health consequences 6.2. Social comparison 6.3. Information about others’ approval 9.1. Credible source |
Beliefs about necessity | ||||
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Provide a chart for them to monitor how their skin is after applying topical treatments each day as part of the 4-week challenge | Core treatments | Reflective motivation | Education and persuasion |
5.1. Information about health consequences 2.3. Self-monitoring of outcomes of behavior |
Beliefs about necessity | ||||
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Provide information on the causes of acne and dispel misconceptions using a myth-busting quiz Provide persuasive and credible information about how acne can be effectively managed using treatment, including scientific evidence and personal stories Provide information about what acne is, the importance of treating it early, and information about referrals Provide advice on when to see an HCPh about acne Provide advice on speaking with an HCP about acne |
Myth-busting quiz; What are spots or acne; Talking to your GPi | Psychological capability, reflective motivation, social opportunity, and physical opportunity | Education, modeling, persuasion, and training |
4.1. Instructions on how to perform the behavior 5.1. Information about health consequences 6.2. Social comparison 6.3. Information about others’ approval 9.1. Credible source |
Cause, timeline, and identity | ||||
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Provide written instructions and an instructional video on how to use topical treatments correctly |
Core treatments | Physical capability, social opportunity, and reflective motivation | Training, modeling, and persuasion |
4.1. Instructions on how to perform the behavior 6.1. Demonstration of the behavior 6.2. Social comparison 6.3. Information about others’ approval 9.1. Credible source |
Concerns over its use | ||||
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4-week challenge: provide a chart to help people record their skin condition when they have used their topical treatment each day | Core treatments | Reflective motivation | Education and persuasion |
5.1. Information about health consequences 2.3. Self-monitoring of outcomes of behavior |
Concerns over its use | ||||
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Provide information on how to incorporate topicals in everyday life Reassure people that applying topicals should not be time-consuming Advise people to plan when to apply their topical Suggest applying their topical at the same time in the same context each day |
Core treatments | Psychological capability and automatic motivation | Education and enablement |
1.4. Action planning 4.1. Instructions on how to perform the behavior 5.3. Information about social and environmental consequences |
Concerns over its use | ||||
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Provide persuasive and credible information about the effectiveness of topicals and antibiotics via scientific evidence and personal stories Provide information about the consequences of long-term oral antibiotic use |
Core treatments and antibiotics | Psychological capability, social opportunity, and reflective motivation | Education, modeling, and persuasion |
5.1. Information about health consequences 6.2. Social comparison 6.3. Information about others’ approval 9.1. Credible source |
Concerns over its use |
aTarget behavior: appropriate use of topical treatments.
bBCW: behavior change wheel.
cBCTTv1: behavior change technique using the Behavior Change Technique Taxonomy (v1).
dECSM: Extended Common-Sense Model of Illness.
eQR: qualitative research (barriers identified from the secondary analysis of published interview data; evidence-based literature).
fSR: systematic review (barriers emerged from systematic review and synthesis of qualitative papers on acne); qualitative research.
GEBL: barriers and facilitators emerged from a review of literature on acne (including studies testing the effectiveness of interventions to improve adherence to acne treatments).
hHCP: health care practitioner.
iGP: general practitioner.
The web-based intervention, Spotless, was developed using the LifeGuide software [
When participants first visit the website, they are taken to a
After the initial visit, participants are taken directly to the main menu page, where they can choose which modules to explore with the option of looking at the
The intervention includes a
Screenshots of the Spotless website.
As part of the development stage, think-aloud interviews [
Overall, participants found the intervention engaging, persuasive, and usable, with some suggestions for changes. Main changes made as a result of the interviews were adding pseudonyms and ages to quotes (these quotes were adapted from the qualitative interview study [
Two public contributors aged 24 and 26 years with experience of acne provided input throughout to enhance the usability and accessibility of the intervention. This included providing feedback to further enhance the intervention before the feasibility trial, commenting on participant facing documents, and advising on the choice of the primary outcome measure for the trial. Comments about the intervention were both positive and negative regarding the layout, content, and appropriateness of the website for the target population. One contributor commented on their preference of the primary outcome measure for the feasibility trial and opted for Skindex-16 [
This was a randomized, unblinded feasibility trial comparing two parallel groups: usual care and usual care plus web-based intervention.
The intervention was aimed at young people with acne managed through primary care in the United Kingdom. Participants were recruited through mail-outs from 20 GP practices in the South of England to people aged 14-25 years whose electronic record included a diagnosis of acne and who had received one or more prescriptions for acne in the past 6 months.
People who had previously taken part in the think-aloud study were excluded, as were people who said their acne had cleared and those taking oral isotretinoin, as it is not recommended to use topical acne treatments at the same time as isotretinoin because of the side effects of dry skin.
Patients aged ≥16 years, who met the criteria, were sent an
The usual care group received treatment as usual from their GP, including appointments, prescriptions, and referrals to the dermatologist, if necessary. Participants in this group were given access to the intervention after they had completed the 6-week follow-up questionnaires.
Participants in the usual care plus web-based intervention group received care as usual with immediate access to the website as described to help them self-manage their acne.
We sought to assess a range of feasibility outcomes including the following:
The rate of recruitment and the number of practices required
Completion rates of questionnaire outcome measures
The acceptability of measuring skin-specific QoL using Skindex-16
The feasibility of a range of quantitative measures
Intervention usage in terms of number of log-ins and modules accessed
Outcome measures included the following: Skindex-16 [
EQ-5D-5L [
The Problematic Experiences Therapy Scale (PETS) [
Participants also completed the Credibility/Expectancy Questionnaire at baseline as a process predictor. It measures how a person thinks and feels about their therapy and its likely success [
The Patient Health Questionnaire-4 (PHQ-4) was used to measure anxiety and depression [
Treatment monitoring questions were included in order to collect data on what topical treatments participants were using, whether they experienced side effects, how they dealt with these, how often they were using treatment, and any other treatments they were using for their acne.
Sociodemographic questions included age, gender, education, age of onset of acne, and whether living with parents or independently.
The target sample size was 65 participants, with 40 in the intervention group and 25 in the usual care group. This was deemed appropriate as guidance on sample sizes in feasibility trials ranged from 12 to >30 participants in each arm [
We intended randomizing all participants into 2 groups in a 2:1 ratio using a computer-generated algorithm. However, because of an error in the randomization software, the block randomization was changed to a 1:1 ratio. The sequence was concealed as this was all done via a computer.
Data were automatically collected via the LifeGuide software [
The feasibility trial was approved by the National Research Ethics Service Committee east of England (ref: 18/EE/0105) and registered on the ISRCTN registry (78626638).
Recruitment took place from September 2018 to April 2019, and the follow-up ended in June 2019. In total, 1193 invitation letters were sent from 20 primary care practices in the South of England. Of the 1193 invitations sent, we received 92 (7.71%) responses, with 63 (5.28%) agreeing to take part and 29 (2.43%) giving reasons why they could not. Of the 63 participants, 53 (84%) registered on the web and were randomized (usual care: 27/53, 51%; usual care plus web-based intervention: 26/53, 49%). Of the 53 registered participants, 46 (87%) participants completed follow-up at 4 weeks, 6 weeks, or both time points (
Flow diagram of recruitment process. *Problem with LifeGuide randomization procedure incurred delay and participants did not log back in; **Felt like homework; not planning on using topicals; not interested.
The sample comprised 72% (38/53) female and 28% (15/53) male participants with a mean age of 19 (SD 2.6) years. The mean age at the onset of acne was reported as 14 (SD 2.1) years. Of the 53 participants, 39 (74%) reported living at home, and 44 (83%) were in full-time education (
Participant characteristics at baseline (N=53).
Participant characteristics | Intervention (n=26) | Usual care (n=27) | Total (n=53) | ||||
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Female | 21 (81) | 17 (63) | 38 (72) | |||
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Male | 5 (19) | 10 (37) | 15 (28) | |||
Age (years), mean (SD) | 18.3 (2.6) | 18.8 (3.4) | 18.6 (3) | ||||
Age at onset of acne (years), mean (SD) | 13.54 (2.1) | 13.8 (2.5) | 13.7 (2.3) | ||||
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Yes | 21 (81) | 18 (67) | 39 (74) | |||
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No | 5 (19) | 9 (33) | 14 (26) | |||
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Yes | 22 (85) | 22 (82) | 44 (83) | |||
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No | 4 (15) | 5 (19) | 9 (17) |
Baseline completion rates were high for all questionnaires (
Questionnaire completion rates (N=53).
Outcome measure | Baseline, n (%) | 4 weeks, n (%) | 6 weeks, n (%) |
Overall Skindex-16 | 53 (100) | 33 (62) | 42 (79) |
EQ-5D-5L | 53 (100) | 32 (60) | 39 (74) |
EQ VASa | 53 (100) | 31 (59) | 34 (64) |
PHQ-4b | 53 (100) | 31 (59) | 36 (68) |
Credibility | 53 (100) | N/Ac | N/A |
Expectancy | 53 (100) | N/A | N/A |
PETSd symptoms (n=26) | 26 (100) | 17 (65) | 17 (65) |
PETS uncertainty (n=26) | 25 (96) | 17 (65) | 17 (65) |
PETS doubts (n=26) | 25 (92) | 17 (65) | 17 (65) |
PETS practical problems (n=26) | 25 (96) | 17 (65) | 17 (65) |
What topical using | 53 (100) | 31 (59) | 36 (68) |
How often using treatment | 53 (100) | 31 (59) | 34 (64) |
Side effects | 51 (96) | 31 (59) | 32 (60) |
Management of side effects (people who reported side effects) | 31 (59) | 19 (36) | 25 (47) |
Other treatment | 53 (100) | 30 (57) | 37 (70) |
aEQ VAS: EuroQol Visual Analogue Scale.
bPHQ-4: Patient Health Questionnaire-4.
cN/A: not applicable.
dPETS: Problematic Experiences Therapy Scale.
The Skindex-16 overall mean score at baseline was 55.4 (SD 21.8) across both groups. There was a substantial improvement in both groups, and the mean differences between groups, when controlling for baseline scores and covariates (gender, age, age onset, and education), suggested a trend toward benefit at both 4 and 6 weeks: at 4 weeks, the intervention group had a score 5.2 points lower (95% CI −14.58 to 4.09) than the usual care group and at 6 weeks 2.9 points lower (95% CI −13.27 to 7.47;
Scores at baseline and follow-up and estimate of mean differences controlling for baseline and covariates (n=53).
Score description | Baseline | 4-week follow-up | 4-week follow-up, controlling for baseline and other covariates, mean difference (95% CI) | 6-week follow-up | 6-week follow-up, controlling for baseline and other covariates, mean difference (95% CI) | ||||||||||||||||
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n value | Value, mean (SD) | n value | Value, mean (SD) |
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n value | Value, mean (SD) |
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Usual care | 27 | 55.4 (24) | 16 | 54.2 (18.7) | N/Aa | 21 | 48 (23.8) | N/A | ||||||||||||
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Web-based intervention | 26 | 55.3 (19.8) | 17 | 45.8 (19.9) | −5.2 (−14.58 to 4.09) | 21 | 43.4 (22.2) | −2.9 (−13.27 to 7.47) | ||||||||||||
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Usual care | N/A | 41.3 (25.5) | N/A | 35.5 (21.5) | N/A | N/A | 37.3 (24.3) | N/A | ||||||||||||
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Web-based intervention | N/A | 31.9 (19.8) | N/A | 30.6 (24.1) | 5.4 (−8.41 to 19.22) | N/A | 27 (21.5) | −0.9 (−11.76 to 10.03) | ||||||||||||
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Usual care | N/A | 72.7 (27.5) | N/A | 74.2 (23.4) | N/A | N/A | 63.6 (28.1) | N/A | ||||||||||||
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Web-based intervention | N/A | 76.6 (21.1) | N/A | 63.7 (22.3) | −12.4 (−24.23 to −0.67) | N/A | 62 (24.3) | −3.9 (−16.65 to 8.75) | ||||||||||||
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Usual care | N/A | 42.6 (28.3) | N/A | 41.2 (22.7) | N/A | N/A | 34.8 (27.8) | N/A | ||||||||||||
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Web-based intervention | N/A | 44.1 (27.9) | N/A | 31.9 (26.8) | −6.4 (−20.52 to 7.79) | N/A | 30.5 (28.9) | −3.4 (−16.75 to 9.9) | ||||||||||||
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Usual care | 27 | 4 (3.5) | 16 | 3.9 (3.3) | N/A | 18 | 3.7 (3.3) | N/A | ||||||||||||
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Web-based intervention | 26 | 4.6 (3.7) | 15 | 2.3 (2.9) | −1.7 (−3.66 to 0.18) | 18 | 3.2 (3.3) | −0.8 (−2.6 to 0.97) | ||||||||||||
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Usual care | 26 | 3.9 (1) | 14 | 4 (1.1) | N/A | 17 | 4.1 (0.9) | N/A | ||||||||||||
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Web-based intervention | 26 | 3.9 (0.9) | 17 | 4.2 (1.2) | 0.2 (−0.65 to 1.15) | 17 | 4.2 (0.9) | 0.2 (−0.47 to 0.82) | ||||||||||||
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Usual care | 26 | 4.5 (0.9) | 15 | 4.5 (1.2) | N/A | 18 | 4.2 (1.1) | N/A | ||||||||||||
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Web-based intervention | 25 | 4.4 (1) | 17 | 4.7 (0.6) | 0.1 (−0.51 to 0.67) | 17 | 4.9 (0.2) | 0.6 (0.19 to 1.08) | ||||||||||||
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Usual care | 27 | 3.8 (1) | 19 | 3.7 (1.1) | N/A | 18 | 3.7 (1.1) | N/A | ||||||||||||
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Web-based intervention | 24 | 3.4 (1.3) | 17 | 4.2 (0.8) | 0.5 (−0.23 to 1.25) | 17 | 4.2 (1) | 0.5 (−0.18 to 1.24) | ||||||||||||
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Usual care | 27 | 3.4 (1.3) | 15 | 3.6 (1.3) | N/A | 18 | 3. (1.3) | N/A | ||||||||||||
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Web-based intervention | 25 | 3.8 (1) | 17 | 4 (1.1) | 0.1 (−0.44 to 0.73) | 17 | 4.1 (1.1) | 0.7 (0.02 to 1.3) |
aN/A: not applicable.
bPHQ-4: Patient Health Questionnaire-4.
cPETS: Problematic Experiences Therapy Scale.
There was no evidence of a trend toward benefit in the symptoms subscale (intervention group 5.4 points higher at 4 weeks: 95% CI −8.41 to 19.22; 0.9 points lower at 6 weeks: 95% CI −11.76 to −10.03); however, some evidence of a trend toward benefit in the emotional subscale (intervention 12.4 points lower at 4 weeks: 95% CI −24.23 to −0.67; 3.9 points lower at 6 weeks: 95% CI −16.65 to 8.75) and functioning subscale (intervention group 6.4 points lower at 4 weeks: 95% CI −20.52 to 7.79; 3.4 points lower at 6 weeks: 95% CI −16.75 to 9.9;
The baseline mean score for anxiety and depression (PHQ-4) suggests that the overall scores between groups were in the mild range for anxiety and depression with a score of 4.3 (SD 3.6) and a trend toward improvement in the intervention group at 4 weeks compared with the usual care group. For all PETS subscales (symptoms, uncertainty, doubt, and practical problems), there were also suggestions of a trend toward benefit (
More people in the usual care group reported using topicals at baseline compared with those in the intervention group. In the intervention group, the percentage of people using topicals increased from baseline to 4 weeks by 13.5% and decreased by 0.8% in the usual care group (
Reported topical treatment use between groups at each interval.
Topical used | Intervention | Usual care | |||||||
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n (%) | N | n (%) | N | |||||
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Baseline | 16 (62) | 26 | 20 (74) | 27 | ||||
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4 weeks | 12 (75) | 16 | 11 (73) | 15 | ||||
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6 weeks | 15 (88) | 17 | 15 (79) | 19 | ||||
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Baseline | 3 (12) | 26 | 6 (22) | 27 | ||||
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4 weeks | 3 (19) | 16 | 4 (27) | 15 | ||||
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6 weeks | 2 (12) | 17 | 4 (21) | 19 | ||||
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Baseline | 7 (27) | 26 | 1 (4) | 27 | ||||
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4 weeks | 1 (6) | 16 | 0 (0) | 15 | ||||
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6 weeks | 0 (0) | 17 | 0 (0) | 19 |
aOther topical treatments including branded products.
At 4 and 6 weeks, the usual care groups reported similar rates of side effects compared with the intervention group (
Reported side effects from topical treatments.
Side effects | Intervention | Usual care | ||||||||
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n (%) | N | n (%) | N | ||||||
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Baseline | 15 (60) | 25 | 16 (62) | 26 | |||||
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4 weeks | 9 (53) | 17 | 8 (57) | 14 | |||||
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6 weeks | 10 (67) | 15 | 12 (71) | 17 | |||||
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Baseline | 10 (40) | 25 | 10 (39) | 26 | |||||
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4 weeks | 8 (47) | 17 | 6 (43) | 14 | |||||
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6 weeks | 5 (33) | 15 | 5 (29) | 17 |
Reported management of side effects from topicals.
Management of side effects | Intervention | Usual care | ||||||||
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n (%) | N | n (%) | N | ||||||
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Baseline | 9 (64) | 14 | 14 (82) | 17 | |||||
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4 weeks | 7 (78) | 9 | 8 (80) | 10 | |||||
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6 weeks | 7 (64) | 11 | 10 (71) | 14 | |||||
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Baseline | 5 (36) | 14 | 2 (12) | 17 | |||||
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4 weeks | 2 (22) | 9 | 0 (0) | 10 | |||||
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6 weeks | 2 (18) | 11 | 1 (7) | 14 | |||||
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Baseline | 2 (14) | 14 | 1 (6) | 17 | |||||
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4 weeks | 1 (11) | 9 | 2 (20) | 10 | |||||
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6 weeks | 1 (9) | 11 | 3 (21) | 14 |
Reported frequency of application of topicals.
Frequency of application | Intervention | Usual care | ||||
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n (%) | N | n (%) | N | ||
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Baseline | 19 (73) | 26 | 19 (70) | 27 | |
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4 weeks | 11 (65) | 17 | 9 (64) | 14 | |
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6 weeks | 13 (81) | 16 | 12 (67) | 18 | |
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Baseline | 7 (27) | 26 | 8 (30) | 27 | |
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4 weeks | 6 (35) | 17 | 5 (36) | 14 | |
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6 weeks | 3 (19) | 16 | 6 (33) | 18 |
Approximately 88% (23/26) of participants in the intervention group completed the core module
Intervention use (N=26).
Measures of intervention use | Web-based intervention, n (%) | ||
Core module completed | 23 (88) | ||
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1 | 3 (12) | |
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2 | 5 (19) | |
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3 | 7 (27) | |
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4 | 7 (27) | |
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5 | 2 (8) | |
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6 | 2 (8) | |
Signed up to 4-week challenge | 10 (38) | ||
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Living with spots or acne | 11 (42) | |
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Myth-busting quiz | 7 (27) | |
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What are spots or acne | 7 (27) | |
|
Other treatments | 7 (27) | |
|
Oral antibiotics | 5 (19) | |
|
Talking to your GPa | 3 (12) |
aGP: general practitioner.
To our knowledge, this is the first web-based behavioral intervention developed for young people with acne, using the PBA along with theory and evidence [
There were several limitations and changes that should be considered based on the findings of this feasibility trial. First, the mail-out through primary care practices received a low response rate, suggesting that people who took part in the trial may be more motivated and possibly have higher literacy than those who did not respond. Therefore, the sample may not be fully representative of young people who consult primary care for their acne. A key reason for not participating was time commitment, which suggests that the level of involvement in the study may need to be made clearer. Another reason for not participating was that some participants’ skin had cleared up. This could be a reflection on the search strategy or the unpredictable nature of their skin condition. The changes to the recruitment process led to a slight increase in response rate which suggests that if implemented earlier this could have potentially improved the numbers recruited. People who took part in the study also seemed to be using topical treatments already, which suggests that recruitment in a future trial should seek participants who are not already using them to benefit from the intervention. We may also need to consider other ways of reaching the target population, including other platforms such as social media, pharmacies, and schools.
Second, there was a low uptake of the optional modules, which suggests that the intervention may need to be refined further. However, the reason for including these modules as optional was that they might not be applicable to everyone at that time but were seen as important in earlier qualitative research. Uptake of the
Although the target sample size was not reached, this was a feasibility study and provided useful information about the changes that need to be considered for a future trial. Owing to the randomization error, participants were randomized in a 1:1 ratio instead of 2:1 for intervention to usual care group. This resulted in less usage data for the intervention group, which could have provided further information on intervention use. Although there was a trend toward benefit in both the primary and secondary outcome measures, a larger sample is needed to draw conclusions about the effect of the intervention.
The findings from this feasibility trial reflect the results of previous trials testing the effectiveness of interventions for acne [
The rate of follow-up in this study was high at 6 weeks (79%) in terms of those completing the primary outcome measure (Skindex-16). This is in line with a previous trial that found a follow-up rate of 84.5% when recruiting through primary care [
This feasibility trial demonstrates that a web-based behavioral intervention for young people with acne can be delivered with high retention, high engagement with the core module, and trends in the direction of benefit for the primary outcome measure. However, recruitment to this study was challenging, and alternative methods of seeking participants should be considered for a full-scale trial of a similar intervention, particularly when seeking a population less likely to be using effective topical treatments for acne.
CONSORT-EHEALTH checklist (V 1.6.1).
general practitioner
Person-based approach
Problematic Experiences Therapy Scale
Patient Health Questionnaire-4
International Prospective Register of Systematic Reviews
quality of life
randomized controlled trial
Template for Intervention Description and Replication
We would like to thank the participants who took part in the research and the primary care practices for helping with recruitment. We would also like to thank the patient representatives who helped develop the intervention and advised on trial materials. This study was funded by the National Institute for Health Research School for Primary Care Research Studentship for Athena Ip. The views expressed are those of the authors and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care.
None declared.