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Knowledge mobilisation: an ethnographic study of the influence of practitioner mindlines on atopic eczema self-management in primary care in the UK
  1. Fiona Cowdell
  1. Faculty of Health Education and Life Sciences, Birmingham City University, Birmingham, UK
  1. Correspondence to Professor Fiona Cowdell; fiona.cowdell{at}bcu.ac.uk

Abstract

Objective To explore how atopic eczema specific mindlines are developed by primary care practitioners.

Design Ethnographic study.

Setting One large, urban general practice in central England.

Participants In observation, all practitioners and support staff in the practice and in interviews a diverse group of practitioners (n=16).

Results Observation of over 250 hours and interview data were combined and analysed using an ethnographic approach through the lenses of mindlines and self-management. Three themes were identified: beliefs about eczema, eczema knowledge and approaches to self-management. Eczema mindlines are set against a backdrop of it being a low priority and not managed as a long-term condition. Practitioners believed that eczema is simple to manage with little change in treatments available and prescribing limited by local formularies. Practice is largely based on tacit knowledge and experience. Self-management is expected but not often explicitly facilitated. Clinical decisions are made from knowledge accumulated over time. Societal and technological developments have altered the way in which practitioner mindlines are developed; in eczema, for most, they are relatively static.

Conclusions The outstanding challenge is to find novel, profession and context-specific, simple, pragmatic strategies to revise or modify practitioner mindlines by adding reliable and useful knowledge and by erasing outdated or inaccurate information thus potentially improve quality of eczema care.

  • atopic eczema
  • ethnography
  • knowledge mobilisation
  • mindlines
  • primary care
  • self-management

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • Twitter @FCowdell

  • Contributors FC is the sole contributor to this paper.

  • Funding Fiona Cowdell is funded by a National Institute for Health Research, Knowledge Mobilisation Research Fellowship, KMRF-2015-04-004.

  • Disclaimer The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests None.

  • Ethics approval The study was approved by a National Health Service REC (16/YH/0252). Process consent was used for observation, on each occasion informal conversations were used to re-check participant’s willingness to be observed. Patients were informed about the study by practitioners and when necessary the researcher exited individual consultations, either at the request of the patient, the practitioner or using personal judgement, although this was infrequently needed. Written consent was taken for audio-recorded interviews. Interview participants consented to publication of anonymised information.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data sets generated and/or analysed during the current study are not publicly available as they are not designed to be re-analysed by others but are available from the corresponding author on reasonable request.

  • Presented at This paper presents independent research funded by the National Institute for Health Research.

  • Patient consent for publication Not required.

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