Example issues identified from the think-aloud interviews and the changes implemented to address these
| Summary of issue identified | Example quote | Change implemented |
| Some found the questions in the brief eczema assessment confusing. | ‘Does your skin feel dry?’ Well, everywhere or in general where you’ve got…eczema? …I don't know if that’s (the question) very clear. (P12, 22–25 year old) ‘Is your skin or redder or darker than usual?’…to me it sounds like ‘is your eczema darker or less dark than your eczema normally is?’, but I think it’s a bit ambiguous whether it means that or their usual skin?.…you could just say ‘is your eczema red or darker than usual?’ (P18, 16–18 years old) ‘Is your skin redder or darker (than usual)?’…maybe it’s the ‘than usual’ bit that needs to be more clearer, because I could interpret that as this being my usual skin, rather than the usual colour of the eczema…maybe, ‘Is your eczema redder or darker than usual?’ or something (P5, 19–21 years old) | The assessment questions were reworded to clarify that we are asking about their eczema at present (rather than in the past) and their eczema skin (rather than skin in general). |
| The feedback for the brief eczema assessment did not always match their experience (eg, feedback suggested they may have an eczema flare-up when they did not). | (Is your skin itchy or sore?) it’s not really sore but it is itchy…I can have itchy dry skin but I only have sore skin when it’s red and inflamed…(recommended the flare control creams module)… it said that I’m having a flare-up now, but I wouldn’t class this as a flare-up. This is kind of just my - how my eczema kind of bobbles along, as in my flare-ups would be much more aggressive than what they were suggesting it is. (P10, 19–21 years old) | We separately asked whether eczema is ‘itchy’ and ‘sore’ so that people do not receive feedback that they are having a flare-up if they just have itchy and not sore skin. Softened the feedback on current eczema severity to avoid disengaging those who do not agree that they are experiencing an eczema flare-up (‘for most people, this means they are having an eczema flare-up’). |
| Some thought the introductory section was too long. | Personally, if I see there’s 21 pages, I’m just going to try and get through them. (P18, 16–18 years old) | Reduce the introductory section significantly with optional click-outs to additional information if needed. |
| Some young people commented that they already knew a lot of the information as they have had eczema for a long time. | (ECO) was really good…because I’ve had it for so long I feel like a lot of the information there I’ve already had drilled into me my whole life, but I feel like for people that either have children with eczema or people with eczema, I don’t know, I think it would be really helpful… personally, I would probably want the more information about the lifestyle stuff and diet (P10, 19–21 years old) I think a lot of stuff I probably kind of already knew from having eczema but it’s good to get a few things that help yes (P19, 13–15 years old) | Added in a quote from another young person who had eczema for a long time saying how they were surprised that the website contained new helpful tips. Emphasise that the information is based on the most up-to-date research evidence (so they may find new information) and that there is information on ‘living with eczema’ (eg, diet advice). |