‘In someone's clinic but not in mine’ – clinicians’ views of supporting lifestyle behaviour change in patients with psoriasis: a qualitative interview study

Background : Psoriasis is associated with significant co-morbidity. Excess alcohol use, smoking, and higher body mass index are all associated with psoriasis and may contribute to its onset and/or exacerbation. Lifestyle behaviour change (LBC) can be beneficial in the prevention of psoriasis and/or reduction in its severity. LBC techniques are effective when used properly by healthcare professionals. Objectives: It is unknown whether clinicians managing psoriasis patients are familiar with LBC techniques or are confident to deliver LBC support in routine consultations. The study aimed to elicit the views and attitudes of healthcare professionals in primary and secondary care about addressing LBC with psoriasis patients. Methods: In-depth semi-structured interviews with 23 dermatology specialist and general practitioners in English primary and secondary care settings stratified by discipline. Data were analysed using constant comparison and principles of Framework Analysis. Results: Clinicians recognised that lifestyle behaviours were important in psoriasis management, but believed it was not their role to facilitate LBC. Limited knowledge of and skills to implement LBC principles and techniques underpinned their beliefs. Participants identified a need for training to enable the incorporation of LBC support activity into psoriasis services. Conclusions:Clinicians are not yet trained to support psoriasis patients with effective LBC methods. Training in these methods is needed to enable healthcare professionals to better assess and manage psoriasis.