Study population

A total of nine community pharmacy organizations (12 individual pharmacies) initially participated in our study. Of these, eight pharmacy organizations (11 pharmacies) participated until the end of the study, and one pharmacy withdrew without providing any data and therefore was not included in the analysis. Of the 11 remaining pharmacies, 11 technicians and two pharmacists completed the survey. Eight interviews with pharmacy technicians were performed, of which one was a duo-interview together with a pharmacist. All participants were female. Most participants were between 41 and 65 years of age, and years of working experience varied between 0 and 20+ years. Through the 11 participating community pharmacies, 188 patients were invited for participation. With 39 patients completing the survey, a 20.7% response rate was reached. The number of respondents from each pharmacy ranged from 0 to 19. A total of 19 respondents were female (48.7%). Among the patients, 15 were between 0 and 36 years of age (38.5%), and 24 were aged 36+ years (61.5%).

Pharmacy staff’s perspectivesInterviews

The interviews lasted 19 min on average (range, 14–29 min). Pharmacy staff’s experiences with the new educational materials could be related to their capability, opportunity or motivation and are described below.

Capability: opinions about the patient booklet

Interviewed pharmacy staff members felt capable to advise patients about AD using the patient information booklet. They were generally positive about the patient booklet. They thought that the booklet provided a clear overview about AD and its treatment for patients. They were especially enthusiastic about the pictures in the booklet, which helped them support their oral explanation:

T2: “The booklet is simply a nice work of reference for us and patients.”

T3: “The booklet makes it easier for us [pharmacy technicians] to provide complete answers to questions about AD and its treatment patients ask during counselling.”

Approximately half of the pharmacy technicians mentioned that the booklet is very extensive. Therefore, some of the pharmacy technicians found it difficult to highlight the main points of the booklet during the counselling sessions.

Capability: change in counselling about AD and its treatment

All technicians responded positively to the information material and gained knowledge about AD, though the extent of their improvement varied based on their initial level of understanding. Some technicians additionally mentioned that they gained new insights into the treatment of AD after following the e-learning.

T2: “The thickness and direction [of application] indeed, that is something I had never heard before.”

T5: “In the past, they said, ‘You need to apply the corticosteroid thinly’, but now you can’t find that information anymore. Because nowadays you read that it [the corticosteroid] will not be effective if it is applied too thinly [on the skin].”

T3: “The information materials did not contain much new information for me, except for the information about the skin. This information helps me to explain more clearly to patients why emollients are also very important in their treatment.”

Capability: signalling of suboptimal use of TCS and emollients

Technicians reported feeling more capable of noticing suboptimal use of TCS or emollients since following the e-learning. According to the technicians, patients often have inadequate knowledge about the effects of an emollient, for example, which may lead to its underuse, overuse of TCS, and potentially even exacerbation of AD symptoms. Additionally, technicians mentioned that patients are often not aware that they should taper off their TCS. This emerged from the counselling sessions that the technicians had with the patients.

T4: “Sometimes, they [the patients] say: ‘I apply it [the emollient] once a day.’ Then we tell them that they actually should apply it more often. They respond with: ‘Oh, I did not know this!’ We hear such things more often since we hand over the patient information booklet and we started to pay more attention to it.”

Motivation: role of the pharmacy in the treatment of AD

Technicians emphasized the crucial role of community pharmacies in providing reliable information on AD treatments, such as TCS and emollients. Therefore, they feel motivated to educate patients about AD (symptoms, causes, tips to avoid exacerbations) and its treatment (mechanisms, application and side effects).

While general practitioners (GPs) and dermatologists often provide initial counselling, patients may forget details. Reiterating this information at the pharmacy helps reinforce key aspects of their condition and its treatment.

T1: “Because when you get told a story, you have forgotten half of it before you even walk out of the doctor’s office. Now [when the patient is educated by using the patient information booklet], they [the patient] will think, ‘Oh, […], it’s better if I don’t shower too hot, let’s lower the temperature’. I think that it really has added value.”

Community pharmacies may be experienced as more accessible than GPs or dermatologists for AD-related questions. However, one technician (T3) mentioned that patients may decline counselling due to time constraints or a lack of confidence in the expertise of pharmacy staff members. The new informational materials may raise awareness of the advantages of community pharmacy services.

T3: “I notice that patients do not want to listen to the pharmacy. They are mainly interested in what the doctor tells them. There could be some more awareness there, […] that the pharmacy can also play an important role in the treatment of AD, […] and that we also have the required expertise to counsel them.”

Eventually, most technicians believed they could contribute to better control of AD symptoms and TCS use by initiating accessible conversations about AD and its treatment when patients collect their medication in the pharmacy.

On the other hand, some pharmacy technicians believed that the most appropriate place for the provision of some specific information, for example regarding the skin condition of AD itself (such as triggers and causes of AD and the prognosis), would be the doctor’s office instead of the pharmacy:

Furthermore, many pharmacy technicians questioned whether patients would actually read the booklet. Therefore, these pharmacy technicians mentioned being less motivated to hand out the booklets during the counselling sessions.

T7: “People generally do not read patient information leaflets at all. Therefore, we often only give them a printout [with information about the TCS or emollient]. But now they receive a whole book to read? I wonder [if they will read it].”

Opportunity: organization

Most technicians agreed that explaining the information booklet during counselling takes extra time, but they certainly recognized its added value. However, some technicians considered this approach impractical for the current situation, since there is already limited time for counselling during busy periods.

T8: “Providing and explaining the information booklet at the counter seems too time-consuming to me, especially considering the limited time we already have during counselling.”

T4: “Explaining the information booklet during counselling costs some extra time; however, it improves the quality of our counselling.”

Opportunity: needed resources to educate patients in the pharmacy

Some technicians noted that digital forms of information materials, such as a mobile app or short videos, would add extra opportunities to inform patients about AD, TCS and emollients. This might also be more comprehensible for patients with low health literacy. In addition, technicians also mentioned that they see value in explanation cards about TCS and emollients for technicians to use in the pharmacy, and separate handouts with schedules to support therapy adherence.

Furthermore, participants found the option of a physical booklet or a summary of the booklet (e.g. leaflet) valuable for specific populations, such as the elderly, parents with young children and disabled people.

Survey about the e-learning

A total of 13 pharmacy staff members (n = 1–3 per pharmacy) followed the e-learning and completed the survey. Participants’ views on the statements are shown in Fig. 1.

Fig. 1

Pharmacy staff views on different statements concerning topical corticosteroids and the e-learning. This figure displays the results of a survey on the effectiveness of an e-learning module about atopic dermatitis. The bars represent the level of agreement with four statements. The majority of respondents agreed with the statements (ranging from 76.9% to 92.3%), while a small percentage remains neutral or unsure, or disagreed

The pharmacy staff members mostly agreed that the e-learning provided them more insight into the skin condition (76.9%). The e-learning allowed pharmacy technicians to better advise patients about the use of both emollients and TCS (respectively 92.3% and 76.9%). In addition, 76.9% of participating pharmacy technicians and pharmacists (n = 10) felt more capable of motivating patients to use their topical corticosteroids properly.

Patients’ perspectivesSurvey about the patient information booklet

Of 39 respondents to the patient survey, 31 (79.5%) patients read the booklet and completed the section about experiences with the information booklet. Two thirds of these patients found the information booklet visually appealing (67.8%) and gained knowledge about AD through the booklet (61.3%). Additionally, the majority of patients found the booklet easy to understand (80.6%) (Fig. 2a). Sixteen patients only read part of the booklet. The chapters that were read by patients who did not read the whole booklet are shown in Appendix I. The question about preferred methods for receiving information about AD was completed by 35 patients. Most patients would prefer to receive a paper hand-out of the information booklet when visiting their healthcare provider (65.7%). Some patients would like to receive the information digitally, for instance through an app (20.0%), email (34.3%) or online video (14.3%).

Fig. 2

Patient views on different statements about a the patient information booklet and b patient counselling in the pharmacy. This figure displays the results of a survey on patient experiences with the patient information booklet and the counselling in the pharmacy. The bars represent the level of agreement with four statements. The majority of respondents agreed with the statements (ranging from 39.5% to 86.8%)

Counselling of patients

Figure 2b presents an overview of patients’ experiences with counselling in the pharmacy (completed by 38 patients). Many patients felt adequately assisted (86.8%) by the pharmacy technician and thought they had sufficient knowledge (84.2%). Counselling sessions increased the confidence in TCS use for 39.5% of patients.