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Objectives: Digital interventions are increasingly used to support behaviour change. In the prevention of chronic work-related skin diseases, the sustainable implementation of appropriate skin protection behaviour following tertiary individual prevention is important. However, there exists no intervention to support the maintenance of these behaviour changes until now. We report the systematic development of a technology-based maintenance programme to support patients to sustainably implement skin protection behaviour and to overcome barriers. Design: Complex intervention development based on a five-step multi-methods process. Setting: Tertiary individual prevention of work-related skin disease in Germany. Methods: Intervention development comprised the following steps--literature review, qualitative focus groups with stakeholders, quantitative assessment of the patients' needs, development of a programme theory, and intervention development and concept validation. Results: We developed a concept for a complex intervention based on results from the literature review, with seven reviews meeting the criteria; qualitative focus groups involving three dermatologists, five health educators, two psychologists and three employees of an accident insurance institution; and a quantitative needs assessment with 72 patients. Key requirements were derived from this process: for example, the need to develop an app to self-monitor skin protection behaviour and skin condition and to inform the individual about ways of dealing with barriers encountered during the uptake and maintenance of skin protection behaviour. In addition, patients will participate in an individual goal-setting exercise to identify individual behavioural goals. Conclusion: A technology-based approach to the prevention of work-related skin diseases was developed. During the process of development, the perspectives of relevant stakeholders and the target group were considered in a participatory way.

Background: A programme based on health education has been developed to prevent foot dermatoses (FD) in patients with work‐related skin diseases (WRSD). Objective: To evaluate the effectiveness of the programme in a prospective cohort study (OCCUPES). Methods: Six and 12 months after completing the programme, follow‐up questionnaires were sent to 231 patients with WRSD and FD. Assessments included occupational footwear and foot care, self‐reported disease course, and health‐related quality of life. Results: Response to follow‐ups was >70%. Wearing functional socks and changing footwear and socks during one work shift increased (all p < 0.001). Complaints about occupational footwear decreased, including sweating and exposure to moisture/wetness. More than 60% reported improved FD while quality of life significantly increased. After 12 months, all foot symptoms were less frequent, including itch (p = 0.009), pain when walking (p = 0.005), pain in rest (p = 0.015) and smell (p = 0.001). The programme received very good ratings by the participants. Conclusions: The intervention was effective in improving occupational footwear, foot care and preventive behaviour. It resulted in a reduced burden of FD and should be implemented in the general care of patients with WRSD. [ABSTRACT FROM AUTHOR]

Background: Programmes for prevention of hand dermatoses in patients with work‐related skin diseases (WRSD) are well established. Similar interventions for foot dermatoses (FD) are widely missing. Objective: To evaluate the effectiveness of a programme for prevention of FD based on health education in patients with WRSD while investigating the impact and possible causative factors of FD. Methods: In a prospective cohort study (OCCUPES), 231 patients with WRSD and FD participating in the programme were recruited. The skin was examined and questionnaires were completed, including assessment of footwear, FD severity, symptoms and health‐related quality of life. Results: The baseline and some early results are presented. A work‐related causation of FD was likely in 60 patients (26.0%) with irritant contact dermatitis being the most frequent diagnosis. Work‐related FD were associated with male sex (p = 0.012), sweating in footwear (p = 0.004) and wearing of safety footwear (p = 0.013). FD were often long‐lasting with a high degree of work‐absenteeism, quality of life impairment, itch and pain, particularly in work‐related FD. Conclusions: Interventions are needed to reduce the burden of FD in patients with WRSD. The programme addresses current shortcomings in prevention of FD. A long‐term evaluation of its effectiveness follows. [ABSTRACT FROM AUTHOR]

Objectives: Digital interventions are increasingly used to support behaviour change. In the prevention of chronic work-related skin diseases, the sustainable implementation of appropriate skin protection behaviour following tertiary individual prevention is important. However, there exists no intervention to support the maintenance of these behaviour changes until now. We report the systematic development of a technology-based maintenance programme to support patients to sustainably implement skin protection behaviour and to overcome barriers. Design: Complex intervention development based on a five-step multi-methods process. Setting: Tertiary individual prevention of work-related skin disease in Germany. Methods: Intervention development comprised the following steps: literature review, qualitative focus groups with stakeholders, quantitative assessment of the patients' needs, development of a programme theory, and intervention development and concept validation. Results: We developed a concept for a complex intervention based on results from the literature review, with seven reviews meeting the criteria; qualitative focus groups involving three dermatologists, five health educators, two psychologists and three employees of an accident insurance institution; and a quantitative needs assessment with 72 patients. Key requirements were derived from this process: for example, the need to develop an app to self-monitor skin protection behaviour and skin condition and to inform the individual about ways of dealing with barriers encountered during the uptake and maintenance of skin protection behaviour. In addition, patients will participate in an individual goal-setting exercise to identify individual behavioural goals. Conclusion: A technology-based approach to the prevention of work-related skin diseases was developed. During the process of development, the perspectives of relevant stakeholders and the target group were considered in a participatory way. [ABSTRACT FROM AUTHOR]

Background: In Germany, a multistep approach has been established to prevent work‐related skin diseases (WRSDs). Objectives: To evaluate the effect of a secondary individual prevention program (SIP) in metalworkers with WRSD and to compare their characteristics with those of participants of a tertiary individual prevention program (TIP). Patients and Methods: In a prospective cohort study, metalworkers with WRSD of the hands participating either in the SIP (n = 114) or in the TIP (n = 83) were recruited. At baseline and at the respective follow‐up 8–12 weeks after the SIP or at dismissal from the TIP (3–4 weeks later), questionnaires were completed and the severity of WRSD was assessed. Saliva samples were collected for assessment of filaggrin (FLG) mutations and an explorative genome‐wide association study (GWAS). Results: Ninety‐three SIP patients (81.6%) attended the follow‐up. Disease severity was significantly reduced, and knowledge and protective behavior were significantly improved compared to baseline. Significant differences between SIP and TIP patients were found regarding duration and severity of symptoms, work absenteeism, tobacco smoking, and presence of atopic dermatitis, but not regarding FLG mutations and by GWAS. Conclusions: The SIP was effective in metalworkers with WRSDs. Individual factors may influence the course of the disease and the need for the TIP. [ABSTRACT FROM AUTHOR]

Background: Metal work apprentices (MWAs) frequently develop work‐related hand eczema (HE). Objectives: To evaluate the effect of health education on incidence of work‐related HE in MWAs and to assess confounding factors. Materials/methods: In a prospective controlled intervention study, 131 MWAs received educational training on prevention of HE, whereas 172 MWAs and 118 office work apprentices served as controls. At baseline and during three yearly follow‐ups, questionnaires were completed and hands were examined. Saliva samples were collected for assessment of filaggrin (FLG) null mutations and an explorative genome‐wide association study (GWAS), and levels of various cytokines were assessed from stratum corneum samples. Results: The 2‐year and 3‐year incidence of HE in the metalwork control group was 20.9% and 32.6%, respectively, which was significantly higher than in the intervention group (odds ratio [OR] 2.63, 95% confidence interval [CI] 1.31 to 5.28, P <.01 and OR 3.47, 95% CI 1.88 to 6.40, P <.0001). The knowledge score was higher in unaffected MWAs (P <.05). Other factors significantly associated with developing HE in MWAs were smoking cigarettes (P <.01) and FLG mutations (P <.001). No significant associations were found regarding epidermal cytokine levels and GWAS. Conclusions: Health education is effective in primary prevention of HE in MWAs. Individual factors should be considered in targeted counseling. [ABSTRACT FROM AUTHOR]

Background. Occupational hand eczema (OHE) is common in 'wet work' occupations. Thus, effective and sustainable prevention strategies are needed. Objectives. To investigate the long-term effectiveness (sustainability) of an interdisciplinary secondary prevention programme. Methods. One hundred and thirty-four patients with OHE consecutively participated in an outpatient skin protection seminar comprising dermatological and educational interventions. Data were obtained at baseline (T0) and at 9 months (T1) and 5 years (T2) after participation. A cohort of 84 patients was available for analysis of the outcomes 'job continuation', 'skin condition', 'skin protection behaviour', and 'disease management'. Results. At T2, 71.4% of patients remained in their occupation. The prevalence and severity of self-reported OHE were significantly reduced as compared with T0 ( p = 0.007, p = 0.002). Of the patients, 13.1% gave up work because of OHE at T2. The intervention was most successful in patients suffering from milder forms of OHE, and there was less success in patients with severe OHE. The results showed a significant reduction in the frequency of 'hand washing' ( p = 0.003) but no measurable change in the use of skin care products ( p = 1.000). Conclusions. The intervention showed sustainable long-term effects. Early detection and reporting of OHE in the initial stages of the disease is of utmost importance for the effectiveness of secondary prevention. In cases of severe OHE, inpatient programmes may be indicated. [ABSTRACT FROM AUTHOR]

Background. The high prevalence of occupational dermatoses indicates the need for effective and sustainable prevention strategies. Objectives. To evaluate the long-term effectiveness of secondary prevention in geriatric nurses. Patients/Methods. One hundred and two geriatric nurses with occupational hand eczema participated in an interdisciplinary prevention programme [intervention group (IG)]. Members of the control group (CG) (n = 107) were medically treated by local dermatologists. Six years after intervention (T2), data on job continuation, skin lesions and skin protection behaviour were obtained by standardized questionnaires and compared with baseline values (T0) and data from a 3-month follow-up (T1). Results. At T2, 65.3% of the IG and 56.8% of the CG still worked as geriatric nurses; 6.9% of the IG and 13.6% of the CG had given up work because of occupational hand eczema. The skin status improved in both cohorts. The data indicated a lower frequency of skin lesions and morphological signs in the IG, for example vesicles (IG, 12.8%; CG, 40.0%; χ2 = 7.00, degrees of freedom = 1, p = 0.008). Conclusions. The results indicate long-term effects regarding job continuation and disease severity, although few results showed statistical significance. It is outlined that controlled long-term studies aiming at proving the general effectiveness of secondary prevention are no longer feasible in Germany, as the statutory accident insurance has led to a legal entitlement of all patients affected by occupational hand eczema to immediate preventive intervention. [ABSTRACT FROM AUTHOR]