Knowledge mobilisation: an ethnographic study of the influence of lay mindlines on eczema self-management in primary care in the UK

OBJECTIVE: To investigate the way in which mindlines, ‘collectively reinforced, internalised tacit guidelines’, are constructed among lay people with eczema in primary care. DESIGN: Ethnographic study. SETTING: Observation in one general practice in the UK and interviews across central England. PARTICIPANTS: In observation, patients in the participating general practice regardless of presenting complaint and in interviews, people with eczema or parents of children with eczema (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. Four themes were identified: doctor knows best; not worth bothering the doctor; I need to manage this myself; and how I know what to do. Themes were set within the context of four broad typologies of lay people’s approach to self-management: content to self-manage; content to accept practitioner management; self-managing by default; and those referred to secondary care. CONCLUSIONS: This study is the first to examine how lay eczema mindlines are developed and to recognise typologies of people with different need for, and receptiveness to, information. Lay eczema mindlines are constructed in many ways. The outstanding challenge is to find strategies to revise or modify these mindlines by adding reliable and useful knowledge and by erasing outdated or inaccurate information.