At all stages of the programme, we sought diversity among both research participants and public contributors. During intervention development, feedback was sought from a diverse group of 55 young people and parents/carers of children with eczema. We sampled participants from a wide range of ethnic and socioeconomic backgrounds, ages, gender and eczema severity. During our clinical trial, we monitored participant characteristics and noticed early on that we were recruiting significantly fewer men aged 13–25 compared to women. In response, we carried out a review of invitation materials to help improve appeal to young men. We showed our study documents to five young men to obtain feedback which led to a series of changes, including adding a QR code to the invitation and making information about gift vouchers more prominent. While this resulted in a small increase in uptake among young men, they remained under-represented in the sample. This highlights the need to engage under-represented groups (in this case young men) more systematically in the earlier phases of intervention development. The INCLUDE Ethnicity Framework80 will be helpful in designing future trials and seeking to maximise inclusion and applicability to underserved groups, although was not available at the start of designing this trial. We are taking this practice forward in our ongoing programme grant Acne Care Online (NIHR PGfAR 202852).
We ensured that all programme materials used inclusive language (e.g. ‘parents and carers’ to include a range of family structures) and used inclusive imagery in all study materials (e.g. ethnic diversity). We iterated all public-facing materials with public contributors to maximise accessibility in terms of language and layout.
In implementing the interventions, we prioritised making the resources freely available to be used by any member of the public who needs them. This was emphasised as a priority throughout the programme by public contributors and is key to ensuring that the benefits of the intervention can be disseminated in a way that minimises the risk of increasing inequalities in health. We have achieved this in the short term by negotiating a 5-year web-hosting term with our commercial partners.