Developing recommendations for promoting wellbeing in individuals with alopecia areata: a modified Delphi study.

A modified Delphi study with three rounds generated and refined recommendations for promoting wellbeing in individuals with alopecia areata across multiple care provider roles.

• Round 1 was a qualitative survey to generate recommendations; round 2 involved a rating survey to work towards consensus; round 3 asked panellists from four different support roles to establish the most relevant items for their respective roles.
• 48 panellists contributed to round 1 (22 experts by support role, 29 experts by experience, and 3 with dual roles).
• 46 panellists contributed to round 2 (21 experts by support role, 27 experts by experience, and 3 with dual roles).
• 23 experts by support role completed round 3.
• Panellists were drawn from healthcare, charitable, and private health and mental health sectors in the UK.

Following round 2 consensus rating, nearly all candidate recommendation items were retained for presentation in round 3.

• Consensus was determined by ≥80% agreement between panellists that items were moderately or very important (rated on a single 1–5 scale).
• Multiple candidate recommendations were generated from round 1, and following round 2, all but one were retained in the list presented in round 3.

Three recommendation items were rated as relevant to all care provider roles in round 3.

• These items were: 'Validate (and explore) the emotional impact of AA', 'Respect and work with individuals' chosen coping strategies (where no clear harm is caused)', and 'There should be a holistic, multi-support-role and multisector approach to psychological support'.
• These cross-cutting recommendations applied across medical professionals, mental health professionals, trichologists, and peer support facilitators.
• Items were identified as universally relevant through round 3 ratings by 23 experts by support role.

There was notable overlap in recommendation principles across each support role, but the details of delivery differed by group, and unique recommendations existed for each role.

• Medical professionals, mental health professionals, trichologists, and peer support facilitators were identified as each able to play a role in promoting psychological well-being.
• The distinct roles and skill sets of each group were found to point to the need for a multidisciplinary approach.
• Both shared principles and role-specific recommendations were identified through the Delphi process.

Alopecia areata is associated with difficulties in psychosocial adjustment, providing the rationale for developing multidisciplinary wellbeing recommendations.

• AA causes hair loss on the scalp and, for some, the head or whole body.
• The condition is described as associated with difficulties in psychosocial adjustment.
• The study was motivated by the need for recommendations applicable across healthcare, charitable, and private health and mental health sectors.