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Using the term "topical medication" instead of "topical steroid," the latter of which may carry negative connotations for some, could improve health literacy and adherence to topical steroid treatments for atopic dermatitis (AD) for some caregivers of children with the condition.

That's according to a survey of 874 caregivers of children with AD, which appeared recently in the .

The research team used Amazon MTurk platform to conduct the survey. Respondents were presented with three descriptions of topical corticosteroids: "topical steroid," "topical medication," or "treatment, similar to the all-natural signals produced by the adrenal glands in the body." Those who were presented with the term "topical medication" reported greater willingness to treat than those presented with a "topical steroid" and "all-natural treatment" in the descriptive heading dataset (P<0.05).

Study co-author, Steven Feldman, MD, PhD, director of the Center for Dermatology Research at Wake Forest University School of Medicine in North Carolina, discussed the survey findings and potential implications with the Reading Room. The exchange has been edited for length and clarity.

Could you explain the context that gave rise to this investigation, and the central question the survey was designed to address?

Feldman: Caregivers are often apprehensive about treating childhood AD with topical corticosteroids but may find comfort if treatments are presented in a patient-centered manner.

We set out to figure out what kind of language might put people more at ease with respect to a common dermatological treatment. There are real fears about steroids, and I don't know that those fears are based on the kinds of steroids we use for conditions like eczema. It could be that people have visions of cheating in professional sports or serious health effects. So, we looked at whether describing something as a steroid, a medication, or an all-natural product might affect a caregiver's willingness to use the treatment.

You used a modernized methodology to conduct the survey. Can you describe the tool you used?

Feldman: It was a fascinating methodology. The survey was done online using Amazon. It used to be that if you wanted to do a survey, you got a bunch of sheets of paper and handed them out to patients, or you could mail them out. A study on psoriasis and the demographics of patients with psoriasis was done in the 1960s by having dermatologists fill out a postcard every time they saw a psoriasis patient and send it to the researcher.

Nowadays, you can just sign up for this Amazon service. You put the questions online and you get the answers back fairly quickly. It's a great tool for answering interesting questions, especially for researchers like me who don't have the natural patience for real research.

What were the survey's key findings?

Feldman: We found there were some slight tendencies toward preferring a standard medical language like it's a medication. I think the take-home message is not that you want to tell everybody it's a medication. We saw a range of preferences. For example, certain people may be more responsive to a medication that's described as an all-natural, organic anti-inflammatory designed to complement their natural healing mechanisms. Whereas in some other population or part of the country, folks are happy to hear it's a medication.

Was the straightforward "steroid" label the least well-received?

Feldman: Yes, but there wasn't a huge difference. We found statistically significant differences, but just because something is statistically significantly different doesn't mean it's very different. So yes, there were some differences, but the overlap was much greater than the differences in the averages.

To put a finer point on it, do these findings indicate that it may be a matter of tailoring the message to the recipient? Is this a potential means of increasing health literacy?

Feldman: Yes. The bottom line is that there's large variation in how comfortable people are in how medications are presented, and it's up to the clinician to be thoughtful about the language used to present something to patients in a way that may be worthwhile.

I do think health literacy is a really good way to frame this. People talk about health literacy in terms of patients, what their knowledge is, and how well they can interpret things. But the human brain is really a fascinating thing. It doesn't measure absolute reality very well, and how you present something to somebody can have an enormous impact on their perception of it.