{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T08:18:54Z","timestamp":1770970734487,"version":"3.50.1"},"reference-count":37,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100013789","name":"Alopecia UK","doi-asserted-by":"publisher","award":["AUK2022_001"],"award-info":[{"award-number":["AUK2022_001"]}],"id":[{"id":"10.13039\/100013789","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,12,21]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Develop recommendations for multidisciplinary, multisector care providers involved in supporting individuals with alopecia areata (AA) to promote their well-being of these individuals. AA is a condition that causes hair loss on the scalp and, for some, the head or whole body and is associated with difficulties in psychosocial adjustment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A modified Delphi consensus study with three rounds: round 1 was a qualitative survey to generate recommendations; round 2 involved a rating survey to work towards consensus on important items to retain and round 3 asked panellists from four different support roles to establish the most relevant items for their respective roles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The UK, across healthcare, charitable and private health and mental health sectors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Panellists held two forms of expertise. One group consisted of experts in support roles, comprising medical professionals (general practitioners and dermatologists), mental health professionals, peer facilitators and trichologists. All were selected due to their experience of working with individuals who have AA. The other group consisted of experts by experience, namely adults living with AA who had some experience of receiving support from the above care providers. 48 panellists contributed to round 1 (22 experts by support role, 29 experts by experience and 3 with dual roles), 46 to round 2 (21 experts by support role, 27 experts by experience and 3 with dual roles) and 23 experts by support role completed round 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data analysis<\/jats:title>\n                    <jats:p>In round 1, data were analysed using qualitative content analysis. In round 2, panellists rated the importance of all recommendation items on a single 1\u20135 scale. Consensus was determined by \u226580% agreement between panellists that items were moderately or very important.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Multiple candidate recommendations were generated from round 1, and following round 2, all but one were retained in the list presented in round 3. Items rated as relevant to all care providers in round 3 included \u2018Validate (and explore) the emotional impact of AA\u2019, \u2018Respect and work with individuals\u2019 chosen coping strategies (where no clear harm is caused)\u2019 and \u2018There should be a holistic, multi-support-role and multisector approach to psychological support\u2019. There was notable overlap in the recommendation principles generated across each support role, but the details of how these can be delivered by each group differed. There were also a number of unique recommendations for each support role.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Medical professionals, mental health professionals, trichologists and peer support facilitators can each play a role in promoting the psychological well-being of individuals with AA. The distinct roles and skill sets of each group point to the need for a multidisciplinary approach to supporting the well-being of affected individuals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-094491","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T15:27:14Z","timestamp":1770737234000},"page":"e094491","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Developing recommendations for promoting wellbeing in individuals with alopecia areata: a modified Delphi study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2813-8015","authenticated-orcid":false,"given":"Fabio","family":"Zucchelli","sequence":"first","affiliation":[{"name":"University of the West of England, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kerry","family":"Montgomery","sequence":"additional","affiliation":[{"name":"Centre for Appearance Research, UWE Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"2026021223252700000_16.2.e094491.1","doi-asserted-by":"publisher","DOI":"10.1038\/jid.2013.464"},{"key":"2026021223252700000_16.2.e094491.2","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1111\/bjd.20628","article-title":"The epidemiology of alopecia areata: a population-based cohort study in UK primary care","volume":"186","author":"Harries","year":"2022","journal-title":"Br J Dermatol"},{"key":"2026021223252700000_16.2.e094491.3","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1007\/s12016-017-8620-9","article-title":"Alopecia Areata: a Comprehensive Review of Pathogenesis and Management","volume":"54","author":"Tr\u00fceb","year":"2018","journal-title":"Clin Rev Allergy Immunol"},{"key":"2026021223252700000_16.2.e094491.4","doi-asserted-by":"crossref","unstructured":"Fukumoto T , Fukumoto R , Magno E , et al . Treatments for alopecia areata: A systematic review and network meta-analysis. Dermatol Ther 2021;34. doi:10.1111\/dth.14916","DOI":"10.1111\/dth.14916"},{"key":"2026021223252700000_16.2.e094491.5","doi-asserted-by":"crossref","unstructured":"Liu M , Gao Y , Yuan Y , et al . Janus Kinase Inhibitors for Alopecia Areata: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023;6. doi:10.1001\/jamanetworkopen.2023.20351","DOI":"10.1001\/jamanetworkopen.2023.20351"},{"key":"2026021223252700000_16.2.e094491.6","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1001\/jamadermatol.2022.6085","article-title":"Prevalence and Odds of Depressive and Anxiety Disorders and Symptoms in Children and Adults With Alopecia Areata","volume":"159","author":"Lauron","year":"2023","journal-title":"JAMA Dermatol"},{"key":"2026021223252700000_16.2.e094491.7","doi-asserted-by":"crossref","first-page":"1054898","DOI":"10.3389\/fmed.2022.1054898","article-title":"Anxiety, depression, and quality of life in children and adults with alopecia areata: A systematic review and meta-analysis","volume":"9","author":"van Dalen","year":"2022","journal-title":"Front Med"},{"key":"2026021223252700000_16.2.e094491.8","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1016\/j.jaad.2019.05.086","article-title":"Association between alopecia areata, anxiety, and depression: A systematic review and meta-analysis","volume":"88","author":"Okhovat","year":"2023","journal-title":"J Am Acad Dermatol"},{"key":"2026021223252700000_16.2.e094491.9","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.14497"},{"key":"2026021223252700000_16.2.e094491.10","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.jaad.2020.06.047","article-title":"Psychosocial and psychiatric comorbidities and health-related quality of life in alopecia areata: A systematic review","volume":"85","author":"Toussi","year":"2021","journal-title":"J Am Acad Dermatol"},{"key":"2026021223252700000_16.2.e094491.11","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1111\/bjd.17463","article-title":"Living with alopecia areata: an online qualitative survey study","volume":"180","author":"Davey","year":"2019","journal-title":"Br J Dermatol"},{"key":"2026021223252700000_16.2.e094491.12","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2008.09014.x"},{"key":"2026021223252700000_16.2.e094491.13","doi-asserted-by":"crossref","unstructured":"Zucchelli F , van Dalen M , Sharratt N , et al . Patients\u2019 experiences of primary healthcare and dermatology provision for alopecia. Skin Health Dis 2024;4. doi:10.1002\/ski2.324","DOI":"10.1002\/ski2.324"},{"key":"2026021223252700000_16.2.e094491.14","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.jaad.2016.10.012","article-title":"Can mindfulness-based interventions improve the quality of life of patients with moderate\/severe alopecia areata? A prospective pilot study","volume":"76","author":"Gallo","year":"2017","journal-title":"J Am Acad Dermatol"},{"key":"2026021223252700000_16.2.e094491.15","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1017\/S1352465823000292","article-title":"The effectiveness of mindfulness-based cognitive therapy for social anxiety symptoms in people living with alopecia areata: a single-group case-series design","volume":"51","author":"Heapy","year":"2023","journal-title":"Behav Cogn Psychother"},{"key":"2026021223252700000_16.2.e094491.16","doi-asserted-by":"crossref","first-page":"35","DOI":"10.2340\/00015555-1012","article-title":"Hypnosis and alopecia areata: Long-term beneficial effects on psychological well-being","volume":"91","author":"Willemsen","year":"2011","journal-title":"Acta Derm Venereol"},{"key":"2026021223252700000_16.2.e094491.17","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.jaad.2005.09.025","article-title":"Hypnotherapeutic management of alopecia areata","volume":"55","author":"Willemsen","year":"2006","journal-title":"J Am Acad Dermatol"},{"key":"2026021223252700000_16.2.e094491.18","unstructured":"Johnson A , Rees J , Delduca C , et al . Psychological support in cancer care: Sharing good practice. MacMillian Cancer Support, 2015:1\u201314."},{"key":"2026021223252700000_16.2.e094491.19","doi-asserted-by":"crossref","first-page":"e130","DOI":"10.1111\/bjd.18498","article-title":"Experience of online peer support for alopecia","volume":"181","author":"Iliffe","year":"2019","journal-title":"Br J Dermatol"},{"key":"2026021223252700000_16.2.e094491.20","doi-asserted-by":"crossref","unstructured":"Montgomery K , White C , Thompson A . A mixed methods survey of social anxiety, anxiety, depression and wig use in alopecia. BMJ Open 2017;7. doi:10.1136\/bmjopen-2016-015468","DOI":"10.1136\/bmjopen-2016-015468"},{"key":"2026021223252700000_16.2.e094491.21","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1037\/sah0000212","article-title":"Becoming known: Disclosure and exposure of (in)visible difference","volume":"5","author":"Sharratt","year":"2020","journal-title":"Stigma Health"},{"key":"2026021223252700000_16.2.e094491.22","doi-asserted-by":"crossref","unstructured":"Zucchelli F , Sharratt N , Montgomery K , et al . Men\u2019s experiences of alopecia areata: A qualitative study. Health Psychol Open 2022;9. doi:10.1177\/20551029221121524","DOI":"10.1177\/20551029221121524"},{"key":"2026021223252700000_16.2.e094491.23","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmp051"},{"key":"2026021223252700000_16.2.e094491.24","doi-asserted-by":"crossref","first-page":"37","DOI":"10.7748\/nr2012.01.19.2.37.c8907","article-title":"Delphi research: issues raised by a pilot study","volume":"19","author":"Clibbens","year":"2012","journal-title":"Nurse Res"},{"key":"2026021223252700000_16.2.e094491.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2011.10.016"},{"key":"2026021223252700000_16.2.e094491.26","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.331.7522.951"},{"key":"2026021223252700000_16.2.e094491.27","doi-asserted-by":"crossref","first-page":"318","DOI":"10.2340\/00015555-1031","article-title":"Psychosocial stress and coping in alopecia areata: a questionnaire survey and qualitative study among 45 patients","volume":"91","author":"Matzer","year":"2011","journal-title":"Acta Derm Venereol"},{"key":"2026021223252700000_16.2.e094491.28","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2648.2000.01567.x"},{"key":"2026021223252700000_16.2.e094491.29","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2007.04569.x"},{"key":"2026021223252700000_16.2.e094491.30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.12.002"},{"key":"2026021223252700000_16.2.e094491.31","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1111\/jdv.19768","article-title":"European expert consensus statement on the systemic treatment of alopecia areata","volume":"38","author":"Rudnicka","year":"2024","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2026021223252700000_16.2.e094491.32","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s41687-020-00240-7","article-title":"\u201c\u2018You lose your hair, what\u2019s the big deal?\u2019 I was so embarrassed, I was so self-conscious, I was so depressed:\u201d a qualitative interview study to understand the psychosocial burden of alopecia areata","volume":"4","author":"Aldhouse","year":"2020","journal-title":"J Patient Rep Outcomes"},{"key":"2026021223252700000_16.2.e094491.33","doi-asserted-by":"crossref","unstructured":"Barkauskaite R , Serapinas D . Therapeutic implications of psychological state in patients with alopecia areata: A qualitative study. Dermatol Ther 2020;33. doi:10.1111\/dth.14269","DOI":"10.1111\/dth.14269"},{"key":"2026021223252700000_16.2.e094491.34","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1027\/2512-8442\/a000086","article-title":"An Evaluation of the PERMA Model as a Framework for Reducing Psychiatric Comorbidity in Individuals With Alopecia Areata","volume":"29","author":"Huck","year":"2022","journal-title":"European Journal of Health Psychology"},{"key":"2026021223252700000_16.2.e094491.35","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.bodyim.2009.03.004","article-title":"The lived experience of alopecia areata: a qualitative study","volume":"6","author":"Welsh","year":"2009","journal-title":"Body Image"},{"key":"2026021223252700000_16.2.e094491.36","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.bodyim.2014.01.004","article-title":"Can you pull it off? Appearance modifying behaviours adopted by wig users with alopecia in social interactions","volume":"11","author":"Wiggins","year":"2014","journal-title":"Body Image"},{"key":"2026021223252700000_16.2.e094491.37","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1177\/1359105317752826","article-title":"Applying the Common Sense Model to predicting quality of life in alopecia areata: The role of illness perceptions and coping strategies","volume":"24","author":"Willemse","year":"2019","journal-title":"J Health Psychol"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-094491","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T07:25:49Z","timestamp":1770967549000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-094491"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":37,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,10]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/bmjopen-2024-094491"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-094491","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}