The Paradox of Education and the Failure of Communication: A Cross-Sectional Study of Topical Corticosteroid Phobia and Its Impact on Treatment Adherence Among Urban Primary Care Patients in Shenzhen, China

Jingkai Huang,1 Weifeng Chen,2 Li Ma,1 Ziping Wen,1 Minglan Shi,1 Fang Hong,1 Suchun Hou1 1Department of Dermatology, Shenzhen University General Hospital, Shenzhen, Guangdong, People’s Republic of China; 2Shuguang Community Health Service Center, Nanshan Medical Group Headquarters, Shenzhen, Guangdong, People’s Republic of ChinaCorrespondence: Suchun Hou, Department of Dermatology, Shenzhen University General Hospital, Shenzhen, Guangdong, People’s Republic of China, Email [email protected]: Topical corticosteroid (TCS) phobia is increasingly recognized as a barrier to treatment adherence in dermatology. However, evidence from community-based primary care settings in urban China remains limited. Understanding patient perceptions in these settings is essential for improving adherence and promoting shared decision-making.Purpose: To investigate the prevalence of TCS phobia among urban primary care patients in Shenzhen, identify associated factors, and evaluate its influence on treatment preferences and adherence behaviors.Patients and Methods: A cross-sectional survey was conducted among community residents attending urban primary care clinics using an anonymous electronic questionnaire. Of the 300 eligible patients approached, 199 provided valid responses, yielding a response rate of 66.3%. An anonymous electronic questionnaire captured demographic data, TCS knowledge, attitudes, information sources, and treatment behaviors. Associations with TCS phobia were assessed using Chi-square tests.Results: TCS phobia was reported by 26.1% of participants. Higher educational attainment was significantly associated with greater phobia (P = 0.021), demonstrating an “education paradox.” Misconceptions related to systemic adverse effects—especially weight gain (P < 0.001) and organ damage (P = 0.009)—were the strongest contributors to phobia. Concerns about local side effects did not differ significantly between groups. TCS phobia was strongly associated with refusal of prescribed therapy and preference for “natural” products (both P < 0.001). Knowledge of appropriate TCS use and information sources (physicians or media) did not significantly influence phobia levels.Conclusion: TCS phobia is common among educated urban primary care patients and is driven primarily by incorrect beliefs about systemic toxicity. These fears have direct, negative consequences on treatment adherence. Current communication strategies appear insufficient. Patient-centered counseling that directly addresses misconceptions and emphasizes the distinction between topical and systemic corticosteroids is urgently needed in primary care practice.Keywords: topical corticosteroid phobia, patient adherence, treatment refusal, health literacy, patient perceptions, primary care