"It's safer to …" parent consulting and clinician antibiotic prescribing decisions for children with respiratory tract infections: An analysis across four qualitative studies. (July 2015)

• Record Type: Journal Article
• Authors: Cabral, Christie; Lucas, Patricia J.; Ingram, Jenny; Hay, Alastair D.; Horwood, Jeremy
• Is Part Of: Social science & medicine. Volume 136/137(2015)
• Page Start: 156
• Page End: 164
• Publication Date: 2015-07
• Subjects: United Kingdom -- Child health -- Primary care -- Consulting -- Prescribing -- Antibiotics -- Health behaviours -- Social norms; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2015.05.027
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: This paper reports a cross-study analysis of four studies, aiming to understand the drivers of parental consulting and clinician prescribing behaviour when children under 12 years consult primary care with acute respiratory tract infections (RTI). Qualitative data were obtained from three primary studies and one systematic review. Purposeful samples were obtained for (i) a focus group study of parents' information needs and help seeking; (ii) an interview study of parents' experiences of primary health care (60 parents in total); and (iii) an interview study of clinicians' experiences of RTI consultations for children (28 clinicians). The systematic review synthesised parent and clinician views of prescribing for children with acute illness. Reoccurring themes and common patterns across the whole data set were noted. Through an iterative approach involving re-examination of the primary data, translation of common themes across all the studies and re-organisation of these themes into conceptual groups, four overarching themes were identified. These were: the perceived vulnerability of children; seeking safety in the face of uncertainty; seeking safety from social disapproval; and experience and perception of safety. The social construction of children as vulnerable and normative beliefs about the roles of parents and clinicians were reflected in parents' and clinicians' beliefs and decision making when a child had an RTI. Consulting and prescribing antibiotics were both perceived as the safer course of action. Therefore perception of a threat or uncertainty about that threat tended to lead to parental consulting and clinician antibiotic prescribing. Clinician and parent experience could influence the perception of safety in either direction, depending on whether previous action had resulted in perceived increases or decreases in safety. Future interventions aimed at reducing unnecessary consulting or antibiotic prescribing need to consider how to make the desired action fit with social norms and feel safer for parents and clinicians. Highlights: The social construction of child vulnerability influenced the management of RTI in children. Social norms influenced parents and clinicians to act to protect children from perceived threats. Consulting and prescribing antibiotics were both perceived as the safer course of action. Perceived threat tended to lead parents to consult and clinicians to prescribe antibiotics. Future interventions should align with social norms and increase children's perceived safety.