A qualitative interview study of parents’ perspectives, concerns and experiences of the management of lower respiratory tract infections in children in primary care

AbstractObjective: To explore parents’ perspectives, concerns and experiences of the management of lower respiratory tract infections (LRTIs) in children in primary care.Design: Qualitative semi-structured interview study.Setting: UK primary careParticipants: 23 parents of children aged from six months to ten years presenting with LRTI in primary care.Method: Thematic analysis of semi-structured interviews (either in person or by telephone) conducted with parents to explore their experiences and views on their children being prescribed antibiotics for LRTI.Results: Four major themes were identified and these are perspectives on: 1) infection, 2) antibiotic use, 3) the GP appointment, and 4) decision-making around prescribing. Symptomatic relief was a key concern: the most troublesome symptoms were cough, breathing difficulty, fever and malaise. Many parents were reluctant to use self-care medication, tended to support antibiotic use, and believed they are effective for symptoms, illness duration and for preventing complications. However, parental expectations varied from a desire for reassurance and advice to an explicit preference for an antibiotic prescription. These preferences were shaped by: 1) the age of the child, with younger children perceived as more vulnerable because of their greater difficulty in communicating, and concerns about rapid deterioration; 2) the perceived severity of the illness; and 3) disruption to daily routine. When there was disagreement with the GP parents described feeling dismissed, and they were critical of inconsistent prescribing when they re-consult. When agreement between the parent and doctor featured, parents described a feeling of relief and legitimation for consulting, feeling reassured that the illness did indeed warrant a doctor’s attention.Conclusion: Symptomatic relief is a major concern for parents. Careful exploration of expectations, and eliciting worries about key symptoms and impact on daily life will be needed to help parents understand when a no antibiotic recommendation or delayed antibiotic recommendation is made