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Parents' and clinicians' views of an interactive booklet about respiratory tract infections in children: a qualitative process evaluation of the EQUIP randomised controlled trial

Parents' and clinicians' views of an interactive booklet about respiratory tract infections in children: a qualitative process evaluation of the EQUIP randomised controlled trial
Parents' and clinicians' views of an interactive booklet about respiratory tract infections in children: a qualitative process evaluation of the EQUIP randomised controlled trial
Background
‘When should I worry?’ is an interactive booklet for parents of children presenting with respiratory tract infections (RTIs) in primary care and associated training for clinicians. A randomised controlled trial (the EQUIP study) demonstrated that this intervention reduced antibiotic prescribing and future consulting intentions. The aims of this qualitative process evaluation were to understand how acceptable the intervention was to clinicians and parents, how it was implemented, the mechanisms for any observed effects, and contextual factors that could have influenced its effects.

Methods
Semi-structured interviews were conducted with 20 parents and 13 clinicians who participated in the trial. Interviews were audio-recorded and transcribed verbatim. Data were analysed using a framework approach, which involved five stages; familiarisation, development of a thematic framework, indexing, charting, and interpretation.

Results
Most parents and clinicians reported that the ‘When should I worry’ interactive booklet (and online training for clinicians) was easy to use and valuable. Information on recognising signs of serious illness and the usual duration of illness were most valued. The interactive use of the booklet during consultations was considered to be important, but this did not always happen. Clinicians reported lack of time, lack of familiarity with using the booklet, and difficulty in modifying their treatment plan/style of consultation as barriers to use. Increased knowledge and confidence amongst clinicians and patients were seen as key components that contributed to the reductions in antibiotic prescribing and intention to consult seen in the trial. This was particularly pertinent in a context where decisions about the safe and appropriate management of childhood RTIs were viewed as complex and parents reported frequently receiving inconsistent messages.

Conclusions
The ‘When should I worry’ booklet, which is effective in reducing antibiotic prescribing, has high acceptability for clinicians and parents, helps address gaps in knowledge, increases confidence, and provides a consistent message. However, it is not always implemented as intended. Plans for wider implementation of the intervention in health care settings would need to address clinician-related barriers to implementation.
1471-2296
Francis, Nick A.
9b610883-605c-4fee-871d-defaa86ccf8e
Phillips, Rhiannon
197e1e95-ea7d-4867-80e0-52e5c7261a8b
Wood, Fiona
7fa2fcc6-81ab-4acf-997e-4c7113c7b1fd
Hood, Kerenza
af7cf839-ca85-4ea9-83c3-3dd31be88b32
Simpson, Sharon
9b735262-6af7-40c4-a2d6-6a43cb2ddd00
Butler, Christopher C.
d2f9102c-54c2-4570-be4e-32324c8c8f1d
Francis, Nick A.
9b610883-605c-4fee-871d-defaa86ccf8e
Phillips, Rhiannon
197e1e95-ea7d-4867-80e0-52e5c7261a8b
Wood, Fiona
7fa2fcc6-81ab-4acf-997e-4c7113c7b1fd
Hood, Kerenza
af7cf839-ca85-4ea9-83c3-3dd31be88b32
Simpson, Sharon
9b735262-6af7-40c4-a2d6-6a43cb2ddd00
Butler, Christopher C.
d2f9102c-54c2-4570-be4e-32324c8c8f1d

Francis, Nick A., Phillips, Rhiannon, Wood, Fiona, Hood, Kerenza, Simpson, Sharon and Butler, Christopher C. (2013) Parents' and clinicians' views of an interactive booklet about respiratory tract infections in children: a qualitative process evaluation of the EQUIP randomised controlled trial. BMC Family Practice, 14 (1), [182]. (doi:10.1186/1471-2296-14-182).

Record type: Article

Abstract

Background
‘When should I worry?’ is an interactive booklet for parents of children presenting with respiratory tract infections (RTIs) in primary care and associated training for clinicians. A randomised controlled trial (the EQUIP study) demonstrated that this intervention reduced antibiotic prescribing and future consulting intentions. The aims of this qualitative process evaluation were to understand how acceptable the intervention was to clinicians and parents, how it was implemented, the mechanisms for any observed effects, and contextual factors that could have influenced its effects.

Methods
Semi-structured interviews were conducted with 20 parents and 13 clinicians who participated in the trial. Interviews were audio-recorded and transcribed verbatim. Data were analysed using a framework approach, which involved five stages; familiarisation, development of a thematic framework, indexing, charting, and interpretation.

Results
Most parents and clinicians reported that the ‘When should I worry’ interactive booklet (and online training for clinicians) was easy to use and valuable. Information on recognising signs of serious illness and the usual duration of illness were most valued. The interactive use of the booklet during consultations was considered to be important, but this did not always happen. Clinicians reported lack of time, lack of familiarity with using the booklet, and difficulty in modifying their treatment plan/style of consultation as barriers to use. Increased knowledge and confidence amongst clinicians and patients were seen as key components that contributed to the reductions in antibiotic prescribing and intention to consult seen in the trial. This was particularly pertinent in a context where decisions about the safe and appropriate management of childhood RTIs were viewed as complex and parents reported frequently receiving inconsistent messages.

Conclusions
The ‘When should I worry’ booklet, which is effective in reducing antibiotic prescribing, has high acceptability for clinicians and parents, helps address gaps in knowledge, increases confidence, and provides a consistent message. However, it is not always implemented as intended. Plans for wider implementation of the intervention in health care settings would need to address clinician-related barriers to implementation.

Text
1471-2296-14-182 - Version of Record
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More information

Accepted/In Press date: 21 November 2013
Published date: 1 December 2013

Identifiers

Local EPrints ID: 436305
URI: http://eprints.soton.ac.uk/id/eprint/436305
ISSN: 1471-2296
PURE UUID: 9d3f46bb-c344-4dad-b79b-46e85ced3f54
ORCID for Nick A. Francis: ORCID iD orcid.org/0000-0001-8939-7312

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Date deposited: 06 Dec 2019 17:30
Last modified: 10 Jan 2022 03:19

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Contributors

Author: Nick A. Francis ORCID iD
Author: Rhiannon Phillips
Author: Fiona Wood
Author: Kerenza Hood
Author: Sharon Simpson
Author: Christopher C. Butler

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