scispace - formally typeset
Search or ask a question
Journal ArticleDOI

Parental experience of prophylactic antibiotics

TL;DR: A behavioural model is proposed that describes phases parents go through while having a child on prophylactic antibiotics and may facilitate medication adherence, reduce anxieties and improve doctor-parent relationships.
Abstract: Background and objectives Long-term prophylactic antibiotics are often used to prevent bacterial infections. However, supporting evidence for this is not always robust. Including parents in decisions relating to medication is key to medicines optimisation. Parental concern regarding medication is a major determinant of poor adherence. This study explores parental experiences of having a child prescribed prophylactic antibiotics and how that affects their antibiotic use behaviour. Methods We conducted a prospective, single-centre, exploratory, qualitative study at Sheffield Children’s Hospital. Through 15 interviews, involving 18 participants, we explored parental ‘lived experiences’ and attitudes towards azithromycin prophylaxis prescribed for various respiratory conditions. Thematic analysis was conducted. Results The overriding factor influencing parental decisions about the uptake of antibiotic prophylaxis is wanting their child to be well now. The main concern voiced by parents is that of antibiotic resistance given their children are high users of antibiotics. This is however seen as a problem for the future, not the present. Preparing families adequately helps prevent practical difficulties relating to medication. Facilitating ‘normalisation’ of prophylaxis through daily routines and minimising disruption to the family environment may reduce parental anxiety, promote adherence and result in easing of potential restrictions to the child’s daily activities. Conclusion Grounded in our deeper understanding, we propose a behavioural model that describes phases parents go through while having a child on prophylactic antibiotics. Time invested in holistically addressing the parental experience and having an awareness of potential issues parents face, may facilitate medication adherence, reduce anxieties and improve doctor-parent relationships.

Summary (2 min read)

Background and objectives

  • Long-term prophylactic antibiotics are often used to prevent bacterial infections.
  • Supporting evidence for this is not always robust.
  • Including parents in decisions relating to medication is key to medicines optimisation.
  • This study explores parental experiences of having a child prescribed prophylactic antibiotics and how that affects their antibiotic use behaviour.

Methods

  • The authors conducted a prospective single centre exploratory qualitative study at Sheffield Children’s Hospital.
  • Through 15 interviews, involving 18 participants, the authors explored parental’ “lived experiences” and attitudes towards azithromycin prophylaxis prescribed for various respiratory conditions.

Results

  • The overriding factor influencing parental decisions about the uptake of antibiotic prophylaxis, is wanting their child to be well now.
  • The main concern voiced by parents is that of antibiotic resistance given their children are high users of antibiotics.
  • Facilitating “normalisation” of prophylaxis through daily routines and minimising disruption to the family environment may reduce parental anxiety, promote adherence and result in easing of potential restrictions to the child’s daily activities.

Background

  • Long-term prophylactic antibiotics are often used to prevent serious bacterial infections and their sequelae in susceptible populations.
  • In other conditions the supporting evidence is less robust [3].
  • The benefits of antibiotic prophylaxis need to be weighed against potential risks of antibiotic resistance and medication side-effects.
  • Including parents and children in decisions relating to medicines is key to medication adherence [6].
  • Parental knowledge and beliefs are essential considerations when changes in patterns of antibiotic prescribing are required [9].

Participants and procedure

  • The authors conducted a prospective, single-centre, exploratory qualitative study at Sheffield Children’s Hospital (SCH) with parents or guardians whose children attended the paediatric respiratory and immunology outpatient clinics.
  • Travel expenses were covered but no other incentive to participate was offered.
  • Parents of children aged 2-10 years who had been taking oral azithromycin prophylaxis for at least 3-months to prevent lower respiratory tract infections, were invited to participate.
  • Theoretical saturation was anticipated to occur between 12 and 20 interviews [12].

Interviews

  • Face-to-face interviews were conducted by SH, at SCH or the family home, depending on parental convenience.
  • Semi-structured interviews were conducted using an interview questionnaire based on topics of interest to the research question and themes previously identified in the literature relating to parents’ perceptions of acute antibiotics .
  • Interviews focused on parents’ “lived experiences” of having a child who had been prescribed prophylactic azithromycin.
  • An iterative approach was taken building on emerging themes from previous interviews.
  • Interviews were recorded using an encrypted digital voice recorder.

Analysis

  • All interviews were transcribed verbatim and standard thematic analysis conducted [13].
  • Six interviews were conducted at SCH and nine in the participant’s home.
  • Barriers to engagement identified by these parents included chaotic consultation rooms, time pressures, social norms of politeness, not wanting to be made to feel like a “drama queen” and seeing the doctor as a higher authority. ” I go into clinic and they are sat at the computer typing.
  • You hear a lot in the press about antibiotics so the authors had lots of questions.” (Parent 1) All parents hoped antibiotic prophylaxis would reduce the number of respiratory tract infections, improve their child’s health and restore normality to their lives.
  • Even now, I didn’t have no medicine for him on Monday.” (Parent 9) Many were concerned about the amount and cost of wasted antibiotics and were not aware of appropriate disposal methods.

Discussion

  • The overriding factor influencing parental decisions about the uptake of antibiotic prophylaxis, is wanting their child to be well now.
  • From their study, clinicians should be mindful of passive parents with unvoiced concerns when making decision regarding prophylaxis.
  • Previous reports suggest parents perceiving their children as low antibiotic users do not see antibiotic resistance as an issue for their children [16].
  • Discussing thresholds for seeking medical assessment during acute illnesses enables parents to feel they are seeking assessment at appropriate times, alleviates anxieties and through good communication with general practitioners, raises awareness of suggested management plans.
  • Parents who did not participate may potentially have other diverse experiences.

Conclusion

  • It is not sufficient for clinicians to prescribe prophylactic antibiotics with the expectation that parents will adhere.
  • This “current” approach does not take into account the complex interplay between health, psychology and behaviour.
  • The authors need to address the parental experience holistically when prescribing long-term antibiotic prophylaxis by preparing families and breaking down barriers that prevent their active involvement in consultations.
  • Time and effort invested in this the authors believe, would facilitate antibiotic adherence, reduce anxieties and improve relationships between parents and medical professionals.

Did you find this useful? Give us your feedback

Content maybe subject to copyright    Report

This is a repository copy of Parental experience of prophylactic antibiotics.
White Rose Research Online URL for this paper:
https://eprints.whiterose.ac.uk/167591/
Version: Accepted Version
Article:
Hardman, S.J., Shackley, F., Condliffe, A. et al. (2 more authors) (2021) Parental
experience of prophylactic antibiotics. Archives of Disease in Childhood, 106 (6). pp. 577-
582. ISSN 0003-9888
https://doi.org/10.1136/archdischild-2020-319191
This article has been accepted for publication in Archives of Disease in Childhood, 2020
following peer review, and the Version of Record can be accessed online at
http://dx.doi.org/10.1136/archdischild-2020-319191. © Authors (or their employer(s)) 2020
Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs
and other images or illustrative material included where another copyright owner is
identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-
Non Commercial 4.0 International (CC-BY-NC 4.0)
https://creativecommons.org/licenses/by-nc/4.0/.
eprints@whiterose.ac.uk
https://eprints.whiterose.ac.uk/
Reuse
This article is distributed under the terms of the Creative Commons Attribution-NonCommercial (CC BY-NC)
licence. This licence allows you to remix, tweak, and build upon this work non-commercially, and any new
works must also acknowledge the authors and be non-commercial. You don’t have to license any derivative
works on the same terms. More information and the full terms of the licence here:
https://creativecommons.org/licenses/
Takedown
If you consider content in White Rose Research Online to be in breach of UK law, please notify us by
emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request.

1
Title: The parental experience of prophylactic antibiotics (PEPPA)
Corresponding author:
Dr Simon Hardman, Room 9, Academic Unit Child Health, Sheffield Children’s Hospital, Damer
Street, S10 2TH. Email: simonhardman@doctors.net.uk
Co-authors:
Dr Fiona Shackley. Sheffield Children's Hospital NHS Foundation Trust, Immunology, Allergy and
Infectious Diseases, Sheffield, UK
Professor Alison Condliffe. The University of Sheffield, Infection, Immunity and Cardiovascular
Disease, Sheffield, UK
Dr Kelechi Ugonna. Sheffield Children's Hospital NHS Foundation Trust, Paediatric Respiratory
Medicine, Sheffield, UK
Dr Andrew Lee. The University of Sheffield School of Health and Related Research, Public
Health, Sheffield, UK
Keywords:
paediatrics, qualitative research, parents, antibiotic prophylaxis, respiratory therapy
Word count: 2500

2
Abstract
Background and objectives
Long-term prophylactic antibiotics are often used to prevent bacterial infections. However,
supporting evidence for this is not always robust. Including parents in decisions relating to
medication is key to medicines optimisation. Parental concern regarding medication is a major
determinant of poor adherence. This study explores parental experiences of having a child
prescribed prophylactic antibiotics and how that affects their antibiotic use behaviour.
Methods
We conducted a prospective single centre exploratory qualitative study at Sheffield Children’s
Hospital. Through 15 interviews, involving 18 participants, we explored parentallived
experiences” and attitudes towards azithromycin prophylaxis prescribed for various respiratory
conditions. Thematic analysis was conducted.
Results
The overriding factor influencing parental decisions about the uptake of antibiotic prophylaxis,
is wanting their child to be well now. The main concern voiced by parents is that of antibiotic
resistance given their children are high users of antibiotics. This is however seen as a problem
for the future, not the present. Preparing families adequately helps prevent practical difficulties
relating to medication. Facilitating “normalisation” of prophylaxis through daily routines and
minimising disruption to the family environment may reduce parental anxiety, promote
adherence and result in easing of potential restrictions to the child’s daily activities.
Conclusion

3
Grounded in our deeper understanding, we propose a behavioural model that describes phases
parents go through whilst having a child on prophylactic antibiotics. Time invested in holistically
addressing the parental experience and having an awareness of potential issues parents face,
may facilitate medication adherence, reduce anxieties and improve doctor-parent relationships.

4
The parental experience of prophylactic antibiotics (PEPPA)
Background
Long-term prophylactic antibiotics are often used to prevent serious bacterial infections and
their sequelae in susceptible populations. Evidence-based guidelines for antibiotic prophylaxis
exist for conditions such as HIV [1]. However, in other conditions the supporting evidence is less
robust [3]. Azithromycin prophylaxis is often used in children with recurrent respiratory tract
infections due to its antibiotic and anti-inflammatory effects. It is recommended for conditions
such as bronchiectasis [4]. The benefits of antibiotic prophylaxis need to be weighed against
potential risks of antibiotic resistance and medication side-effects.
Including parents and children in decisions relating to medicines is key to medication adherence
[6]. Indeed, parental concerns regarding medication contribute to poor adherence, which is a
significant problem in chronic paediatric illnesses [7, 8]. Parental knowledge and beliefs are
essential considerations when changes in patterns of antibiotic prescribing are required [9].
Few studies have investigated parental perceptions of antibiotic prophylaxis. Parents may see
antibiotic prophylaxis as beneficial [10, 11], but this may not necessarily result in good
adherence [11]. Parental concerns about antibiotic resistance were perceived to be a
community problem rather than an issue affecting their children [10]. This study seeks to
understand the parental experience of having a child prescribed prophylactic antibiotics and
how that affects their antibiotic use behaviour.

References
More filters
Journal ArticleDOI
TL;DR: Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology as mentioned in this paper, and it offers an accessible and theoretically flexible approach to analysing qualitative data.
Abstract: Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.

103,789 citations

Journal ArticleDOI
TL;DR: In this article, the authors compared two approaches to assess saturation: code saturation and meaning saturation, and examined sample sizes needed to reach saturation in each approach, what saturation meant, and how to assess it.
Abstract: Saturation is a core guiding principle to determine sample sizes in qualitative research, yet little methodological research exists on parameters that influence saturation. Our study compared two approaches to assessing saturation: code saturation and meaning saturation. We examined sample sizes needed to reach saturation in each approach, what saturation meant, and how to assess saturation. Examining 25 in-depth interviews, we found that code saturation was reached at nine interviews, whereby the range of thematic issues was identified. However, 16 to 24 interviews were needed to reach meaning saturation where we developed a richly textured understanding of issues. Thus, code saturation may indicate when researchers have "heard it all," but meaning saturation is needed to "understand it all." We used our results to develop parameters that influence saturation, which may be used to estimate sample sizes for qualitative research proposals or to document in publications the grounds on which saturation was achieved.

1,508 citations

Journal ArticleDOI
TL;DR: Medication non-adherence is related to increased health care use in children and adolescents who have a chronic medical condition and should be addressed in clinical care.
Abstract: BACKGROUND AND OBJECTIVE: Advanced understanding of modifiable predictors of health care use in pediatric chronic illness is critical to reducing health care costs. We examined the relationship between medication non-adherence and health care use in children and adolescents who have a chronic medical condition. METHODS: A systematic review of articles by using PubMed, PsycINFO, and CINAHL was conducted. Additional studies were identified by searching reference sections of relevant manuscripts. Studies that tested the relationship between medication non-adherence and health care use (ie, hospitalizations, emergency department visits, outpatient visits) or cost in children and adolescents (mean age ≤18 years) who have a chronic medical condition were included. Extraction of articles was completed by using predefined data fields. RESULTS: Ten studies met our inclusion criteria. Nine of the 10 studies reviewed (90%) demonstrated a relationship between medication non-adherence and increased health care use. The directionality of this relationship varied depending on the outcome variable of interest. CONCLUSIONS: Medication non-adherence is related to increased health care use in children and adolescents who have a chronic medical condition and should be addressed in clinical care. Future studies should include randomized controlled trials examining the impact of adherence promotion efforts on health care use and costs.

181 citations

Journal ArticleDOI
TL;DR: Parental concerns about controller medications were associated with poor medication adherence for this population of urban children with asthma, highlighting the importance of addressing parental concerns at the time of medication prescription.

154 citations

Journal ArticleDOI
27 Jan 2012-PLOS ONE
TL;DR: Interventions to influence parental consulting and antibiotic use should: engage children, occur prior to an illness episode, employ delayed prescribing, and provide guidance on specific symptoms, support the wider implementation of interventions to reduce inappropriate antibiotic use in children.
Abstract: Background Respiratory tract infections (RTIs) are common in children and generally self-limiting, yet often result in consultations to primary care. Frequent consultations divert resources from care for potentially more serious conditions and increase the opportunity for antibiotic overuse. Overuse of antibiotics is associated with adverse effects and antimicrobial resistance, and has been shown to influence how patients seek care in ensuing illness episodes.

126 citations

Frequently Asked Questions (2)
Q1. What are the contributions in this paper?

This article has been accepted for publication in Archives of Disease in Childhood, 2020 following peer review, and the Version of Record can be accessed online at http: //dx. doi. org/10. 1136/archdischild-2020-319191. © Authors ( or their employer ( s ) ) 2020 Reuse of this manuscript version ( excluding any databases, tables, diagrams, photographs and other images or illustrative material included where another copyright owner is identified ) is permitted strictly pursuant to the terms of the Creative Commons AttributionNon Commercial 4. 0 International ( CC-BY-NC 4. 0 ) https: //creativecommons. 

The main concern voiced by most parents is that of antibiotic resistance, but this is seen as a problem for the future, not the present. However, parents in their cohort see their children as high users of antibiotics, who are at risk of resistance ( albeit in the future ) and weighed this factor when making decisions about prophylaxis. Finally, further research is necessary to explore the ethnic and cultural dimensions influencing parents ’ experiences and to confirm the proposed model which may not be generalisable to other indications of antibiotic prophylaxis. An awareness of this cycle may help clinicians prepare families for prophylaxis, pre-empt potential difficulties and focus on areas to improve the family ’ s experience.