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Understanding parents' decisions to seek care for children with serious bacterial infections: a qualitative study
Evelien B van Kempen1,2, Maarten Willemsen2, Rianne Oostenbrink3
1Department of General Pediatrics, Erasmus MC Sophia, Rotterdam, The Netherlands e.vankempen@erasmusmc.nl.
Insights
Parents seek medical care for children with serious bacterial infections (SBI) based on perceived illness changes and alarming symptoms. External barriers like work and GP access can delay seeking help.
Area of Science:
- Pediatric infectious diseases
- Parental decision-making in healthcare
- Health informatics
Background:
- Fever in young children (0-5 years) can indicate serious bacterial infections (SBI).
- Understanding parental triggers for seeking medical care is crucial for timely intervention.
- Existing e-health tools may not fully capture parental decision-making factors.
Purpose of the Study:
- To identify factors parents perceive as most significant in seeking medical care for children with fever due to SBI.
- To inform the development of a parent-centered e-health tool for assessing illness severity.
Main Methods:
- Qualitative study utilizing semi-structured interviews with 15 parents of children aged 0-5 years admitted with suspected SBI.
- Thematic analysis of transcribed interviews to identify key themes in parental help-seeking behavior.
- Interviews conducted in an urban teaching hospital in the Netherlands.
Main Results:
- Parents sought care based on perceived shifts in illness state, including alarming symptoms (e.g., altered consciousness, breathing difficulties) or symptom combinations.
- Previous experiences and prolonged fever also influenced decisions, with many parents recognizing professional red flag indicators.
- External barriers such as work constraints and limited general practitioner access were identified as delays to seeking care.
Conclusions:
- Parental perception of illness severity, alongside clinical symptoms, significantly influences help-seeking for febrile children with SBI.
- Findings underscore the need for parent-centered resources, like e-health tools, to aid in assessing illness and guiding care-seeking decisions.
- Effective tools should consider both parental interpretation of symptoms and external influencing factors.
Objective:
To explore which factor or combination of factors is perceived by parents as most distinctive in prompting them to seek medical care for children aged 0-5 years who were admitted to the hospital with fever due to a serious bacterial infection (SBI), in order to inform further development of an e-health tool.
Design:
A qualitative study was conducted using semi-structured interviews with a purposive sampling strategy. Interviews were conducted by a medical intern and supervised by a clinician researcher. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis to identify key themes in parental decision-making.
Setting:
Paediatric ward of the Juliana Children's Hospital in The Hague, an urban teaching hospital in the Netherlands, between April and June 2024.
Participants:
Parents of children aged 0-5 years admitted with a suspected SBI were eligible. Of the 17 parents approached, 15 agreed to participate in 13 interviews (ie, in two interviews both parents participated).
Results:
13 interviews with 15 parents revealed five themes. Parents sought medical attention when they perceived a shift in their child's illness state, based on three themes: perceived abnormal illness presentation through either single alarming symptoms (altered consciousness, breathing difficulties, skin changes) or symptom combination, symptom recognition based on previous experiences or prolonged fever and respiratory complaints. Many parents demonstrated awareness of symptoms aligning with professional red flag indicators. The fourth and fifth themes, work constraints and limited general practitioner access, highlighted external barriers that sometimes delayed help-seeking.
Conclusion:
This study highlights key factors influencing parents' decisions to seek medical care for febrile children with an SBI, emphasising the importance of both parental perceptions and clinical symptoms. The findings may inform parent-centred resources including an e-health tool, which support parents in assessing illness severity and deciding when to seek medical care.
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