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
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DOI：
10.1186/1471-2296-14-182
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发表时间：
2013-12-01
影响因子：
2.9
通讯作者：
Butler, Christopher C.
中科院分区：
文献类型：
--
作者：
Francis, Nick A.;Phillips, Rhiannon;Butler, Christopher C.
背景：“我什么时候应该担心？”是一个互动的小册子，为家长提出与呼吸道感染（RTI）的儿童在初级保健和相关的培训，为临床医生。一项随机对照试验（EQUIP研究）表明，这种干预减少了抗生素处方和未来的咨询意向。这个定性的过程评估的目的是了解如何接受的干预是临床医生和家长，它是如何实施的，任何观察到的效果的机制，和上下文因素，可能会影响其effects.Methods：半结构化访谈进行了20名家长和13名临床医生谁参加了试验。对访谈进行了录音和逐字记录。数据进行了分析，使用一个框架的方法，其中涉及五个阶段;熟悉，发展的主题框架，索引，制图，和interpretation.Results：大多数家长和临床医生报告说，“当我应该担心”的互动小册子（和在线培训的临床医生）易于使用和宝贵的。关于识别严重疾病体征和通常患病时间的信息最受重视。在磋商期间互动使用小册子被认为是重要的，但这并非总是发生。临床医生报告说，缺乏时间，不熟悉使用手册，难以修改他们的治疗计划/咨询方式，这些都是使用障碍。临床医生和患者的知识和信心增加被视为有助于减少抗生素处方和试验中看到的咨询意向的关键组成部分。这是特别相关的情况下，儿童呼吸道感染的安全和适当的管理被视为复杂的决定和家长报告经常收到不一致的messages.Conclusions：“当我应该担心”的小册子，这是有效地减少抗生素处方，具有很高的可接受性，为临床医生和家长，有助于解决知识的差距，增加信心，并提供了一致的信息。然而，它并不总是按预期执行。在卫生保健环境中更广泛地实施干预措施的计划需要解决与临床医生有关的实施障碍。
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.