Developing a parent-targeted online intervention to improve primary care utilisation using real time paediatric respiratory tract infection surveillance data

Rationale
Respiratory tract infections (RTIs) are one of the main reasons for paediatric primary care consultations and prescription of antibiotics for children. An online intervention combining real-time microbiological and syndromic surveillance data and symptom duration information may reduce unnecessary primary care visits for self-limiting, low-risk RTIs.

Aims
This study aimed to develop a parent-targeted online intervention presenting real-time paediatric RTI surveillance information.

Methodology
Semi-structured interviews (N = 30 mothers) were conducted with parents participating in a wider study evaluating the feasibility of collecting community-based RTI surveillance information. Interviews explored parents’ views on the content, design and potential impact of surveillance information on home care and primary care help seeking. Participants were selected purposefully based on deprivation (index of multiple deprivation decile), child age and whether RTI symptoms had been reported in the feasibility study. During the interviews, participants were presented with examples of the intervention, including locally relevant real-time RTI surveillance and symptom duration information.

Analysis
The interviews were transcribed and analysed using framework analysis. The first three interviews were independently double coded and the study team met regularly to discuss the data interpretation. Using the interview findings and other relevant evidence from previous studies, potential pathways of influence of an online intervention on parents’ behaviour were modelled to decide on relevant intervention components. A logic model was developed using the COM-B framework, which accounts for parents’ capability, opportunity and motivation for the target behaviours: caring appropriately for a child with an RTI and avoiding unnecessary primary care visits.

Results
The majority of parents were interested in using the online information. Proposed impacts of the information included: identifying the RTI likely to be causing child symptoms and informing judgements about when to seek primary care help. Alternatively, some parents anticipated minimal impact on approaches to caring for children due to parent reluctance to consult primary care for RTI symptoms and confidence in providing home care. Some parents reported that information on circulating RTIs and symptom duration may reassure parents and reduce parent concern by enabling child symptoms to be labelled as a circulating RTI, increasing awareness of how long symptoms are likely to last and informing them that symptoms are prevalent locally. Increased parent concern due to heightened awareness of circulating RTIs and perceived RTI severity were proposed as potential negative consequences by others. Parents stressed the importance of providing further guidance on caring for children in addition to information on circulating RTIs.
In response to parent interviews the online intervention will include information on: common locally circulating RTIs, their symptoms and symptom duration; how to care for a child with an RTI; and when to seek primary care help. This should increase parents’ knowledge and skills to care for their child (capability) and change their beliefs about their child’s condition and beliefs in their self-care capabilities, reducing concerns (motivation). In combination with referring parents to further resources and creating a social norm of caring for children with RTIs at home (opportunity), this should increase the likelihood of home care and reduce unnecessary primary care visits.

Conclusions
Parent-targeted online interventions using real-time RTI surveillance data, symptom duration and home care advice could improve the management of paediatric RTI and reduce consultations and antibiotic prescribing for children with RTI. The developed intervention will be tested in a future online experimental study.