The influence of clinical communication on parents’ antibiotic expectations for children with Respiratory Tract Infections

PURPOSE The purpose of this study was to understand clinicians’ and parents’
perceptions of communication within consultations for respiratory tract infections (RTI) in children and what influence clinician communication had on parents’ understanding of antibiotic treatment.

METHODS We video recorded 60 primary care consultations for children aged 3
months to 12 years who presented with RTI and cough in 6 primary care practices in England. We then used purposive sampling to select 27 parents and 13 clinicians for semistructured video-elicitation interviews. The videos were used as prompts to investigate participants’ understanding and views of communication within the consultations. We analyzed the interview data thematically.

RESULTS While clinicians commonly told parents that antibiotics are not effective
against viruses, this did not have much impact on parents’ beliefs about the
need to consult or on their expectations concerning antibiotics. Parents believed
that antibiotics were needed to treat more severe illnesses, a belief that was
supported by the way clinicians accompanied viral diagnoses with problem minimizing language and antibiotic prescriptions with more problem-oriented
language. Antibiotic prescriptions tended to confirm parents’ beliefs about what
indicated illness severity, which often took into account the wider impact on a
child’s life. While parents understood antimicrobial resistance poorly, most held
beliefs that supported reduced antibiotic prescribing. A minority attributed it to
resource rationing, however.

CONCLUSIONS Clinician communication and prescribing behavior confirm parents’ beliefs that antibiotics are needed to treat more severe illnesses. Interventions to reduce antibiotic expectations need to address communication within the consultation, prescribing behavior, and lay beliefs.