Understanding the key influences on parents seeking health care for children experiencing acute illness: Paired qualitative and quantitative systematic reviews

Problem

Acute illness in children is a common reason for parents to seek immediate healthcare. Previous research has shown that parents experience anxiety about children’s symptoms and are unsure when care should be accessed. There is a well-developed literature on different types of influences on parental consulting including parental beliefs and concerns, illness characteristics and population demographics. However, there is a knowledge gap in explaining which influences play the greatest role in triggering a decision to consult. It is anticipated that identification of the role these influences have on requests for care will permit development of an on-line tool to support families during episodes of acute illness and optimise their use of health services.

Approach

We are conducting two systematic reviews, one of the qualitative evidence about why parents consult and the other of the quantitative evidence of the predictors or parental consulting for children with acute illness.We conducted a systematic search of the quantitative literature and a purposeful search of the qualitative literature. Quality appraisal of studies meeting inclusion criteria will be conducted using tools appropriate for study type. We are synthesising the qualitative evidence following standard procedures for meta-ethnography. The quantitative evidence will be analysed using a metaregression approach where data is homogenous. If possible, quantitative analysis will also entail subgroup analyses for primary and secondary outcomes (consultation, setting and antibiotic prescription) by study type, (e.g. cohort vs. casecontrol) and child age. Findings from both reviews will be combined in a narrative synthesis.

Findings

Preliminary findings from the qualitative reviews indicate that signs and symptoms such as fever and breathing problems proved to be a continual worry to parents. Symptoms that lasted longer than expected, or those failing to respond to home treatment were interpreted by parents as ‘uncontrolled’. In addition, lack of understanding about illness progression and the threat symptoms presented left families unable to contain the illness at home. This represented the point at which care was sought. Catalysts for seeking care included: families’ need for reassurance that their child was safe from harm, impact on social routines the desire for the illness episode to be resolved as quickly as possible. Preliminary findings from the quantitative review indicate that characteristics of the illness, the child and the household were all predictive, further analysis is needed to determine relative importance of each factor.

Consequences

Understanding what drives high use of health care services by parents during episodes of acute illness is key to optimising parental use of services, which will help address the crisis in the NHS struggling to meet demand for health care.