title: Improving communication and recall of information in paediatric diabetes consultations: a qualitative study of parents' experiences and views.
abstract: BACKGROUND
  Parents of non-adolescent children with type 1 diabetes are responsible for most of their child's diabetes management tasks. Consultations are used to provide diabetes education, review clinical progress and promote diabetes management tasks. This study explored parents' experiences of, and views about, their child's diabetes consultations. The objective was to identify ways in which consultations could be improved to aid communication, understanding and knowledge retention.
  
  
  METHODS
  In-depth interviews with 54 parents of children (aged ≤12 years) with type 1 diabetes. Data were analysed using an inductive thematic approach.
  
  
  RESULTS
  Parents' accounts revealed structural and contextual factors which could hinder effective communication and knowledge acquisition during consultations. Most reported feeling anxious going into consultations and worrying about being reprimanded by health professionals if their child's glycaemic control had not improved. As a consequence, many parents highlighted problems concentrating and assimilating information during consultations. In extreme cases, worries about being reprimanded led parents to omit or fabricate information when discussing their child's treatment or even to their cancelling appointments. Many parents described wanting opportunities to speak to health professionals alone because young children could be distracting and/or they did not want to raise distressing issues in front of their child. Parents described the benefits of receiving clinical advice from health professionals familiar with their family circumstances and disliking attending busy clinics and seeing different health professionals on each occasion. Parents also highlighted the benefits of receiving treatment recommendations in a written form after the consultation.
  
  
  CONCLUSIONS
  This study has highlighted unrecognised and undocumented aspects of the consultation which may result in parents leaving uncertain about the main issues discussed and with questions unanswered and support needs unaddressed. Structural and contextual changes to consultations are recommended to improve concentration, knowledge acquisition and retention. These include: sending letters/written summaries after consultations highlighting key decisions, providing opportunities for parents to consult health professionals without their child being present, encouraging parents to ask more questions during consultations, having procedures in place to promote continuity of care and providing parents with consistent and non-contradictory advice.
authors.affiliation: Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School. Teviot Place, Edinburgh, EH8 9AG, UK. j.lawton@ed.ac.uk.
authors.forename: Julia
authors.initials: J
authors.lastname: Lawton
authors.affiliation: Health Sciences, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. norman.waugh@warwick.ac.uk.
authors.forename: Norman
authors.initials: N
authors.lastname: Waugh
authors.affiliation: Royal Hospital for Sick Children, Sciennes Road, Edinburgh, EH9 1LF, UK. Kathryn.Noyes@nhslothian.scot.nhs.uk.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Noyes
authors.affiliation: Human Development and Health, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK. k.barnard@soton.ac.uk.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Barnard
authors.affiliation: Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School. Teviot Place, Edinburgh, EH8 9AG, UK. Jeni.Harden@ed.ac.uk.
authors.forename: Jeni
authors.initials: J
authors.lastname: Harden
authors.affiliation: Royal Hospital for Sick Children, Sciennes Road, Edinburgh, EH9 1LF, UK. Louise.Bath@luht.scot.nhs.uk.
authors.forename: Louise
authors.initials: L
authors.lastname: Bath
authors.affiliation: Child Health Department, Borders General Hospital, Melrose, TD6 9BS, UK. Dr.Stephen@borders.scot.nhs.uk.
authors.forename: John
authors.initials: J
authors.lastname: Stephen
authors.affiliation: Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School. Teviot Place, Edinburgh, EH8 9AG, UK. a.d.rankin@ed.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: Rankin
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards; D001007:Anxiety; D002648:Child; D003142:Communication; D003266:Continuity of Patient Care; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D010353:Patient Education as Topic / Q000592:standards; D011368:Professional-Family Relations; D036301:Qualitative Research; D012017:Referral and Consultation / Q000592:standards*