title: Influence of Clinical Communication on Parents' Antibiotic Expectations for Children With Respiratory Tract Infections.
abstract: OBJECTIVE
  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.
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, England christie.cabral@bristol.ac.uk.
authors.forename: Christie
authors.initials: C
authors.lastname: Cabral
authors.affiliation: Centre for Health & Social Care, School of Policy Studies, University of Bristol, Bristol, England.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ingram
authors.affiliation: Centre for Child & Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, England.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Lucas
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, England.
authors.forename: Niamh M
authors.initials: NM
authors.lastname: Redmond
authors.affiliation: School of Medicine, University of Nottingham, Medical School, Nottingham, England.
authors.forename: Joe
authors.initials: J
authors.lastname: Kai
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, England.
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Hay
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, England.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Horwood
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003142:Communication; D004739:England; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D010290:Parents / Q000523:psychology*; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D036301:Qualitative Research; D012017:Referral and Consultation; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D014741:Video Recording
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotics; child; communication; parent; respiratory tract infections; treatment