Table 3 Thematic Framework of what parents expect from safety netting advice for their acutely ill child presenting to ambulatory care
Themes | Subthemes |
|---|---|
They want: | |
1. Relevant background information | Disease prevention; indications for consultation (knowing when to make an appointment and when not to) Basic disease epidemiology and management: how often and when do fever and (common) childhood illnesses occur, how severe are they, how can you best manage them as a parent? The diagnostic process and the associated diagnostic uncertainty Antibiotics: how they work, when they are (not) indicated, and what alternatives there are to antibiotics? Technical examinations: what they can(not) tell us, when they are (not) indicated? E.g., blood works, throat swab, ultrasound, X-ray, etc |
2. To know what to expect, what to look out for | Red flags: what clinical signs and symptoms in the acutely ill child to be concerned about? Yellow flags: emotional states in one or both parent(s) that might compromise their ability to adequately care for the child. E.g., being concerned about the illness to a detrimental extent; having no idea about how to best manage the child’s illness and being afraid you might make it worse, like when two physicians provide different advice Green flags: what clinical signs and symptoms in the child are positively reassuring? What to expect: how will the child’s illness most likely progress? If there are several likely scenarios, parents want to know about them all |
3. Instruction on child homecare and when to revisit a medical professional | Continuity of medical care: which medical professional to consult when Practical instructions for further actions so that parents know exactly what to do in which circumstances. E.g., a decision tree, a step-by-step action plan, and/or a delayed prescription Homecare provided by parents |
4. The physician to consider the parents’ perspectives and contexts | Parents’ ideas, concerns, and expectations, e.g., concerning their child’s illness, the management plan, or what to expect in the next few days Parents’ own perception of the goal of safety netting advice: empowerment, reassurance, and memory aid Impact of the child’s disease on the parents and the dynamic between them. E.g., tension due to miscommunication or differing viewpoints |
5. A reliable source that provides safety netting advice only when necessary, possibly in a multimodal way | Reliable source: preferably a physician, but not necessarily a physical person (e.g., online, pamphlet) Only when necessary: e.g., for first-time parents, not for each and every minor infection like the common cold The option of multimodality: this allows parents to access it at different moments in time, in different ways, and in different places. E.g., given orally by a physician, on a leaflet, and on a website or app provided with photos and/or videos |