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Nama : Suci Martha Aprilia

Nim : 1710913420030

TUGAS I
Jurnal 1 : Analisis Hubungan Karakteristik Kepala Keluarga Dengan Perilaku Pencegahan Demam Berdarah Di
Pakijangan Brebes
No Struktur Jurnal Penjelasan
1. Judul Judul penelitian dapat memberikan gambaran mengenai
penelitian yang telah dilakukan.
Misalnya : ” Analisis Hubungan Karakteristik Kepala
Keluarga Dengan Perilaku Pencegahan Demam Berdarah Di
Pakijangan Brebes “
2. Abstrak Abstrak berbeda dengan ringkasan. Bagian abstrak dalam
jurnal ilmiah berfungsi untuk mencerna secara singkat isi
jurnal. Abstrak di sini dimaksudkan untuk menjadi penjelas
tanpa mengacu pada jurnal. Bagian abstrak harus
menyajikan sekitar 250 kata yang merangkum tujuan,
metode, hasil, dan kesimpulan.
3. Pendahuluan Bagian ini dapat mencakup informasi tentang latar belakang
masalah, seperti ringkasan dari setiap penelitian yang telah
dilakukan dan bagaimana sebuah percobaan akan membantu
untuk menjelaskan atau memperluas pengetahuan dalam
bidang umum. Semua informasi latar belakang yang
dikumpulkan dari sumber lain harus menjadi kutipan.
4. Tinjauan Pustaka Pada bagian ini berisi tentang landasan teori yang
menunjang masalah yang diteliti atau untuk mengkaji dan
memecahkan masalah
5. Metode Bagian ini menjelaskan ketika percobaan telah dilakukan.
Peneliti menjelaskan desain percobaan, peralatan, metode
pengumpulan data, dan jenis pengendalian. Jika percobaan
dilakukan di alam, maka penulis menggambarkan daerah
penelitian, lokasi, dan juga menjelaskan pekerjaaan yang
dilakukan, populasi penelitian dan waktu yang ditempuh
dalam pengumpulan data. Aturan umum yang perlu diingat
adalah bagian ini harus memaparkan secara rinci dan jelas
sehingga pembaca memiliki pengetahuan dan teknik dasar
agar bisa diduplikasikan.
6. Hasil dan Pembahasan Hasil : Di sini peneliti menyajikan data yang ringkas dengan
tinjauan menggunakan teks naratif, tabel, atau gambar. Data
yang dikumpulkan dalam tabel/gambar harus dilengkapi teks
naratif dan disajikan dalam bentuk yang mudah dimengerti.
Pembahasan: Pada bagian ini, peneliti menafsirkan data
dengan pola yang diamati. Setiap hubungan antar variabel
percobaan yang penting dan setiap korelasi antara variabel
dapat dilihat jelas. Dalam jurnal : peneliti melakukan
wawancara dan menyertakan hasil statistik.
7. Kesimpulan Bagian ini hanya menyatakan bahwa peneliti berpikir
mengenai setiap data yang disajikan berhubungan kembali
pada pertanyaan yang dinyatakan dalam pendahuluan.
8. Daftar Pustaka Semua informasi (kutipan) yang didapat peneliti harus
ditulis sesuai abjad pada bagian ini. Hal tersebut berguna
untuk pembaca yang ingin merujuk pada literatur asli.
Perhatikan bahwa referensi yang dikutip benar-benar
disebutkan pada jurnal

Jurnal 2 : A systematic review of parent and clinician views and perceptions that influence prescribing decisions
in relation to acute childhood infections in primary care
No Struktur Jurnal Penjelasan
1. Judul Setiap jurnal ilmiah harus memiliki judul yang jelas.
Dengan membaca judul, akan memudahkan pembaca
mengetahui inti jurnal tanpa harus membaca keseluruhan
dari jurnal tersebut Misalnya : ” A systematic review of
parent and clinician views and perceptions that influence
prescribing decisions in relation to acute childhood
infections in primary care “
2. Abstrak Abstrak adalah ringkasan dari penelitian meliputi
pendahuluan, metode, hasil, pembahasan dan kesimpulan
Pendahuluan Isi pendahuluan menerangkan apa judul, siapa pengarang,
penjelasan umum mengenai topik artikel/buku, tujuan
penulisan artikel/buku, ringkasan mengenai apa yang
disimpulkan dari artikel/buku, argumentasi serta alasannya,
serta diakhiri dengan pernyataan umum mengenai penilaian
terhadap artikel/buku.
3. Bahan dan Metode Dalam bagian ini kita akan menjelaskan tentang proses
percobaan yang dilakukan. Informasi yang dijelaskan di sini
mencakup desain percobaan, peralatan yang dipergunakan,
metode dalam pengumpulan data, gambaran lokasi, dan
jenis pengendalian. Perlu diperhatikan dalam bagian ini kita
harus menjelaskan secara rinci dan jelas.
4. Hasil Memuat hasil yang diperoleh, serta bahasan ringkas
mencangkup permasalahan yang dipecahkan
5. Pembahasan Dalam bagian pembahasan, peneliti menafsirkan data-data
yang ada dengan pola yang diamati, Peneliti harus
menyertakan sebuah penjelasan yang berbeda dari hipotesis
atau hasil yang berbeda atau serupa dengan setiap
percobaan terkait dengan penelitian yang dilakukan orang
lain. Perlu diperhatikan bahwa dari setiap percobaan yang
dilakukan tidak selalu harus merujuk kepada perbedaan
besar atau kecenderungan untuk menjadi penting. Jika
ditemui hasil yang negatif bisa dijelaskan dan mungkin saja
merupakan sesuatu yang penting yang harus dirubah dalam
kegiatan penelitian yang kita lakukan.
6. Kesimpulan Berisi simpulan berupa jawaban atas permasalahan dalam
penelitian.
7. Ucapan Terimakasih Ucapan terimakasih pada seseorang atau pemberi dana
8. Pernyataan Kepentingan Tanggung jawab penulis dalam pembuatan karya tulis atau
penelitian
9. Daftar Pustaka Bagian daftar pustaka merupakan kumpulan dari nama-
nama literatur yang kita gunakan sebagai referensi dalam
pembuatan jurnal. Dari keseluruhan informasi yang berupa
kutipan, kita harus menuliskan daftar pustaka sesuai dengan
aturan penulisan daftar pustaka yang baik dan benar.

INFOKES, VOL 6 NO 1, Juli 2016 ISSN : 2086 - 2628


ANALISIS HUBUNGAN KARAKTERISTIK KEPALA KELUARGA
DENGAN PERILAKU PENCEGAHAN DEMAM BERDARAH DI
PAKIJANGAN BREBES
1
Iroma Maulida, 2Ratih Sakti Prastiwi, 3 Liestiani Harlyn Hapsari
1,2,3
Diploma III Kebidanan, Politeknik Harapan Bersama iroma.maulida@yahoo.co.id

Abstrak
Penelitian ini bertujuan untuk mengetahui hubungan karakteristik kepala keluarga dengan
perilaku pencegahan DBD kepala keluarga di Desa Pakijangan Kecamatan Bulakamba
Kabupaten Brebes Tahun 2014. Populasi dalam peneltian ini adalah kepala keluarga (KK) Desa
Pakijangan dengan sampel sebanyak 98 kepala keluarga. Data dikumpulkan melalui wawancara
dengan pengambilan sampel menggunakan multistage sampling, yaitu teknik stratified
proportional sampling dengan RW sebagai strata dan accidental sampling untuk pengambilan KK
di tiap RW. Hasil penelitian menunjukkan bahwa sebagian besar kepala keluarga telah
melaksanakan pencegahan DBD dengan baik (51 %) dengan karakteristik kepala keluarga
mayoritas berpendidikan ≤ SMP (65,7 %), berumur > 36 tahun (60,2 %), bekerja (76,5 %), dan
berjenis kelamin laki-laki (73,5 %). Tetapi hasil penelitian menunjukkan tidak ada hubungan
antara karakteristik kepala keluarga meliputi pendidikan (pvalue: 0,126); pekerjaan (pvalue:
0,189); umur (pvalue: 0,457) dan jenis kelamin (pvalue: 0,736) dengan perilaku dalam
pencegahan DBD. Hal ini kemungkinan karena masing-masing karakteristik berhubungan dengan
faktor-faktor lain dalam mempengaruhi perilaku pencegahan DBD, seperti keterpaparan kepala
keluarga dengan media komunikasi, jenis pekerjaaan kepala keluarga, dan lain-lain.
Kata Kunci: karakteristik, perilaku, pencegahan, DBD

Abstract
The aim of this study is to analyse characteristic head family relationship to prevention dengue
fever behavior.in Pakijangan village, Bulakamba District, Brebes Regency 2014. Population of
this study is all head family in Pakijangan village, using stratified sampling technic the sample of
this study are 98 participants. Data collected by interviewing participants and observed the
condition of their house. The result of this study is 51% participants are doing prevention. The
characteristic of the participant who doing prevention correctly are 65.7% almamater of junior
high, 60,2 % of participants are ≥ 36 years old, 76.5% are worker, and 73.5% of participants are
male. But this study showed that characteristic are not related to their behavior in preventing
dengue fever like education (pvalue:0.126); work state (pvalue: 0.189), age (pvalue: 0.457); and
gender (pvalue: 0.736). it could happened because each characteristic related to another factors
like exposed by mass media, work place, etc. .
Keywords: characteristic, behavior, prevention, dengue fever

PENDAHULUAN fasilitas kesehatan dalam menindaklanjuti


Demam berdarah dengue (DBD) merupakan penderita DBD (Ginanjar, 2007; Misnadiarly,
jenis penyakit menular yang dapat menimbulkan 2009; Depkes Jateng, 2013).
wabah. DBD selalu menjadi ancaman bagi Upaya pemberantasan penyakit DBD tidak
masyarakat Indonesia setiap tahunnya. Kasus akan maksimal tanpa perilaku pencegahan
DBD setiap tahunnya memiliki kecenderungan DBD oleh masyarakat. Penularan penyakit
terus meningkat walaupun angka kematian akibat DBD di masyarakat akan lebih cepat bila
DBD cenderung turun. Berbagai upaya untuk banyak terdapat nyamuk di rumah-rumah
mencegah DBD terus dilakukan oleh pemerintah penduduk. Perilaku menurut Lawrence Green
seperti pelaksanaan fogging, pemberian bubuk dipengaruhi oleh 3 (tiga) faktor yaitu faktor
larvasida, pelaksanaan 3M plus, penyediaan predisposisi, faktor pemungkin dan faktor
anggaran bagi daerah dengan KLB DBD, penguat. (Mujiati dan Novianti, 2015).
mengeluarkan kebijakan kepada rumah sakit Kecamatan Bulakamba merupakan
untuk meningkatkan pelayanan dan kecamatan dengan kasus DBD tertinggi di
Kabupaten Brebes pada tahun 2015, yaitu 46

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INFOKES, VOL 6 NO 1, Juli 2016 ISSN : 2086 - 2628

kasus dan terdapat 4 kasus kematian akibat 12 Perilaku penunjang lain seperti
DBD. Pakijangan merupakan desa yang penggunaan obat anti nyamuk, kelambu,
terletak di kecamatan Bulakamba dan maupun
merupakan penyumbang kasus DBD terbanyak menggunakan pakaian panjang
yaitu 15 kasus dan 1 kasus meninggal. Oleh (Misnadiarly, 2009).
karena itu peneliti berupaya melihat gambaran
perilaku masyarakat di Desa Pakijangan dalam METODE
pencegahan DBD. Peneliti juga berupaya Penelitian ini menggunakan pendekatan
melihat hubungan karakteristik dimana sebagai cross sectional di desa Pakijangan. Pakijangan
salah satu faktor predisposisi perilaku merupakan salah satu desa di kecamatan
kesehatan dengan pelaksanaan pencegahan Bulakamba Kabupaten Brebes yang memiliki
DBD oleh kepala keluarga di Desa Pakijangan. kasus DBD tertinggi pada tahun 2015.
Populasi pada penelitian ini adalah seluruh
TINJAUAN PUSTAKA kepala keluarga di desa Pakijangan yaitu 4371
Demam Berdarah Dengue (DBD) • yang tersebar di 9 RW. Sampel penelitian
merupakan penyakit yang hanya ditemukan di diambil menggunakan teknik stratified
daerah tropis. Penyakit demam berdarah proportional sampling dengan RW sebagai strata.
dengue merupakan salah satu penyakit menular Sedangkan dalam pengambilan sampel KK di
yang disebabkan oleh virus dengue yang tiap RW menggunakan teknik accidental
ditularkan melalui gigitan nyamuk Aedes sampling dan didapatkan sampel sejumlah 98
aegypti dan Aedes albopictus (Addin, 2009; [18]. Peneliti menggunakan kuesioner yang
Pangemanan dan Nelwan, 2012). telah divalidasi oleh Dinas Kesehatan
Proses penularan DBD terjadi di waktu pagi Kabupaten Brebes bidang Kesehatan
dan sore hari. Penderita yang tertular DBD Lingkungan untuk mengetahui faktor-faktor
akan menjadi infektif bagi nyamuk pada saat perilaku pencegahan DBD yang dilaksanakan
viremia, yaitu sejak beberapa saat sebelum oleh kepala keluarga dimana perilaku
panas sampai masa demam berakhir. Namuk pencegahan DBD dikelompokkan menjadi 2,
menjadi infektif pada jari ke 8-12 setelah yaitu perilaku pencegahan DBD baik dan
menhisap darah penderita viremia dan akan buruk. Perilaku pencegahan DBD dikatakan
tetap infektif selama hidup penderita. Masa baik bila seorang kepala keluarga telah
inkubasinya sendiri terjadi pada hari ke 4-7 melaksanakan kegiatan pencegahan ≥ rata-rata
(Warsidi, 2009). perilaku pencegahan DBD yang dilaksanakan
Pencegahan penularan DBD tergantung KK di Desa Pakijangan tersebut.
pada pengendalian nyamuk vektor. Perilaku Pengumpulan data dilakukan pada bulan Mei
manusia dan aktifitas serta kondisi sosial hingga September 2015 dengan melakukan
demografi berperan dalam meningkatkan wawancara terhadap responden dan
kejadian penyebaran penyakit seperti DBD. mengobservasi kondisi rumah khususnya dalam
Walaupun komunitas dan organisasi setempat pencegahan DBD seperti 3M, mengganti vas
telah berupaya menurunkan risiko kejadian bunga, membakar barang bekas, menggunakan
penularan namun komitmen individu lebih obat anti nyamuk, memasang kawat kasa,
berpotensi dalam memutus rantai penularan memakai kelambu, menggunakan larvasida,
DBD (Wong dan AbuBakar, 2013). memelihara ikan pemakan jentik. Data yang
Menurut Wong dan AbuBakar (2013) telah didapatkan kemudian dianalisis
individu dapat melakukan beragai upaya untuk menggunakan analisis bivariate chi-square
mencegah terjadinya DBD seperti: untuk melihat hubungan antara karakteristik
1. Menguras tempat yang berpotensi responden kepala keluarga dengan perilaku
menampung air serta menjadi sarang pencegahan DBD.
perkembangbiakan nyamuk vektor;
[1]. Menutup tempat penampungan air HASIL DAN PEMBAHASAN
seperti kaleng, pot, maupun bambu; Peneliti melakukan wawancara terhadap 98
[2]. Membuang sampah yang ada di rumah responden dan didapatkan data karakteristik
serta mengubur benda-benda yang dapat sebagaimana disajikan pada tabel 1. Latar
menjadi tempat perkembangbiakan nyamuk; belakang responden dilihat dari pendidikan
[3]. Penggunaan larvasida pada sebagian besar memiliki tingkat pendidikan
penampungan air setiap 2-3 bulan; dan rendah. Latar belakang pekerjaan responden
mayoritas merupakan petani dan sebagian kecil

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INFOKES, VOL 6 NO 1, Juli 2016 ISSN : 2086 - 2628

merupakan pegawai di sebuah instansi Tabel 2. Hasil analisis hubungan


pemerintah dan swasta. Pada latar belakang karakteristik kepala keluarga dengan
umur, responden termuda berusia 20 tahun dan perilaku pencegahan DBD
tertua adalah 60 tahun. Karakteristik Perilaku Pencegahan ρ-
Tabel 1. Karakteristik Responden DBD value
Penelitian Buruk Baik
n % N %
Karakteristik f (%)
Pendidikan*
Pendidikan Pendidikan Wajib 19 29.2 46 70.8
Pendidikan Wajib 65 65.7 Pendidikan 5 15.2 28 84.8 0.126
Pendidikan Lanjut 33 33.3 Lanjut
Umur
Umur Umur < 36 tahun 8 20.5 31 79.5
Umur < 36 tahun 39 39.8 Umur > 36 tahun 16 27.1 43 72.9 0.457
Umur ≥ 36 tahun 59 60.2 Pekerjaan
Bekerja 16 21.3 59 78.7
Pekerjaan 0.189
Tidak Bekerja 8 34.8 15 65.2
Bekerja 75 76.5 Jenis Kelamin
Tidak Bekerja 23 23.5 Perempuan 7 26.9 19 73.1
0.736
Laki-laki 17 23.6 55 76.4
Jenis Kelamin
Perempuan 26 26.5 Keterangan Pendidikan*
Laki-laki 72 73.5 Pendidikan Wajib: Tidak tamat sekolah, Tamat
Total 98 100 SD dan SMP
Pendidikan Lanjut : Tamat SMA dan
Berdasarkan tabel 2, perilaku pencegahan
Perguruan Tinggi
DBD yang baik lebih banyak dilakukan oleh
responden dengan latar belakang pendidikan Karakteristik umur mencerminkan
lanjut dan perilaku pencegahan yang buruk lebih kemampuan seseorang dalam berperilaku. Bakta
banyak dilakukan pada responden dengan latar dan Bakta (2015) menyebutkan bahwa Umur >
belakang pendidikan wajib. Hal ini senada 36 tahun merupakan umur yang dianggap
dengan penelitian Pradono dan Sulistyowati seseorang telah memiliki kemampuan berpikir
(2013) yang menyebutkan bahwa semakin lama yang matang. Sehingga semakin bertambahnya
seseorang menempuh pendidikan semakin besar umur maka tingkat pengetahuan yang
kemungkinan terpapar permasalahan yang lebih didapatkannya juga pegalaman yang dialami
kompleks sehingga membentuk lebih tinggi. Namun hasil uji statistik
menunjukkan tidak ada hubungan antara umur
individu yang lebih kompleks dan
dengan perilaku pencegahan DBD (ρ-value=
perkembangan kognitif yang lebih tinggi
0.457) walaupun pada tabel menunjukkan
dibanding dengan mereka yang lebih pendek
mayoritas pelaku perilaku pencegahan DBD yang
menempuh pendidikan. Namun dari hasil uji
baik lebih banyak dilakukan oleh responden
statitik menunjukkan tidak ada hubungan yang
dengan usia < 36 tahun dan perilaku pencegahan
signifikan (ρ-value= 0.126) antara pendidikan
DBD yang buruk banyak dilakukan oleh
kepala keluarga dengan perilaku pencegahan
responden dengan usia > 36 tahun. Hal ini
DBD, hal tersebut dapat terjadi dikarenakan
adanya faktor lain yang mempengaruhi. dapat terjadi dikarenakan semakin
Responden dengan pendidikan wajib dapat berkembangnya media massa yang semakin
berperilaku baik dikarenakan seringnya meningkat dan menarik sehingga masyarakat
terpapar informasi baik melalui media massa yang melihat semakin tertarik untuk
maupu melalui penyuluhan. Hal ini melakukannya salah satunya adalah
ditunjukkan dari perilaku responden dengan penggunaan obat nyamuk (Armandhani dan
pendidikan wajib dan lanjut yang keduanya Sukatmadja, 2014; Monitja, 2015).
melakukan pencegahan DBD yang baik dengan Astama (2012) dalam penelitiannya
melakukan 3M, penggunaan larvasida, menyebutkan bahwa dengan pemberian
kelambu dan obat nyamuk. (Mulyana, 2013; pendidikan informasi melalui media yang
Hidayati dan Kusmaningrum, 2015). bervariasi membantu meningkatkan
pengetahuan masyarakat sehingga masyarakat
mau mengubah untuk mengubah perilaku
menjadi lebih baik. Pernyataan tersebut

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didukung oleh penelitian Wowiling et. al. simpatik, memelihara kooperatif, mandiri dan
(2014), dalam penelitiannya menyebutkan senang membantu. Fenomena tersebut
bahwa usia 20-30 tahun merupakan usia menghasilkan perempuan yang lebih peduli
produktif dimana usia tersebut memiliki terhadap kondisi lingkungan dan kesehatannya
kemampuan untuk memodifikasi lingkungan (Jaya, 2009; Putra dan Giantri, 2014; Santoso
menjadi lingkungan yang lebih menjamin dan Putri, 2015).
kesehatan. Hasil uji statistik menujukkan tidak ada
Harmani dan Hamal (n.d.) dalam hubungan antara jenis kelamin kepala keluarga
penelitiannya menyebutkan bahwa seseorang dengan perilaku pencegahan DBD (ρ-value=
yang tidak bekerja memiliki waktu yang lebih 0.736) walalupun pada tabel 2 terlihat perilaku
banyak dirumah sehingga memiliki kesempatan pencegahan DBD yang baik dilakukan oleh
lebih banyak dalam melakukan kegiatan kepala keluarga berjenis kelamin laki-laki
kebersihan rumah yang secara tidak langsung dibandingkan dengan perempuan. Hal ini
bertujuan untuk mencegah terjadinya DBD. bertentangan dengan teori diatas. BAPPENAS
Namun Hasil uji statistik pada karakteristik status (2002) menyebutkan bahwa saat ini laki-laki
pekerjaan responden dengan perilaku pencegahan sebagai kepala keluarga memiliki akses yang
DBD menunjukkan tidak ada hubungan yang lebih mudah dalam mendapatkan informasi
signifikan (ρ-value= 0.189). Hal ini menujukkan khusunya tentang penyuluhan kesehatan
responden yang bekerja dan tidak bekerja lingkungan dimana hampir seluruh peserta
memiliki peluang yang sama dalam melakukan penyuluhan dihadiri oleh laki-laki. Sehingga
pencegahan DBD. Hal tersebut dapat terjadi tidak hanya perempuan saja yang dapat
karena pekerjaan dapat mempengaruhi perilaku melakukan pencegahan DBD, dengan adanya
seseorang karena informasi mengenai menjaga kesehatan
secara langsung maupun tidak langsung lingkungan laki-laki juga dapat melakukan
lingkungan pekerjaan memberikan pengetahuan pencegahan DBD.
dan pengalaman yang lebih, selain itu seseorang
yang bekerja akan memiliki KESIMPULAN
kesadaran akan pentingnya kesehatan Dari uraian diatas dapat diketahui tidak ada
lingkungan. Selain itu seseorang yang bekerja kaitan/ hubungan antara karakteristik
cenderung meluangkan waktu sekurang- responden dengan perilaku pencegahan DBD
kurangnya sekali atau pada hari libur untuk karena masing-masing karakteristik
membersihkan rumah dan melakukan berhubungan dengan faktor lain dalam
pemberantasan sarang nyamuk DBD. Selain itu mempengaruhi perilaku pencegahan DBD.
status pekerjaan yang tidak terikat dengan Oleh karena itu perlu dilakukan penelitian
instansi juga memberikan waktu yang lebih selanjutnya untuk melihat faktor lain seperti
leluasa sehingga dalam kasus ini pekerjaan adanya pemberian pendidikan kesehatan,
responden tidak mempengaruhi perilaku pengaruh paparan media informasi, peran
pencegahan DBD (Trisnaniyanti et. al., 2010; kader dalam memotivasi perilaku pencegahan
Hardayati et. al., 2011; Monintja, 2015). DBD masyarakat, dan lain-lain.
Penjelasan diatas menunjukkan bahwa
lingkungan pekerjaan tidak hanya DAFTAR PUSTAKA
mempengaruhi perilaku menjadi lebih negatif Addin.(2009). Pencegahan dan
namun justru sebaliknya. Begitu pula dengan Penanggulangan Penyakit. Bandung:
orang yang tidak bekerja, sekalipun waktu Puri Delco
luang lebih banyak namun terdapat beberapa Armandhani, H. dan Sukaatmadja, I., 2014.
faktor yang mempengaruhi perilaku tersebut Analisis Perbandingan Brand Equity
seperti pencegahan DBD yang benar (Harmani Produk Obat Anti Nyamuk Oles Merek
dan Hamal, n.d.). Autan dengan Merek Soffel di Kota
Karakteristik lain yang mempengaruhi Denpasar. E-Jurnal Manajemen
perilaku pencegahan DBD adalah jenis Universitas Udayana, 3(1).
kelamin. Jenis kelamin sering dihubungkan Astama, D. 2012. Pengaruh Pendidikan
dengan peran, tingkah laku, preferensi, dan Kesehatan pada Ibu-ibu Kader
atribut lain. Jenis kelamin perempuan Pemberdayaan Keluarga dan
merupakan sosok yang memiliki Kemasyarakatan (PKK) dalam
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Jurnal Ilmiah Rekam Medis dan Informatika Kesehatan 4


INFOKES, VOL 6 NO 1, Juli 2016 ISSN : 2086 - 2628

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Scandinavian Journal of Primary Health Care

ISSN: 0281-3432 (Print) 1502-7724 (Online) Journal homepage: http://www.tandfonline.com/loi/ipri20

A systematic review of parent and clinician


views and perceptions that influence
prescribing decisions in relation to acute
childhood infections in primary care

Patricia J. Lucas, Christie Cabral, Alastair D. Hay & Jeremy Horwood

To cite this article: Patricia J. Lucas, Christie Cabral, Alastair D. Hay & Jeremy
Horwood (2015) A systematic review of parent and clinician views and perceptions
that influence prescribing decisions in relation to acute childhood infections in primary
care, Scandinavian Journal of Primary Health Care, 33:1, 11-20, DOI:
10.3109/02813432.2015.1001942
To link to this article: https://doi.org/10.3109/02813432.2015.1001942

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Scandinavian Journal of Primary Health Care, 2015; 33: 11–20

ORIGINAL ARTICLE

A systematic review of parent and clinician views and perceptions that


influence prescribing decisions in relation to acute childhood infections in
primary care

1 2 2 2
PATRICIA J. LUCAS , CHRISTIE CABRAL , ALASTAIR D. HAY & JEREMY HORWOOD
1 2
School for Policy Studies, University of Bristol, UK, School of Social and Community Medicine, University of Bristol, UK

Abstract
Objectives. To investigate the views of parents, clinicians, and children pertaining to prescribing decisions for acute childhood
infection in primary care. Methods. A systematic review of qualitative studies. Meta-ethnographic methods were used, with data
drawn from the primary studies in an interpretive analysis. Results. A total of 15 studies met the inclusion criteria. The literature was
dominated by concerns about antibiotic over-prescription. Children’s views were not reported. Clinicians prescribed antibiotics when
they felt pressured by parents or others (e.g. employers) to do so, when they believed there was a clear clinical indication, but also
when they felt uncertain of clinical or social outcomes they prescribed “just in case”. Parents wanted antibiotics when they felt they
would improve the current illness, and when they felt pressure from daycare providers or employers. Clinicians avoided antibiotics
when they were concerned about adverse reactions or drug resistance, when certain they were not indicated, and when there was no
perceived pressure from parents. Parents also wished to avoid adverse effects of antibiotics, and did not want antibiotics when they
would not relieve current symp-toms. Some parents preferred to avoid medication altogether. Within paediatric consultations,
parents sought a medical evaluation and decision. Primary care clinicians want satisfied parents and short consultations.
Conclusions. Antibiotic pre-scriptions for childhood infections in primary care often result from “just in case” prescribing. These
findings suggest that interventions which reduce clinician uncertainty regarding social or clinical outcomes and provide strategies to
meet parents’ needs within a short consultation are most likely to reduce antibiotic prescribing.

Key Words: Anti-bacterial agents, child, general practice, primary health care, qualitative research, systematic review, United Kingdom

Introduction
The factors that affect the decision to prescribe are
Prescription decisions in primary care matter because of likely to be important for determining responses to both
the scale of prescribing. In England alone nearly a over-prescribing and under-prescribing. The views of
billion prescriptions were issued by primary care in clinicians and patients (in this case parents and children)
2010, of which nearly 50 million were for infections will influence the decision to prescribe, and a better
[4]. Over-prescription of antibiotics for self-limiting understanding of the views of parents, clinicians, and
illness is a significant problem for health services, children regarding prescriptions for minor childhood
contributing to drug resistance [2–5] and re-consultation illness in primary care is needed. Findings from
for minor illness [6]. There is particular concern individual studies are useful in moving forward
regarding overuse of antibiotics for children with self- knowledge in the field, but qualitative stud-ies by their
limiting illness [7,8]. At the same time, severe infections nature often have restricted sample sizes, offer a view
are sometimes missed by clinicians and prescriptions not unique to the particular circumstances of included
issued [9,10]. Similarly, non-specific abdominal pain in participants, and reflect the particular interpretations of
childhood is often under-investigated and over- one group of study authors [12]. These qualities are
medicated in primary care [11]. integral to the phenomenological and interpretive
approach of qualitative research

Correspondence: Patricia Lucas, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK. Tel: 1 44 117 954 6755.
E-mail: Patricia.lucas@bristol.ac.uk
This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (http://creativecommons. org/licenses/by-
nc/3.0)

(Received 2 June 2014; accepted 30 November 2014)


ISSN 0281-3432 print/ISSN 1502-7724 online © 2015 The Author(s)
DOI: 10.3109/02813432.2015.1001942
13 P. J. Lucas et al.
Search strategy for the identification of studies
What is known is that inappropriate medication of
childhood infection, particularly overuse of Search terms for prescriptions or antibiotics were
antibiotics, is a concern. Primary care clinicians combined with terms for acute childhood infection,
report feeling pressured by parents to prescribe parents or clinicians, and qualitative methods (see
antibiotics. What this study adds is that: Supplemental File). An information specialist devel-
oped a pre-planned, comprehensive search strategy in
• Clinicians often prescribe antibiotics “just in Medline and adapted it for use in other databases. Eight
case”, when they feel uncertain about clinical electronic databases were searched for studies published
or social outcomes. In contrast, anti-biotics are before October 2012: MEDLINE, EMBASE, CINAHL,
avoided where there is concern about adverse PsycINFO, SSCI, SIGLE, Dissertation Express
effects or drug resistance, or where parents do databases, and the NHS eco-nomic evaluation database.
not ask for them. In addition, hand search-ing was carried out in Social
• Parents want prescriptions when they believe Science and Medicine, Sociology of Health and Illness,
they will improve the current illness, but also British Journal of General Practice, Journal of Family
wish to avoid adverse effects and some-times Practice, and Health Expectations, which were
have a “no treatment” preference. identified by our Steering Committee and management
• Within paediatric consultations, the medical group as most likely to publish relevant articles. We used
examination in itself is reassuring to parents. forward citation tracking and screened reference lists of
Primary care clinicians want satisfied parents, included studies.
but they also want shorter consultations.
• Reducing uncertainty regarding social or
clinical outcomes might reduce “just in case”
prescribing. Inclusion criteria
Study focus: Studies which considered parent, child, or
clinician views, attitudes, beliefs, knowledge, and values
in relation to any prescriptions for medicines to treat
[13], but can mean it is more difficult to know whether
acute minor childhood illness. Studies with general
the findings are also likely to be pertinent at another
population samples were included where views towards
time and place. Systematic reviews (SR) of qualitative
prescribing for children were included and explicitly
studies are useful in synthesizing across studies to find
reported (and in these cases only data regarding
common themes, a broader range of views and
paediatric consultations were extracted).
experiences, and the bringing together of different
viewpoints. Design: Studies using qualitative methods (e.g. inter-
We know of no reviews of the views of both clini- views, focus groups, observations) to collect and analyse
cians and parents with regard to the use of prescrip-tions data. Studies had to report direct quotes from parents
for any acute minor illness in children. A previous SR and/or clinicians or themes, concepts, and ideas in
considered clinicians’ views regarding the use of analysis to ensure we were identifying empirical,
antibiotics for respiratory tract infections (RTIs) only qualitative work (and excluding discussion papers,
and did not focus on children [14]. A SR of parents’ surveys, and opinion pieces).
views regarding home care decisions did not focus on
Setting: Studies based in or concerning any Primary
prescription medication and needs updating [15].
Health Care settings (including general or family
practices and walk-in-centres) in any country belong-ing
Our objective was to review the literature on the
to the Organisation for Economic Co-operation and
views, beliefs, and attitudes of parents, children, and
Development and published in any language.
prescribing clinicians that influenced prescribing deci-
sions for acute childhood infection in primary care. Population: Parents of children aged between three
months and 12 years, children in the same age group,
and clinicians with authority to prescribe for children in
Material and methods this age group with acute minor illnesses.
We followed Cochrane Qualitative and Implementa-tion
Methods Group guidance in the conduct of the review Exclusion criteria
[16], including a broader search strategy than might be (a)Studies that included only quantitative reports of
usual in systematic reviews of effectiveness studies and attitudes using closed questions (e.g. surveys). (b)
use of an expert group including clini-cians to guide our Studies where views were in the context of children
methodological decisions.
with concomitant long-term conditions.
Parent and clinician views on prescribing for childhood infections 13
Selection of studies tations) concepts identified from the primary studies
were compared across studies, grouping those that were
The title and abstracts of the first 1000 hits were
conceptually similar under third-order con-structs
independently screened (using translations where
“translating” the studies into each other. We followed
necessary) by two researchers and results were
guidance from Noblit & Hare [19] in incorporating the
compared and discussed to refine selection criteria in an
studies in chronological order. The synthesis was an
iterative process. Once double screening was producing
iterative process: third-order constructs were developed
no differences in selection, one researcher screened the
in discussion between the researchers, considering
remainder of all searches. Final selec-tion was
reciprocal (where concepts support each other),
undertaken independently by two research-ers reviewing
refutational (where concepts are contested), and line of
full texts of relevant papers.
argument (interpreting across the complete set of
constructs) [19].
Data extraction and critical appraisal approach
Data extraction was conducted by two researchers Results
working independently. We assessed study quality
considering the primary marker, context sensitivity, Searches of electronic resources yielded 7045 records of
sampling strategy, data quality, theoretical adequacy, which 114 were retrieved in full text. While most were
generalizability, and typicality [17], these judgements published in English, 12 were published in other
are explained and summarized in Table II. We also languages. Online translation services together with
considered whether any studies were fatally flawed (that review by native speakers were used to decide on
is, the quality of the research was judged as so poor that inclusion. Fifteen studies met our inclusion crite-ria.
it should not be included) and no studies were excluded Figure 1 shows the flow of studies including reasons for
on this basis. exclusion.
The main features of the included studies are shown
in Table I. Six studies were carried out in the UK [20–
25], three in Iceland [26–28], two in the USA [29,30],
Synthesis of findings
and one each in France [31], Norway [32], and New
We undertook an interpretive analysis, producing a new Zealand [33], while one compared the views of GPs in
understanding of the data drawn from the primary the UK, France, Poland, Spain, and Belgium regarding
studies using meta-ethnographic methods interventions to reduce anti-biotic use [14]. Five
[19]. First order (reflecting participants’ understand- considered patients in primary care with any
ings) and second order (reflecting authors’ interpre- presentation [25–27,30,33], seven only

7,045 unique records


Identified by electronic database searching
0 unique records
Identified through hand searching

6,931 records
Excluded in title/abstract screening

114 studies
Identified for full screening

99 studies excluded:
9 were not primary studies
78 did not report any qualitative data
7 did not report any child specific findings
1 was not in primary care settings
4 did not report on phenomena of interest

15 studies
Included

Figure 1. Flow chart of inclusion. Literature search and study descriptions.


Table I. Description of included studies (in date order).

14 P. J. Lucas et al.
First author, Focus on antibiotic
date prescribing Location Parent sample Clinician sample Illness Study focus

Clarke 1989 No Leeds, UK Families None RTI & febrile To investigate how parents from different ethnic groups manage
[20] Urban illness their children’s RTIs & fevers & their consultation with GPs.
Face-to-face interviews
Butler 1998 Yes Cardiff, UK 5 mothers 21 GPs Sore throat To better understand reasons antibiotics are prescribed for sore
[21] [1–28 years as throats. Face-to-face interviews
principles]
Barden 1998 Yes, and in context Atlanta, USA Urban 29 parents 22 physicians URTI To assess the attitudes and assumptions of physicians and
[29] of overuse parents regarding antimicrobial use and misuse. Focus groups
Elwyn 1999 Yes, and in context Cardiff, UK Urban 2 mothers 1 GP Tonsillitis To examine the “shared-decision-making” model in situations of
[22] of overuse 1 father conflict over preferred treatments. Discourse analysis of
recorded consultations
Arrol 2002 Yes, and in context Auckland, New Parents consulting 13 physicians General To explore issues and attitudes regarding delayed prescription
[33] of overuse Zealand Urban for children use from the perspectives of family physicians and patients.
Face-to-face interviews
Bjornsdottir Yes Iceland Urban & None 10 GPs General This study aims at understanding GPs’ decision-making when
2002 [26] rural deciding whether or not to prescribe antibiotics. Face-to-face
interviews
Jonsson 2002 No Iceland Urban 17 mothers, 6 None Otitis media To explore the views and feelings of parents of pre-school
[28] fathers children with newly diagnosed acute otitis media towards the
disease and its diagnosis and treatment. Face-to-face
interviews
Pradier 2003 Yes, and in context France 8 groups of 2 groups of GPs Feverish To explore ways of modifying attitudes and behaviours of doctors
[31] of overuse parents 1 group of nasopharyngitis (GPs and paediatricians), parents, and pharmacists towards
paediatricians the over-prescription of antibiotics. Focus groups
2 groups of
pharmacists
Everitt 2003 Yes UK 11 mothers None Conjunctivitis To explore patients’ understanding of conjunctivitis and its
[23] management. Face-to-face interviews
Petursson Yes, and in context Iceland Urban & None 16 GPs General To explore reasons given by Icelandic GPs for non-
2005 [27] of overuse rural pharmacological prescribing. Face-to-face interviews
Larson 2006 Yes New York, USA 25 mothers 3 health care General To describe the knowledge, attitudes, beliefs, and practices of
[30] Urban professionals Latino community members regarding the use of antibiotics.
2 pharmacy Focus groups
employees
Rose 2006 Yes, and in context Sheffield & None 39 GPs Conjunctivitis To investigate the non-clinical determinants of the management
[24] of overuse Berkshire, UK of acute infective conjunctivitis in children. Telephone
interviews
Hawkings Yes South Wales, UK Adults, of whom None General To achieve a deeper understanding of the use of antibiotics in
2008[25] 9 were mothers the community. Face-to-face interviews
Hoye 2010 Yes, and in context Norway None 33 GPs RTIs To explore Norwegian GPs’ views and experiences of delayed
[32] of overuse antibiotic prescribing in patients with URTIs. Focus groups
Tonkin-Crine Yes, and in context UK, France, Poland, None 52 GPs RTIs To elicit GPs’ views on strategies for antibiotic prescribing.
2011 [14] of overuse Spain, Belgium Face-to-face and telephone interviews
Parent and clinician views on prescribing for childhood infections 15
those with RTIs [14,20–22,29,31,32], two with con- Views and perceptions that trigger a
junctivitis [23,24] and one with otitis media [28]. decision/preference to prescribe
More than 300 individuals, including 86 moth-ers,
Four factors triggered decisions to prescribe among
15 fathers, and 207 clinicians (usually GPs), were
clinicians: perceived pressure from parents; perceived
included in these studies (sample sizes were not always
pressure from outsider the consulting room, a belief they
reported for specific participant groups). Six studies
should be prescribed “just in case”; and where clinicians
included the views of parents and clinicians [21,22,29–
believed they were clearly indicated. Perceived pressure
31,33], five those of clinicians only [14,24,26,27,32],
from parents was reported as the principle reason to
and four those of parents only [20,23,25,28]. No study
prescribe in several studies [14,27,29], although this did
included the views of chil-dren. Study appraisals are
not necessarily imply a stated expectations or desire.
presented in Table II.
This perceived pressure could also result from parental
Studies were published between 1998 and 2011, and
anxiety [24,27,28,33], fear of litigation, and concern for
only two earlier studies [20,28] did not focus only on
the consequences for the doctor–patient relationship
prescriptions for antibiotics (see study focus Table I).
(including re-con-sultation). Perceived external pressure
Thirteen asked specifically about antibiotic treatment, of
came from educators, employers [24,26,29], and in the
which eight set this within the context of over-
US study from drugs companies [29]. The only clear
prescribing. This context influenced design, data
indica-tions for prescribing antibiotics given by
collection, and analysis – for example, by includ-ing
clinicians in these studies was “green nasal discharge”
questions about perceptions of overprescribing [29], or
[29] and as a “treatment” for high parental anxiety. In
by purposively sampling and comparing high and low
addition to these positive decisions to prescribe, there
prescribers [33]. Therefore findings reported here often
were a number of contexts within which clinicians
concern antibiotic prescribing only.
prescribed “just in case”. Where they felt over-
prescription was not a problem, or not a problem for
them (e.g. located in secondary care) they felt there was
Synthesis
no reason not to prescribe [29]. Where clinicians felt
Figure 2 provides an example of the process of iden- uncertain of the consequences of not prescribing they
tifying and translating constructs. Constructs emerged would also sometimes prescribe. This occurred both
relating to beliefs and behaviours that influ-enced where diag-nosis was unclear, and also where they were
preferences and decisions regarding prescrip-tion of uncertain that parents could manage the illness
antibiotics for both parents and clinicians, along with themselves, par-ticularly where there was no continuity
consultation needs. These constructs are summarized in of care so doc-tor and parent did not know each other
Table III, separated into views and perceptions that [27].
trigger a decision to prescribe, sup-port a decision not to Two factors drove parents to certainly want a pre-
prescribe, and consultation needs for each of clinicians scription. In line with clinician reports, some parents
and parents. reported that pressure from daycare providers and

Table II. Study appraisal.


Primary marker: Context sensitivity: Sampling strategy: Data quality: Theoretical Generalizability
Is the aim of the Is the research Is the sampling Are different adequacy: and typicality:
research to design sensitive to strategy described sources of Is process from What claims are
explore subjective the context in appropriate and knowledge/ theory to being made, and
First author, meanings of which study takes informed by theory understanding interpretation do they follow
date experience? place? or context? compared? explicit? from the data?

Clarke 1989 [20] Partly satisfied Partly satisfied Unclear Partly satisfied Satisfied Satisfied
Butler 1998 [21] Satisfied Unclear Satisfied Satisfied Satisfied Satisfied
Barden 1998 [29] Satisfied Unclear Unclear Satisfied Not satisfied No claims
Elwyn 1999 [22] Partly satisfied Unclear Satisfied Partly satisfied Satisfied No claims
Arrol 2002 [33] Satisfied Unclear Satisfied Satisfied ? No claims
Bjornsdottir 2002 [26] Satisfied Unclear Unclear Satisfied Satisfied Satisfied
Jonsson 2002 [28] Satisfied Unclear Satisfied Satisfied Satisfied Unclear
Pradier 2003 [31] ? Unclear Unclear Satisfied Not satisfied Unclear
Everitt 2003 [23] Satisfied Unclear Satisfied Partly satisfied Not satisfied Satisfied
Petursson 2005 [27] Satisfied Unclear Satisfied Partly satisfied Satisfied No claims
Larson 2006 [30] Satisfied Unclear Satisfied Satisfied Satisfied Satisfied
Rose 2006 [24] Partially satisfied Unclear Satisfied Satisfied Unclear Not satisfied
Hawkings 2008 [25] Satisfied Satisfied Satisfied Unclear Satisfied Satisfied
Hoye 2010 [32] Satisfied Unclear Unclear Satisfied Unclear Satisfied
Tonkin-Crine 2011 [14] Satisfied ? Satisfied Satisfied Not satisfied Satisfied
16 P. J. Lucas et al.

Quotation presented in study (1st Order Construct)


Theme present in literature (2nd Order Construct)
“[They know the case] in spite of the best .. intentions
Some doctors described time pressure as an occasional
of not doing it (laughs) you see, to spend a long time
reason for prescribing, for example when lacking time
on something else when one has to cope, it is
to explain to the patient the inadequacy of antibiotics.
impossible. [J]” Bjorndottir 2002 p.21 Q3
Bjorndottir 2002

3rd Order Construct


Clinicians wanted quick
consultations

Theme present in literature (2nd Order


Construct)
Physicians commented that prescribing
antibiotics allowed them to conclude the patient
visit rapidly (Barden 1998)

Figure 2. Examples of third-order development.

employers meant they wanted antibiotics to reduce the Consultation needs


risk of absence, or to reduce the risk of infection
Some of the factors influencing decisions to prescribe
[22,23,29]. Parents also wanted antibiotics where they
related to the consultation needs of parents and clini-
believed they were efficacious for their child’s current
cians as described in this group of studies. Where the
illness: they would improve the severity or duration of
needs of these two parties were at odds, this seemed to
symptoms including pain [22,24,28,29], reduce the
feature in antibiotic prescribing decisions. Parent needs
likelihood they would need to return to the doctor
were threefold; they wanted a medical exami-nation and
[22,29], or in one study that conjunctivi-tis would persist
evaluation [20,23,28,29], they wanted a medical
and be transmitted to others with-out treatment [23].
decision [14,20–33], and finally (depending on this
decision) they wanted appropriate treatment [20–
23,29,31]. Importantly, where they felt they had received
Views and perceptions that support a a good evaluation parents were happy to accept
decision/preference not to prescribe clinicians’ advice and decisions even where this differed
from their expectations. They trusted the clinicians’
Concerns regarding adverse effects and antibiotic greater knowledge of the problems they were
resistance discouraged clinicians from prescribing [22], experiencing. Clinicians needed a consultation that was
as did concerns regarding over-prescription in general quickly completed and where both parents and clinician
[29,31]. Where clinicians did not feel there was pressure were satisfied with the outcome [24,29]. They also
from parents to give a prescrip-tion, this enabled them to wanted to educate parents to understand that antibiotics
avoid prescribing anti-biotics [26,29,32]. GPs in France were not necessary [21,29], but found this difficult to
and Poland used near-patient tests to reduce uncertainty achieve [21]. The pressure to keep consultations short
concern-ing diagnosis [14]. meant some gave in order to bring consultations to a
rapid conclusion [26,29].
A “no treatment” preference among parents was
reported in several studies and this decreased demand
for antibiotics. Parents wanted to monitor their child’s Discussion
illness, and were happy to hear that antibiot-ics were not
Principal findings
required [21,23,25,30]. For some, resis-tance to
prescriptions was explicitly linked to concerns about Across these studies clinicians described limited occa-
harmful effects of antibiotics or med-icines in general sions when they were certain about the prescription
[23,25,28] and to fears that antibi-otics would produce decision (either to prescribe or not to prescribe). More
resistance within their own child and thus he/she would often, clinicians reported prescribing when uncertainty
not benefit from future treat-ment [25,28,29]. Some existed either because of the lack of diagnosis, or uncer-
parents in one study reported deliberately limiting tainty regarding the social, health, or legal
consumption of prescribed anti-biotics [25]. Parents consequences of not prescribing and therefore took a
could feel unhappy when they received antibiotics but “just in case” approach. Clinicians also report
not the reassurance or infor-mation they wanted, or if
prescribing under pressure, when factors other than
the symptoms they were concerned about (e.g. pain)
clinical presentation (parents, employers, drugs
were not addressed [20,21].
companies, time for consul-tation) pushed them into
prescribing. All of these fac-tors increased the likelihood
they would prescribe, even
Parent and clinician views on prescribing for childhood infections 17
Table III. Factors influencing prescription decision (third-order constructs).
Influence on Third order construct Supporting sub themes

Clinician factors Just in case Non-treatment is too risky where there is uncertainty about the
supporting decisions consequences of not prescribing, uncertainty about a parent’s ability
to prescribe to cope, uncertainty about diagnosis [24,27]
Pressures from outside US based clinicians said incentives & free samples from pharmaceutical
the consulting room industry encouraged prescription [29]
Requirement to end consultation quickly [26,29]
Pressure to give antibiotics to allow return to work or daycare [24,26]
Clinicians believed that use of day care and other group exposures were
a major cause of antibiotic overuse because it led to frequent
infections [29]
Clinically indicated A green nasal discharge indicated antibiotics were needed [29]
Antibiotic prescription can reduce parental anxiety [24,27,28,33]
Perceived pressure from Potential for litigation, repeat consultations, visits to other doctors, late
parents night calls, [14,29,31]
To increase patient satisfaction and reinforce the doctor-patient
relationship [29,31,14]
Prescribing was ‘less stressful’ for the clinician than an ‘anxious and
angry’ parent. [28, 33, 24, 27]
Potential for litigation, repeat consultations, visits to other doctors, late
night calls, [14, 29, 31]
Clinicians felt that parental expectations for antibiotics was the principle
factor that influenced them to prescribe antibiotics when not needed
[27, 29]
Parent factors Prescription is needed A minority of parents believed antibiotics would resolve symptoms and
supporting decisions avoid repeat consultations and that they were needed when home
to prescribe management failed [21, 22, 29, 23, 24, 28]
Because the current illness is bacterial [29]
External pressures From day care providers/school or employment demands [22,23,29]
Clinicians factors Concern about adverse Concern about adverse outcomes [22]
supporting decisions outcomes
not to prescribe Lack of pressure to Lack of perceived parental pressure [26,29,32]
prescribe
Certainty a prescription Near patient tests provided certainty a prescription is not needed [14]
not needed
Concern about over Belief that they or their practice colleagues already overprescribe [29,31]
prescription
Parent factors No-intervention Preference for a no-intervention approach [21,23,25,30]
supporting decisions preference
not to prescribe Concern about side Concern about adverse outcomes [22,23,25,28,29]
effects
Do not believe will be Belief the prescription will not improve symptoms [20,21]
helpful
Clinician consultation A good consultation A good consultation is one which is quickly completed, and both
needs parents and clinician are satisfied [24,29]
Parent education To educate parents about illness/treatment [21, 29]
Parent consultation A medical assessment A medical evaluation and medical information [20,23,28,29,31]
needs A necessary appointment Don’t want to “bother” the doctor unnecessarily [22]
“Appropriate” treatment To receive “appropriate” treatment as recommended by a doctor
[20–23,29,31]
A medical decision A medical decision (which could be that no treatment was necessary)
[21,23,29,20,21,33]

when they did not believe antibiotics were clinically satisfied with treatment decisions which differed from
indicated. Some parents wanted a prescription because their expectations where this was the case.
they believed it would improve their child’s illness. But
parents were also concerned to get appropriate advice or
Strengths and weaknesses of the study
treatment for their child, and some preferred to avoid
medicines if possible. Parents sought a thorough med- This review is the first to consider the views of both
ical assessment from a doctor they trusted, and were parents and primary care clinicians regarding
18 P. J. Lucas et al.
all prescriptions for minor acute childhood infection. them, but that trust and open communication within the
The scope of this review is wide, which resulted in a consultation are key to achieving this [40].
diffuse search strategy but also enabled us to include the
views of a large number of people from diverse contexts, Meaning of the study
and to draw on unpublished work and papers published
This review suggests that clinicians prescribe antibiotics
in languages other than English.
“just in case” when faced with clinical uncertainty. This
One of the strengths of a systematic approach to
is important, because exhortations not to prescribe will
reviewing is in the ability to comment on what is absent,
not address this uncertainty. It is not certain which cases
as well as what is present in the literature. We noted that
may develop complications and require hospitalization,
no studies included the views of children, and this is a
or whether individual children might benefit from
weakness of the literature. Further, we noted that the
antibiotics [9,10,41].
literature was dominated by concerns about over-
This review further suggests that parental concerns
prescribing of antibiotics. The means there is a focus on
or desire for a medical evaluation may be misinterpreted
clinicians’ perceptions regarding those occasions when
as a demand for medical treatment (a prescription), and
they prescribe despite believing they are probably not
that some parents prefer not to use medication for their
clinically indicated. We do not know about those cases
children. It is important that clinicians check and address
where clinicians believe they have made a clinically
parental concerns, as this may reduce the perceived
sound decision (either to pre-scribe or not) [34], so we
pressure to prescribe.
cannot comment on whether or how these would differ.
Good medicine includes emotional as well as clinical
In common with other reviews of qualitative
care [42] and guidance that clinicians explic-itly address
research, in pooling findings across studies and meth-
parental concerns already exists [43]. The findings of
ods we lose contextual details that may have relevance
this study suggest how clinicians might better present
in understanding our findings. Our search strategy may
responses to these. First, infor-mation on the natural
have missed studies of interest where they did not
history of an illness should respond to parents’ desire for
mention words relating to prescriptions.
information that is specific to this child on this occasion.
Second, the physical examination in itself may be
Comparison with literature important for reassuring parents.
Previous studies have shown that parents do not always
get what they need from primary care consultations.
Reports suggest parents leave consultations with insuf-
Acknowledgements
ficient information on diagnosis and treatment options
and feeling uncertain [35,36], and that poor clinical This paper summarizes independent research funded by
assessments and lack of access to health care contribute the National Institute for Health Research (NIHR) under
to hospitalization for RTI [10]. Our review suggests this its Programme Grant for Applied Research (Grant
dissatisfaction might arise when parents’ desire for a Reference Number RP-PG-0608-10018). The views
thorough medical evaluation conflicts with a clinician’s expressed are those of the author(s) and not necessarily
desire for a speedy consultation or when it is interpreted those of the NHS, the NIHR or the Department of
by clinicians as anxiety or demands for antibiotics. Health.
Parental anxiety about child illness has been shown to The authors would like to thank all authors of
increase the frequency of consultations and antibiotic studies included in this review, Jo Abbot for assis-tance
use [37], but requests for medical evaluations and state- with database searches, and Debbie Allnock and Audrey
ments of concerns by parents may be misinterpreted as Leonel for assistance with data extrac-tion and
requests for treatment [27,38,39]. translation.
A recent study would agree with our findings. This research on which this paper is based is part of
Brookes-Howell and colleagues considered parent sat- the TARGET programme. The authors would like to
isfaction with prescribing decisions in four European thank the whole team, all have whom contribute to the
countries. In 50 of the 63 cases examined, parents were research programme. The TARGET team con-sists of:
satisfied with the prescription decision and their rea-sons Alastair D. Hay, Andrew Lovering, Brendan Delaney,
were similar to those reported here: beliefs that Christie Cabral, Hannah Christensen, Hannah Thornton,
particular symptoms needed antibiotics, that antibiotics Jenny Ingram, Jeremy Horwood, John Leeming,
were efficacious, and, in contrast, that medication should Margaret Fletcher, Matthew Thomp-son, Niamh
be avoided if possible. In common with our review, the Redmond, Patricia Lucas, Paul Little, Peter Blair, Peter
authors note that parents are often ready to accept
Brindle, Peter Muir, Sandra Hollinghurst, Sue Mulvenna,
clinician decisions, even when they disagree with
Talley Andrews, and Tim Peters.
Parent and clinician views on prescribing for childhood infections 19
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