Parental views on acute otitis media (AOM) and its therapy in children - results of an exploratory survey in German childcare facilities

Abstract

BackgroundAcute otitis media (AOM) is one of the main reasons for medical consultation and antibiotic use during childhood. Although 80 % of AOM cases are self-limiting, antibiotic prescription is still high, either for physician- or for parent-related factors. This study aims to identify parental knowledge about, beliefs and attitudes towards, and experiences with AOM and its therapy and thus to gain insights into parents’ perspectives within the German health care system.MethodsAn exploratory survey was conducted among German-speaking parents of children aged 2 to 7 years who sent their children to a childcare facility. Childcare facilities were recruited by convenience sampling in different urban and rural sites in Germany, and all parents with children at those facilities were invited to participate. Data were evaluated using descriptive statistical analyses.ResultsOne-hundred-thirty-eight parents participated. Of those, 75.4 % (n = 104) were AOM-experienced and 75.4 % (n = 104) had two or more children. Sixty-six percent generally agree that bacteria cause AOM. 20.2 % generally agree that viruses cause AOM. 30.5 % do not generally agree that viruses cause AOM. Eight percent generally agree that AOM resolves spontaneously, whereas 53.6 % do not generally agree. 92.5 % generally (45.7 %) and partly (42.8 %) agree that AOM needs antibiotic treatment. With respect to antibiotic effects, 56.6 % generally agree that antibiotics rapidly relieve earache. 60.1 % generally agree that antibiotics affect the gastrointestinal tract and 77.5 % generally agree that antibiotics possibly become ineffective after frequent use. About 40 % generally support and about 40 % generally reject a “wait-and-see” strategy for AOM treatment. Parental-reported experiences reveal that antibiotics are by far more often prescribed (70.2 %) than actively requested by parents (26.9 %).ConclusionsParental views on AOM, its therapy, and antibiotic effects reveal uncertainties especially with respect to causes, the natural course of the disease and antibiotic effects on AOM. These results indicate that more evidence-based information is needed if parents’ health literacy in the treatment of children with AOM is to be enhanced. The discrepancy between reported parental requests for antibiotics and reported actual prescriptions contradicts the hypothesis of high parental influence on antibiotic use in AOM.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0516-3) contains supplementary material, which is available to authorized users.

Parents’ Expectations and Experiences of Antibiotics for Acute Respiratory Infections in Primary Care

“…Our findings are largely in line with those of previous studies on parental beliefs about antibiotics' benefits for acute respiratory infections, [18][19][20][21][22][23][24][25][26] although our study is among the first to quantify them. Of course, such expectations were not homogeneous across parents and illnesses-parents knew that not using antibiotics is sometimes acceptable, consistent with previous findings.…”

“…Of course, such expectations were not homogeneous across parents and illnesses-parents knew that not using antibiotics is sometimes acceptable, consistent with previous findings. 26 Beliefs about the need for antibiotics for acute otitis media were different from those for sore throat and cough, suggesting a role for clinicians in carefully eliciting perceptions and misperceptions that parents might have and tailoring their communication accordingly. 27,28 About one-half of parents reported antibiotic resistance as a potential harm, similar to proportions found in other cross-sectional studies, 21,28,29 although there was confusion among many about what resistance actually was, as has been reported by others.…”

Video Discharge Instructions for Acute Otitis Media in Children: A Randomized Controlled Open‐label Trial

“…This may reflect a misconception that antibiotics have analgesic benefits or that analgesia is no longer a priority once antibiotic therapy has been initiated. Almost 57% of parents in a recent German study believed that antibiotics “rapidly relieve earache.” To ensure compliance with the American Academy of Pediatrics guidelines, our findings underscore that health care providers should emphasize to parents the importance of providing appropriate analgesia in the first 3 days of treating AOM, whether or not antibiotics are prescribed.…”

“…Almost three‐quarters of parents report a significant impact on their work attendance and identify pain and disturbed sleep as the most important sources of AOM‐related burden . Survey data suggest high levels of parental uncertainty regarding the treatment of AOM . Moreover, less than 30% of U.S. parents with children with AOM receive instructions on pain management, and only a minority of parents report reading discharge instructions .…”

Hot Off the Press: Video for Acute Otitis Media Discharge Instructions

“…3,4 There is significant parental uncertainty regarding treatment of AOM and less than 30% of U.S. parents receive instructions on appropriate analgesia for their children. 5,6 Discharge instruction complexity and inadequate comprehension is associated with medication errors, suboptimal postdischarge care, and unnecessary recidivism. [7][8][9][10] Medication errors can be reduced using standardized discharge instructions, and parents prefer these to verbal summaries.…”