Article Text

Download PDFPDF
Missed opportunities for earlier treatment? A qualitative interview study with parents of children admitted to hospital with serious respiratory tract infections
  1. Nick A Francis1,2,
  2. Joanna C Crocker1,2,
  3. Arla Gamper3,
  4. Lucy Brookes-Howell1,2,
  5. Colin Powell4,
  6. Christopher C Butler1
  1. 1Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
  2. 2South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
  3. 3School of Medicine, Cardiff University, Cardiff, UK
  4. 4Children's Hospital for Wales, Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
  1. Correspondence to Dr Nick A Francis, Department of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN, UK; francisna{at}


Objective To identify potential opportunities for earlier intervention among children who develop a complicated respiratory tract infection (RTI).

Design Qualitative, face-to-face, individual interview study, either in hospital or at home, with parents of children admitted to hospital with a complicated RTI.

Setting Participants were recruited from a large UK teaching hospital, and described events (largely) prior to hospital admission.

Participants Parents of 22 children (12 with empyema, 8 with pneumonia, 1 with peritonsillar abscess and 1 with mastoiditis).

Results Parents' accounts revealed missed opportunities for timely treatment resulting from parental and health service associated factors. Themes relating to parental factors included problems assessing the severity of the illness (5 parents), beliefs about accessing health services (10 parents; including fear of appearing ‘neurotic’, belief that their concerns would not be taken seriously, and belief that their child would not be prescribed antibiotics or would be prescribed antibiotics too readily) and feeling powerless to challenge clinical authority (7 parents). Health service associated factors included perceived problems accessing healthcare services (13 parents; including inadequate primary care triage, barriers to accessing timely consultations and past experience of problems accessing healthcare leading to failure to consult) and perceived poor quality clinical encounters (11 parents; including inadequate assessment and communication).

Conclusion Addressing, where appropriate, these parental (skills, fears and beliefs) and health service (access and consultation quality) associated factors may lead to more prompt care for seriously ill children.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding The Cymru Alliance of Primary Care – Oriented Research Network (CAPRICORN, now AQUARIUS) provided NAF with a Priorities and Needs Fellowship and a Dissemination Fellowship, which funded this project. The authors declare complete independence from the funder.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the South East Wales Local Research Ethics Committee Panel B (05/WSE02/186).

  • Provenance and peer review Not commissioned; externally peer reviewed.