Felt or enacted criticism has been identified as an important variable influencing parents’ decision making when seeking help for an acutely sick child at home in the white British population (Neill et al. 2013).
Aim To explore the transferability of the felt or enacted criticism concept to children’s hospitals in Ireland and South Asian and Travelling family communities in the UK.
Methods Comparative thematic analysis was used to draw comparisons between data coded to felt or enacted criticism in three qualitative data sets: Two community based studies in the UK with parents of children under 5 years; One study in Ireland with parents of hospitalised children 7 to 16 years. The process was informed by Glaserian formal grounded theory development processes.
Results Felt or enacted criticism was found to operate in all three studies demonstrating its applicability, or ‘work’ in Glaser’s terms, across the childhood age range, social groups and contexts in the English speaking Western world. All components of felt or enacted criticism were identified in all data sets: labelling, discrediting attributes, fear of discrimination and unequal power distribution. The effect was most stark in the hospital setting where parents feared ‘over stepping the mark’ and avoided ‘bothering’ staff, reducing communication.
The concept was often expressed in the context of perceived social hierarchy with doctors seen as socially superior to parents themselves. Parent’s use of strategies to avoid criticism varies more between settings than between social groups, illustrating the modifiability of the theory.
Conclusion Parents experiences of criticism, even when not explicitly verbal in nature, influence their decision making about health service use and/or their interactions with health care professionals during health service use for their children. Such criticism leads to avoidance of future events and leads to parents self limiting access to services and, consequently, support and advice. There is a need for health care professionals to develop a more empowering approach in their encounters with parents of young children.
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