Participants indicated multiple factors affected their decision to contact out-of-hours primary care for their child with gastroenteritis and detailed areas of disconnect between their expectations and actions taken by the general practitioner.
Results from a qualitative study of parents who contacted out-of-hours primary care for their child’s acute gastroenteritis are providing an overview of parental motivations and expectations for seeking additional medical care.
Parents sought out-of-hours primary care contact for unusual behavior, absent micturition, and ongoing vomiting and/or diarrhea, with decreased or no fluid intake, and expected general practitioners to perform a thorough physical examination, provide information, and make follow-up plans.1
“Knowledge of parental motivations, expectations, and experiences could improve [general practitioner] care and increase parental satisfaction with [out-of-hours primary care] contacts, treatments, and outcomes, while providing opportunities to increase self-management by parents,” wrote investigators.1
Gastroenteritis can affect people of all ages, although young children may be especially vulnerable because their immune system isn’t mature. Seeing a healthcare provider is recommended for children with gastroenteritis who develop a fever, are tired, have bloody diarrhea, or are dehydrated.2
To explore motivations, expectations, and experiences with out-of-hours primary care contacts among the parents of children with acute gastroenteritis, Anouk Weghorst, MD, of the department of general practice and elderly care medicine at the University of Groningen in the Netherlands, and a team of investigators conducted semistructured interviews with parents who contacted out-of-hours primary care services in Groningen, Assen, and Zwolle regions of the Netherlands. To be included in the study, parents were required to contact out-of-hours primary care for a child younger than 6 years with acute gastroenteritis, speak Dutch, and provide written informed consent.1
Investigators used purposive sampling to obtain representation of contact type, gender, and age of the child. Upon inclusion, gender and age of the parents, parental work status, education level, household composition, and number of children were also assessed.1
In total, investigators interviewed 14 parents, including 11 mothers (78.6%) and 3 fathers (21.4%) with an average age of 32 years (22-46 years). Most children were < 1 year of age (35.7%) and were a first child (71.4%) or an only child (50%). Interviews lasted 30-45 minutes and were audio recorded, transcribed, and analyzed by investigators between January 2021 and March 2021.1
During the interviews, investigators addressed parental motivations, expectations, and experiences with open questions, performing interviews until thematic saturation appeared to be achieved by iterative data analysis. Investigators completed 4 additional interviews in which no new codes were found, and data was analyzed using the constant-comparison method in which each code was constantly compared with other codes.1
Upon analysis, results suggested parents immediately sought out-of-hours primary care contact for 3 major symptoms: a change in their child’s behavior, lack of micturition, and the combination of ongoing vomiting and/or diarrhea with decreased or no fluid intake. Parental feelings of uncertainty, helplessness, and panic were also motivations for out-of-hours primary care contact.1
Investigators pointed out parents expressed concerns about dehydration, duration of fever, change in their child’s behavior, and perceived pain. Of note, household type and child’s age appeared to influence the amount of parental concern, with younger child age and parental inexperience associated with greater worry.1
Most participants indicated they contacted out-of-hours primary care because of the perceived urgency or because they felt their own general practitioner had not listened to them adequately. They expected to receive information about different aspects of the disease, the symptoms to be aware of, and what to do in given situations, for their child to undergo a physical examination, and to be reassured by a general practitioner. Parents labeled the contact as satisfying if their expectations were met and they felt the general practitioner cooperated and recognized their feelings. This included receiving information and advice on how to improve fluid intake, alarm symptoms, what to expect over the course of the disease, and when and whom to call.1
Further analysis showed participants reported dissatisfaction if they received no information about the disease or follow-up, the general practitioner did not perform a physical examination, showed a prejudice toward the parent, or did not show interest in the parent’s concern.1
“The results of this study indicate that it is important for GPs to keep in mind that some children are not severely sick or dehydrated, but parents might be worried and want to prevent severe illness. In addition to reassurance, parents are in need of clear, practical information regarding the natural course of the disease, alarm symptoms, and when to contact again,” investigators concluded.1