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Parents' Beliefs and Knowledge About Acute Otitis Media

Parents' Beliefs and Knowledge About Acute Otitis Media


We interviewed 15 mothers with a mean age of 37 years (SD = 5, range 29 to 49). They had an average of two children; most (n = 12) had tertiary education and 4 had a health professional qualification (nursing or allied health). Participants had a mean REALM score of 65.53 (SD = .83, range 63 to 66), which indicates that all parents had a reading level above Grade 9. Table 2 shows characteristics of parents. Thirteen out of the 15 children were treated with per oral antibiotics for the most recent episode of acute otitis media (Table 3). A delayed prescription was offered to one family however antibiotics were initiated at the same day. The mean duration of interviews was 21 min (range 15 to 31 min). The results which emerged could be framed around 4 themes: causes of acute otitis media, reasons for consulting a GP, beliefs about treatments, and sources of knowledge.

Causes of Acute Otitis Media

Various causes of acute otitis media were suggested by parents, with many not having an accurate understanding.
"Absolutely no idea, I don't even know what an ear infection is really, it's just something that I'm told that my children have" (Participant 1)
Some parents related the cause of acute otitis media to having a cold that develops into an ear infection.
"I thought it was like an extended version of a cold. A cold gone wrong basically, or gone worse" (Participant 6)
"I'd say he probably had a cold beforehand which then turned into something more than that" (Participant 9)
Acute otitis media was also associated with teething, ear wax congestion, swimming, dirty bathing water and the size or shape of the Eustachian tubes in children.
"Teething maybe, build up of ear wax I think" (Participant 1)
"I think in our children they have been water related. They've been swimming, something hasn't drained, a little germ has festered in the ear and it's got out of all control" (Participant 4)
"I think it's because the Eustachian tubes are straight at that age, so anything like mucus and saliva and things that they have a cold can quite easily make their way to their ears" (Participant 12)

Reasons for Consulting a GP

Pulling at the ear, pain, fever, no appetite and sleep disturbance were the signs and symptoms most parents reported when they suspected acute otitis media. Parents predominantly attended the GP because they did not want their child to be in any pain or because they wanted reassurance. The concerns that parents desired reassurance for were related to the possibility of a serious infection (e.g. septicaemia) or that their child would require hospitalisation.
"…you don't like little ones to be in pain, so it is quite traumatising when they carry on. You know when you're not really treating anything and just letting go. So it is quite emotional as well. I want it to be fixed right then and there" (Participant 11)
"Well it could go further down and they could get like a… I have heard of people getting, well even septicaemia from going into the blood systems" (Participant 15)
"Possibly end up in hospital on a rehydration drip, which she has done previously, when she was very little" (Participant 4)
Some parents were also concerned that their child's eardrum would perforate and many worried about long-term damage, especially hearing loss.
"I don't really want his eardrum to burst" (Participant 5)
"I think most mothers worry about their child's hearing…" (Participant 14)
"I would probably say that it might have a long-term impact on hearing. Irreversible" (Participant 13)

Beliefs About Treatments

Most parents believed that antibiotics were the best and only treatment for their child's acute otitis media. Others thought that the treatment strategy should depend on the type of infection (that is, viral or bacterial origin) and a few parents were unsure about the treatment.
"…each time the antibiotics have worked like magic." (Participant 4)
"I kind of thought it was quite simple really, just had an ear infection and that I needed antibiotics" (Participant 15)
"I think first of all you need to find out whether it's viral or bacterial and then follow the according treatment" (Participant 11)
Parents' perceptions about the best treatment were mainly based on their previous experience and the advice of the GP. However, responses from parents suggested that they were not fully informed and had not previously considered the options.
"The only option we were given was antibiotics. Apart from that, I wouldn't imagine that there's much else" (Participant 7)
"Well the only thing I've ever been offered is antibiotics, so I don't know of anything else" (Participant 1)
"No, it was just, 'Here's the antibiotics and off you go'" (Participant 14)
A few parents would accept 'no antibiotic treatment' as an option, if their child's infection was monitored and they had the back-up of being able to re-consult if needed.
"Yes, I think in certain circumstances, but it would have to be monitored, so… that the infection is resolving and that they're not going to have any hearing issues as a result" (Participant 10)
"I would try it [no antibiotic treatment], as long as my option would be then to go back in a few days to make sure that it hasn't got worse…" (Participant 3)
Other parents were more cautious about this option and feared long-term damage such as hearing loss if antibiotics were not used or wanted a fast recovery (believing antibiotics would provide this). The time pressure of recovery was related to the importance of getting back to work or being on holiday for some parents.
"… I am thinking well if they don't treat him, what if he goes deaf?" (Participant 1)
"Preferably not, not when it comes to ears. I don't want to take that chance with my child's hearing" (Participant 2)
"…he was in full-time day care and from my point of view I had to get it fixed. So we went and got it filled that morning" (Participant 9)
"We are on holidays, we are in a different environment, if antibiotic is a suggested option, I will certainly go down that track…" (Participant 5)
Pain relief medication, such as paracetamol (acetaminophen) or non-steroidal anti-inflammatory drug (NSAID), were used by all parents, mainly for temperature reduction and pain relief. However, most parents did not think of symptomatic relief of paracetamol or NSAIDs as a sufficient treatment on their own and they believed that treatment (such as antibiotics) to cure the infection was also needed.
"But if I knew straight away that it was an ear infection, then I wouldn't bother with just Panadol or something like that, I would go straight to the antibiotics to help their body knock it" (Participant 4)

Sources of Knowledge

All parents relied on and trusted the GPs' knowledge and assumed it was based on recent research and continuing medical education such as reading medical journals or attending conferences. A few parents mentioned that they preferred GPs who had children themselves because they felt that they had a better understanding of managing sick children.
"Well I actually hope he knows what's best, because he's done more studies that what I've done… yeah, I mean we put a lot of faith in our GP's" (Participant 3)
"Well, one hopes that they're [GP's] trained better than us to have a lot more information than we do, and I suppose we have to trust that they have done the research and that they do know" (Participant 13)
…some GPs have children themselves and understand that children need to be seen straight away… (Participant 6)
Most parents preferred to receive information from the GP when they had a sick child. However, three other major sources of information for this situation were identified; (a) the internet; (b) close family and social contacts, particularly participants' mothers and (c) other health professionals such as ear, nose and throat specialists and pharmacists.
"I probably get the most information from the GP and trust that that source of information is relevant to my child, because I think every child is different" (Participant 5)
"I probably go to 'Google' or 'Doctor Google', one of those" (Participant 14)
"…mum usually diagnoses anything for everyone before they even suspect there's something wrong themselves" (Participant 4)
"…if I couldn't get into a doctor or something, which happens quite regularly, I would maybe go to the pharmacist…" (Participant 1)
While it was expected that GPs knew about the best treatment for acute otitis media, only four parents recalled receiving an adequate explanation about the evidence of the management options for acute otitis media.
"…there [are] options presented as hypotheticals, but they [GP's] will always come to a decision and say, look I think we need to do the medication"… (Participant 5)
"Well I know they [GPs] used to give antibiotics, but I've been explained by the GP that that's not what they do anymore. That they [antibiotics] don't seem to alter the course of the illness, they tend to just give them pain relief and wait and see what happens…" (Participant 12)
Although most parents thought they could ask their usual GP for a thorough explanation, some stated that if they saw another GP or an after hours doctor they often felt as if the consultation was rushed and there was no time for explanations.
"…because it is an emergency appointment it feels quite rushed, it's in and out the door…" (Participant 2)

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