Watchful Waiting for Cases of Pediatric Otitis Media: Modeling Parental Response to Physician Advice

Abstract

Watchful waiting (WW) can reduce unnecessary antibiotic use in the treatment of pediatric otitis media (ear infection), but its utility is impaired by underutilization and noncompliance. Guided by advice response theory, the current study proposes advantage and capacity as factors that predict how caregivers evaluate and respond affectively to WW. Parents (N = 373) of at least 1 child age 5 years or younger completed questionnaires that assessed responses to hypothetical WW advice for their youngest child. Perceptions of advantage from WW and the capacity to monitor and manage symptoms predicted advice quality, physician trust, and future compliance both directly and indirectly through negative affect. The findings suggest the elaboration of advice response theory to include more aspects of advice content evaluation (e.g., advantage) and the influence of negative affect. The study also provides practical guidance for physicians seeking to improve caregiver reception of WW advice.

Funding

This project was supported by the Commonwealth of Pennsylvania and Get Smart: Know When Antibiotics Work through Cooperative Agreement No. CDC-RFA-CK14-1401PPHF14. The content is solely our own responsibility and does not necessarily represent the views of the Centers for Disease Control and Prevention.

Notes

¹ Youngest children should have been 5 years old or younger, but numbers may have been intended to represent months, and there were no other indications of problematic data from these participants, so data were retained.

² Clinical practice guidelines (Lieberthal et al., 2013) recommend immediate antibiotics for children ages 6 months or younger, and either immediate antibiotics or WW is recommended for children ages 6 months to 2 years. Although these differences in guidelines could affect parent receptiveness to WW advice, preliminary analyses revealed no correlation between child age and any of the variables examined in this study, so we did not exclude or conduct separate analyses on these data.

Additional information

Funding

This project was supported by the Commonwealth of Pennsylvania and Get Smart: Know When Antibiotics Work through Cooperative Agreement No. CDC-RFA-CK14-1401PPHF14. The content is solely our own responsibility and does not necessarily represent the views of the Centers for Disease Control and Prevention.