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Tuffrey C. How can paediatric teams best respond to growing need with limited resources? Dev Med Child Neurol 2024; 66:677-678. [PMID: 38451605 DOI: 10.1111/dmcn.15893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 03/08/2024]
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Mills S, Tuffrey C, Tbaily L, Tighe M. Modification of the Paediatric Gastro-oesophageal Reflux Disease Symptom and Quality of Life Questionnaire (PGSQ) for children with cerebral palsy: a preliminary study. BMJ Paediatr Open 2024; 8:e002256. [PMID: 38378669 PMCID: PMC10882336 DOI: 10.1136/bmjpo-2023-002256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/06/2023] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVE Gastro-oesophageal reflux disease (GORD) is a common condition affecting children, characterised by the passage of gastric contents into the oesophagus causing pain, vomiting and regurgitation. Children with neurodisability (such as cerebral palsy; CP) are predisposed to more severe GORD due to coexisting gut dysmotility and exclusive/supplementary liquid diet; however, there are no existing tools or outcome measures to assess the severity of GORD in this patient group. For children without CP, the 'Paediatric Gastro-oesophageal Symptom and Quality of Life Questionnaire' (PGSQ) assesses symptoms and response to treatment, but the questions are not suitable for children with significant cognitive impairment. We aimed to adapt the existing PGSQ assessment tool to enable use in evaluating children with CP and GORD. PATIENTS/INTERVENTIONS Cognitive interviews were conducted by the research team with six parents/carers of children (aged 3-15) with CP (Gross Motor Function Classification System level V) who have current or past symptoms of reflux. They were asked to interpret the questionnaire using a 'think-aloud technique,' and offer suggestions on alterations to questions. Reasons for changing questions included confusing/difficult to understand questions, differing interpretations of questions and response choices not applying to the patient group. RESULTS The PGSQ was modified iteratively following each interview. Overall, parents/carers reported that it was acceptable to recall information over the past 7 days. In the final version, it was felt the questions were relevant, useful and related to symptoms that they observed. It was easy to comprehend with no uncomfortable questions. Suggestions for future work included a section specifically focusing on the school day answered by school staff and home life answered by carers who assist them in the home. CONCLUSIONS We have adapted the PGSQ to improve relevance and acceptability for families/carers of children with symptoms of GORD and neurodisability. Further work is needed to validate the questionnaire for this patient group.
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Affiliation(s)
- Sarah Mills
- Paediatrics, Department of Child Health Services, Poole Hospital, Poole, UK
| | - Catherine Tuffrey
- Department of Community Paediatrics, Solent NHS Trust, Portsmouth, UK
| | - Lee Tbaily
- Research and Innovation University Hospitals Dorset NHS Trust, Poole, UK
| | - Mark Tighe
- Paediatric Department, University Hospitals Dorset NHS Trust, Poole, UK
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Craig GM, Hajdukova EB, Harding C, Flood C, McCourt C, Sellers D, Townsend J, Moss D, Tuffrey C, Donaldson B, Cole M, Gill A. Psychosocial support for families of children with neurodisability who have or are considering a gastrostomy: the G-PATH mixed-methods study. Health Serv Deliv Res 2020. [DOI: 10.3310/hsdr08380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background
Evidence reviews recommend consistent and structured support for children with neurodisability and their caregivers in care pathways in which professionals recommend a gastrostomy feeding tube. To date, and to our knowledge, no research has shown how these recommendations have been implemented.
Objectives
The objectives were to describe different exemplar models of psychosocial support and provide an estimate of their resources and costs.
Design
This was a mixed-methods study involving (1) a web-based survey, (2) a qualitative, collective case study of psychosocial support provision in four services and (3) an estimate of costs and preference through a willingness-to-pay study.
Setting
Four service configurations in different locations in England and Scotland.
Participants
Participants were staff who responded to a survey (n = 67) and interviewees (staff, n = 58; parents/children, n = 29).
Findings
Psychosocial support was rarely formalised or documented; it was delivered by different members of the multidisciplinary team, rather than by designated staff, and it was often integrated into appointments dominated by clinical care. Parents expressed different needs for support but reported little opportunity to discuss emotional aspects. Psychologists were not routinely involved and, in general, families were underserved by psychosocial services. Professionals constructed families’ need for psychosocial support in terms of their own roles and the management of risk. Mechanisms for integrating and delivering support were identified, including models of care that linked community and tertiary health services and integrated health and education through pooled budgets. Although generally valued by both staff and parents, peer-to-peer parent support was not consistently offered. Barriers included concerns about confidentiality and appropriately matching parents. Parents participated as members of a feeding committee at one site. Three analytical constructs described the provision of psychosocial support: ‘hidden work’, expressing emotional vulnerability and negotiations around risks and values. The cost-of-support study found that there was a mean of 2.25 appointments (n = 8 parents or carers) over the previous 12 months. The cost of health-care professionals’ time spent on providing psychosocial support ranged from £0.00 to £317.37 per child per year, with an average cost of £76.42, at 2017 prices. In the willingness-to-pay study the median rank of enhanced support, involving the opportunity to see a psychologist and parental peers, was significantly higher than that of usual care (n = 96 respondents, both carers and professionals, who completed rating of the service; p < 0.001).
Limitations
It proved difficult to disseminate a national survey, which resulted in a small number of returns, and to cost the provision of psychosocial support, which we designated as ‘hidden work’, owing to the lack of recording in clinical systems. Moreover, estimates were based on small numbers.
Conclusions
Parent interviews and the willingness-to-pay study demonstrated a preference for enhanced psychosocial support. The study suggests that there is a need for services to formally assess families’ needs for psychosocial support to ensure that provision is planned, costed and made explicit in care pathways. Personalised interventions may assist with the targeting of resources and ensuring that there is an appropriate balance in focus on both clinical care and psychosocial support needs in relation to and following treatment.
Future work
More work is needed to develop tools to assess families’ needs for psychosocial support and the effectiveness of training packages to strengthen team competency in providing support.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 38. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gillian M Craig
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
- School of Health Sciences, City, University of London, London, UK
| | - Eva Brown Hajdukova
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Celia Harding
- School of Health Sciences, City, University of London, London, UK
| | - Chris Flood
- School of Health Sciences, City, University of London, London, UK
| | | | - Diane Sellers
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Joy Townsend
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Dawn Moss
- Borders General Hospital, Melrose, UK
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Grantham-Hill S, Evans HJ, Tuffrey C, Sanders E, Elphick HE, Gringras P, Kingshott RN, Martin J, Reynolds J, Joyce A, Hill CM, Spruyt K. Psychometric Properties and Predictive Value of a Screening Questionnaire for Obstructive Sleep Apnea in Young Children With Down Syndrome. Front Psychiatry 2020; 11:285. [PMID: 32425820 PMCID: PMC7212346 DOI: 10.3389/fpsyt.2020.00285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 03/24/2020] [Indexed: 12/11/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is common in children with Down syndrome (DS) and is associated with adverse health and cognitive outcomes. Daytime clinical assessment is poorly predictive of OSA, so regular screening with sleep studies is recommended. However, sleep studies are costly and not available to all children worldwide. We aimed to evaluate the psychometric properties and predictive value of a newly developed screening questionnaire for OSA in this population. METHODS 202 children aged 6 months to 6th birthday with DS were recruited, of whom 188 completed cardio-respiratory sleep studies to generate an obstructive apnea hypopnea index (OAHI). Parents completed the 14-item Down syndrome OSA screening questionnaire. Responses were screened, a factor analysis undertaken, internal consistency calculated and receiver operator characteristic (ROC) curves drawn to generate an area under the curve (AUC) to assess criterion related validity. RESULTS Of 188 children who completed cardiorespiratory sleep studies; parents completed the screening questionnaire for 186. Of this study population 15.4% had moderate to severe OSA defined by an OAHI of ≥5/h. Sixty-three (33.9%) participants were excluded due to "unsure" responses or where questions were not answered. Using the remaining 123 questionnaires a four-factor solution was found, with the 1st factor representing breathing related symptoms, explaining a high proportion of the variance. Internal consistency was acceptable with a Cronbach alpha of 0.87. ROC curves for the total score generated an AUC statistic of 0.497 and for the breathing subscale an AUC of 0.603 for moderate to severe OSA. CONCLUSION A well designed questionnaire with good psychometric properties had limited predictive value to screen for moderate to severe OSA in young children with DS. The use of a screening questionnaire is not recommended. Screening for OSA in this population requires objective sleep study measures.
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Affiliation(s)
- Sarah Grantham-Hill
- Faculty of Medicine, School of Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
| | - Hazel J Evans
- Faculty of Medicine, School of Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom.,Department of Sleep Medicine, Southampton Children's Hospital, Southampton, United Kingdom
| | - Catherine Tuffrey
- Department of Community Child Health, Solent NHS Trust, Portsmouth, United Kingdom
| | - Emma Sanders
- Faculty of Medicine, School of Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
| | - Heather E Elphick
- Department of Respiratory and Sleep Medicine, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Paul Gringras
- Department of Sleep Medicine, Evelina London Children's Hospital, Guys St Thomas's NHS Trust, London, United Kingdom
| | - Ruth N Kingshott
- Department of Respiratory and Sleep Medicine, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Jane Martin
- Southampton Centre for Biomedical Research, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Janine Reynolds
- Department of Respiratory and Sleep Medicine, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Anna Joyce
- School of Psychotherapy & Psychology, Faculty of Humanities, Arts and Social Sciences, Regent's University London, London, United Kingdom
| | - Catherine M Hill
- Faculty of Medicine, School of Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom.,Department of Sleep Medicine, Southampton Children's Hospital, Southampton, United Kingdom
| | - Karen Spruyt
- Laboratoire de Physiologie intégrée du système d'éveil CRNL- INSERM U1028-CNRS UMR 5292, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon, France
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Parr JR, Todhunter E, Pennington L, Stocken D, Cadwgan J, O’Hare AE, Tuffrey C, Williams J, Cole M, Colver AF. Drooling Reduction Intervention randomised trial (DRI): comparing the efficacy and acceptability of hyoscine patches and glycopyrronium liquid on drooling in children with neurodisability. Arch Dis Child 2018; 103:371-376. [PMID: 29192000 PMCID: PMC5890631 DOI: 10.1136/archdischild-2017-313763] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/22/2017] [Accepted: 10/02/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Investigate whether hyoscine patch or glycopyrronium liquid is more effective and acceptable to treat drooling in children with neurodisability. DESIGN Multicentre, single-blind, randomised controlled trial. SETTING Recruitment through neurodisability teams; treatment by parents. PARTICIPANTS Ninety children with neurodisability who had never received medication for drooling (55 boys, 35 girls; median age 4 years). EXCLUSION CRITERIA medication contraindicated; in a trial that could affect drooling or management. INTERVENTION Children were randomised to receive a hyoscine skin patch or glycopyrronium liquid. Dose was increased over 4 weeks to achieve optimum symptom control with minimal side-effects; steady dose then continued to 12 weeks. PRIMARY AND SECONDARY OUTCOMES Primary outcome: Drooling Impact Scale (DIS) score at week-4. SECONDARY OUTCOMES change in DIS scores over 12 weeks, Drooling Severity and Frequency Scale and Treatment Satisfaction Questionnaire for Medication; adverse events; children's perception about treatment. RESULTS Both medications yielded clinically and statistically significant reductions in mean DIS at week-4 (25.0 (SD 22.2) for hyoscine and 26.6 (SD 16) for glycopyrronium). There was no significant difference in change in DIS scores between treatment groups. By week-12, 26/47 (55%) children starting treatment were receiving hyoscine compared with 31/38 (82%) on glycopyrronium. There was a 42% increased chance of being on treatment at week-12 for children randomised to glycopyrronium relative to hyoscine (1.42, 95% CI 1.04 to 1.95). CONCLUSIONS Hyoscine and glycopyrronium are clinically effective in treating drooling in children with neurodisability. Hyoscine produced more problematic side effects leading to a greater chance of treatment cessation. TRIAL REGISTRATION NUMBERS ISRCTN 75287237; EUDRACT: 2013-000863-94; Medicines and Healthcare Products Regulatory Agency: 17136/0264/001-0003.
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Affiliation(s)
- Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK,The Great North Children’s Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Emma Todhunter
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - Lindsay Pennington
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Deborah Stocken
- Biostatistics Research Group, Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Jill Cadwgan
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK,The Great North Children’s Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Anne E O’Hare
- Salvesen Mindroom Centre, University of Edinburgh, Edinburgh, UK
| | | | - Jane Williams
- Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Mike Cole
- Biostatistics Research Group, Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Allan F Colver
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
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Sanders E, Hill CM, Evans HJ, Tuffrey C. The Development of a Screening Questionnaire for Obstructive Sleep Apnea in Children with Down Syndrome. Front Psychiatry 2015; 6:147. [PMID: 26539127 PMCID: PMC4611960 DOI: 10.3389/fpsyt.2015.00147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 09/24/2015] [Indexed: 11/21/2022] Open
Abstract
Obstructive sleep apnea is a condition which affects an estimated 50% of children with Down syndrome, particularly in their early years. It can cause serious sequelae in affected children but may not be recognized by parents or health professionals. Routine screening has been recommended in some countries, but is not standard practice. There are no validated questionnaire-based tools available to screen this population of children for this particular sleep-related disorder. Using existing validated sleep questionnaire items, we have developed a questionnaire to screen children with Down syndrome up to 6 years of age for obstructive sleep apnea, which corresponds with the recommendations made in UK national guidelines. This paper describes these first steps in demonstrating content validity for a new questionnaire, which will be subject to further in-depth psychometric analysis. Relevance, clarity, and age appropriateness were rated for 33 items using a content review questionnaire by a group of 18 health professionals with expertise in respiratory pediatrics, neurodevelopmental pediatrics, and sleep physiology. The content validity index was calculated for individual items and contributed to decisions about item inclusion. Scale level content validity index for the modified questionnaire of 14 items was at an accepted level of 0.78. Two parents of children with Down syndrome took part in cognitive interviews after completing the modified questionnaire. We describe the development of this 14 item questionnaire to screen for OSA in children with DS from infancy to 6 years.
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Affiliation(s)
- Emma Sanders
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Catherine Mary Hill
- Faculty of Medicine, University of Southampton, Southampton, UK
- Southampton Children’s Hospital, Southampton, UK
| | - Hazel Jean Evans
- Faculty of Medicine, University of Southampton, Southampton, UK
- Southampton Children’s Hospital, Southampton, UK
| | - Catherine Tuffrey
- Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Child Health, Solent NHS Trust, Southampton, UK
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Affiliation(s)
- Rebecca MacLeod
- Department of Paediatrics, Hampshire Hospitals NHS Trust, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Catherine Tuffrey
- Child Health Services, Unit A4 Alpha Court, Segensworth Business Centre, Fareham, UK
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Tuffrey C, Bateman BJ, Colver AC. The Questionnaire of Young People's Participation (QYPP): a new measure of participation frequency for disabled young people. Child Care Health Dev 2013; 39:500-11. [PMID: 23763251 DOI: 10.1111/cch.12060] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The concept of participation was introduced by the World Health Organisation in the International Classification of Functioning, Disability and Health, 2001. Instruments to measure participation have been developed for children and adults, but none specifically for adolescents. Adolescence is a life stage with distinct patterns of participation, and previous research has shown that young people with disabilities have poorer participation than the general population. The aim of this study was to develop a measure of participation frequency, covering all major domains, for young people with cerebral palsy (CP). CP was chosen as an exemplar because it is a significant cause of disability in young people, with affected individuals experiencing a range of different impairments of varying severity. METHODS A pool of 88 items was developed using the published literature, existing measures and qualitative data from young people. The item pool was revised following expert review by 17 experts. Cognitive interviews on the items were carried out with 12 young people and 12 carers; field-testing was then undertaken with 107 young people with CP aged 13-21 years, and 540 young people from the general population to enable item reduction and to examine reliability and construct validity. RESULTS The content review resulted in a 92-item draft questionnaire, content validity index of 93%. Cognitive interviews led to further wording changes. Following field-testing, the questionnaire was shortened to 45 items. Known-groups validity was demonstrated by correlation with impairment severity. Test-retest reliability was satisfactory for all domains. Internal consistency varied between domains. CONCLUSION This is the first instrument developed specifically to measure frequency of participation across multiple domains for young people with disability. Use of the questionnaire in research and clinical work will enable its properties to be better understood and its generalizability to wider groups to be clearer.
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Affiliation(s)
- C Tuffrey
- Solent NHS Trust, Child Health Services, Alpha Court, Segensworth Business Centre, Fareham, UK.
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Abstract
Adolescence is a time of profound developmental change-socially, cognitively and psychologically. Although we know that many young people with a variety of long-term conditions negotiate adolescence with no more difficulty than other young people, those with physical disabilities can face barriers to their development in a number of areas. While many of these may not affect their physical health directly, it is important for health professionals to take a holistic view and remember that, as with other areas of child development, opportunities lost at critical periods may have later consequences. We need to anticipate potential difficulties early and discuss them with young people, parents and other professionals if we are to best improve outcomes for this group of patients.
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Affiliation(s)
- Catherine Tuffrey
- Child Health Services, Unit A4, Alpha Court, Segensworth Business Centre, Fareham, Hampshire PO15 5RQ, UK.
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Affiliation(s)
- Catherine Tuffrey
- Child Health, Solent NHS Trust, Segensworth Business Centre, Fareham PO15 5RQ, UK.
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Abstract
BACKGROUND there are few studies in the literature describing or evaluating the workload of children's community nurses prior to and following the death of a child with a non-oncological life-limiting disorder. METHOD a documentary analysis of nursing records of all children under the care of the Lifetime Service who died during a 5-year period was carried out. RESULTS the number of visits and telephone calls involving children's community nurses in the end of life and bereavement periods was analysed and the level of the input to families found to vary widely. In total, the number of visits range from 0 to 50 (median 8). The total number of telephone calls made or received for each child ranged from 0 to 127 (median 20). Calls and visits were with a wide range of people relating to diverse subject areas and continued even when children were in hospital. CONCLUSION community children's nurses liase with a wide range of professionals and organisations and the nature of their workload at the end of life is often hidden.
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Affiliation(s)
- Catherine Tuffrey
- Northumbria Healthcare Trust, North Tyneside General Hospital, Rake Lane, North Shields Tyne and Wear NE29 8NH, UK
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Abstract
AIMS (1) To establish how many parents of children seen in paediatric outpatient departments use the internet to find information about their child's medical condition. (2) To ascertain what information is sought and found, and what proportion of all parents had access to the internet at home or elsewhere. METHODS Over a six week period in 2000, parents of children attending general paediatric outpatient clinics in the district general hospital in Bath and in the 10 associated community hospitals, were asked to complete a questionnaire survey. RESULTS Of the 577 questionnaires distributed, 485 were returned, a response rate of 84%. A total of 332 (69%) families owned a computer and 248 (51%) had internet access; 107 (22%) had looked on the internet for information about the problem for which their child was being seen in clinic that day. Parents who knew their child's diagnosis were more likely to have used the internet than those who named their child's symptoms only. A health professional had suggested that parents seek information on the internet in 6% of cases. These parents were more likely to use the internet than parents to whom this had not been suggested (67% v 20%, p < 0.001). Eighty nine (84%) parents who had used the internet prior to this clinic appointment found it useful. Thirty six (34%) parents had discussed or were planning to discuss the information they had found with their doctors. CONCLUSION A significant proportion of parents have access to the internet and use it to find information about their child's medical condition. The parents who discuss what they find with the clinic doctor are in the minority. Doctors should be prepared to ask parents about their information needs and discuss use of the internet.
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Affiliation(s)
- C Tuffrey
- Department of Child Health, NHS House, Newbridge Hill, Bath BA1 3QE, UK.
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