Helping parents know when to seek help for an acutely ill child: Evidence based co-development of a mobile phone app using complex intervention methodology.

BACKGROUND: Acute illness accounts for the majority of episodes of illness in children under five years of age and is the age group with the highest consultation rate in general practice in the UK. The number of children presenting to emergency care is also steadily increasing, having risen beyond pre-pandemic numbers. Such high, and increasing, rates of consultation have prompted concerns about parents' level of knowledge and confidence in caring for their children when they are ill, and particularly when and how to seek help appropriately. AIM: The ASK SNIFF collaboration research programme identified parents' need for accurate and accessible information to help them know when to seek help for a sick child in 2010. This paper presents the resulting programme of research which aimed to co-develop an evidence-based safety netting intervention (mobile app) to help parents know when to seek help for an acutely ill child under the age of five years in the UK. METHODS: Our programme used a collaborative six step process with 147 parent and 324 health professional participants over a period of six years including: scoping existing interventions, systematic review, qualitative research, video capture, content identification and development, consensus methodology, parent and expert clinical review. RESULTS: Our programme has produced evidence-based content for an app supported by video clips. Our collaborative approach has supported every stage of our work, ensuring that the end result reflects the experiences, perspectives and expressed needs of parents and the clinicians they consult. CONCLUSION: We have not found any other resource which has used this type of approach, which may explain why there is no published evaluation data demonstrating the impact of existing UK resources. Future mobile apps should be designed and developed with the service users for whom they are intended.

Exploring the feasibility of using evidence-based feeding practices to promote children's healthy eating in holiday clubs.

OBJECTIVE: Encouraging healthy eating is a public health priority in the United Kingdom (UK), given the high prevalence of poor diet and overweight/obesity among school-aged children. Holiday clubs are organisations providing childcare and activities during the school holidays and frequently provide food to children at risk of food insecurity, primarily through government-funded programmes like the Holiday Activities and Food programme. However, the research suggests that holiday clubs could do more to maximise opportunities to promote children's healthy eating by using evidence-based feeding practices. DESIGN: During August-September 2020, video-based interviews were conducted exploring staff perceptions of the feasibility of using four evidence-based feeding practices to promote children's healthy eating: modelling; involvement in food choice; involvement in food preparation and cooking and involvement in meal planning. Feasibility was assessed using four dimensions of a feasibility framework (acceptability, demand, practicality and implementation). SETTING: UK holiday clubs. PARTICIPANTS: Twenty-five staff actively involved in delivering UK holiday clubs (project leaders, coordinators, cooks and coaches/youth workers). RESULTS: Staff generally reported good acceptability (dimension 1) and demand (dimension 2) for the feeding practices. However, the practicality (dimension 3) of using the practices was dependent on various factors (logistics, resources, staff readiness, children, peers and parents). Promisingly, in the fourth feasibility dimension (implementation), staff provided numerous practical solutions to overcome these barriers. CONCLUSIONS: Evidence-based feeding practices can be implemented in numerous ways and are therefore generally feasible in holiday clubs. Holiday clubs should be empowered to use evidence-based feeding practices through training resources, sharing networks and provision of sustainable funding.

Navigating uncertain illness trajectories for young children with serious infectious illness: a modified grounded theory study.

BACKGROUND: Infectious illness is the biggest cause of death in children due to a physical illness, particularly in children under five years. If mortality is to be reduced for this group of children, it is important to understand factors affecting their pathways to hospital. The aim of this study was to retrospectively identify organisational and environmental factors, and individual child, family, and professional factors affecting timing of admission to hospital for children under five years of age with a serious infectious illness (SII). METHODS: An explanatory modified grounded theory design was used in collaboration with parents. Two stages of data collection were conducted: Stage 1, interviews with 22 parents whose child had recently been hospitalised with a SII and 14 health professionals (HPs) involved in their pre-admission trajectories; Stage 2, focus groups with 18 parents and 16 HPs with past experience of SII in young children. Constant comparative analysis generated the explanatory theory. RESULTS: The core category was 'navigating uncertain illness trajectories for young children with serious infectious illness'. Uncertainty was prevalent throughout the parents' and HPs' stories about their experiences of navigating social rules and overburdened health services for these children. The complexity of and lack of continuity within services, family lives, social expectations and hierarchies provided the context and conditions for children's, often complex, illness trajectories. Parents reported powerlessness and perceived criticism leading to delayed help-seeking. Importantly, parents and professionals missed symptoms of serious illness. Risk averse services were found to refer more children to emergency departments. CONCLUSIONS: Parents and professionals have difficulties recognising signs of SII in young children and can feel socially constrained from seeking help. The increased burden on services has made it more difficult for professionals to spot the seriously ill child.

Staff perspectives on the feeding practices used in holiday clubs to promote healthy eating in disadvantaged communities.

An increasing number of holiday clubs provide free meals to alleviate children's hunger during the school holidays. Holiday clubs are well-placed to promote healthy eating among children from disadvantaged communities who may be at risk of experiencing food insecurity, but currently little is known about the feeding practices used by staff and whether these are conducive to maximising opportunities to promote healthy eating. Unlike previous research which has predominantly studied feeding practices in parent-child dyads and childcare settings, this qualitative study explored staff perspectives on the feeding practices they use to promote healthy eating within nine UK holiday clubs working with children from disadvantaged communities. Nine individual interviews and four focus groups were completed with 27 holiday club staff during the 2019 summer holidays. Thematic analysis revealed seven feeding practice themes, including teaching about nutrition; encouraging balance and variety; modelling; involvement; non-food rewards; restriction; and reoffering foods. The results revealed that some staff implement various positive feeding practices which align with the existing evidence-base of feeding practices in other contexts, which is a promising finding given the current lack of information and guidance from which to draw on. However, staff also sometimes reported using maladaptive feeding practices, including overt restriction and punishment. These results emphasise the need for guidance on effective ways to implement feeding practices with children in holiday clubs. Indeed, staff demonstrated their receptivity to engaging with training resources to maximise their opportunities to promote healthy eating behaviours among children.

Adaptations to Holiday Club Food Provision to Alleviate Food Insecurity During the Covid-19 Pandemic.

Holiday clubs play a pivotal role in providing food and vital enrichment opportunities to alleviate food insecurity among children during the school holidays (holiday hunger). The need for these opportunities increased substantially for families throughout 2020, as food insecurity quadrupled in the UK during the Covid-19 pandemic. In this qualitative study, holiday club staff from England and Wales reflected on the adaptations they implemented in order to maintain food supplies and food-related enrichment activities for families during the first UK national Covid-19 lockdown and subsequently throughout the summer of 2020. Staff also reflected on the opportunities and challenges related to implementing these adaptations during this period. Twenty-five holiday club staff engaged in video-based interviews during August and September 2020. The findings revealed a range of innovative changes to holiday club food provision, and the challenges and opportunities faced varied across holiday clubs. Challenges during the pandemic in some clubs included staff shortages (typically due to furloughing and/or increased working demands) and difficulties sourcing adequate funding. However, staff identified that the opportunities for holiday clubs included enhanced partnership working during the pandemic, increased engagement with digital technology to communicate with families and deliver their online cooking sessions, and their ability to continue providing food and much needed creative opportunities for children unable to attend school and/or the holiday club. The ability of clubs to adapt their models of working when faced with adversity was essential in protecting their organisational resilience and delivering their vital services. The findings emphasise the important role that holiday clubs play in their communities and highlight their willingness to adapt and expand their role in response to the pandemic to continue to tackle food insecurity and provide vital food and food-related enrichment opportunities to families. The findings also identify lessons that can be applied to practise in the future.

Caring for a sick or injured child during the COVID-19 pandemic lockdown in 2020 in the UK: An online survey of parents' experiences.

BACKGROUND: During the COVID-19 pandemic, the first UK lockdown (March to May 2020) witnessed a dramatic reduction in children presenting to primary/emergency care, creating concern that fear of the virus was resulting in children presenting late. METHODS: An online survey was co-developed with UK parents to understand the impact of the lockdown on parents' help-seeking for, and care of, their sick/injured child(ren). The survey was advertised through social media and snowballing to parents whose children had been ill/injured during the lockdown. Analysis used descriptive statistics, SPSSv25 and thematic analysis. RESULTS: The survey was fully completed by 198 UK parents. The majority asked for help (144/198): from their family doctor (78), national helplines (48) or an Emergency Department (23). Most reported that their decision-making had not changed, although how they sought help had changed. A few parents reported that the severity and duration of illness had increased because of uncertainty about and/or difficulty accessing services. Parents did not always report seeking help for symptoms rated red or amber by the Royal College of Paediatrics and Child Health. Parents reported accessing information through the internet or using information that they already had. PARENT CONTRIBUTION: This was a collaboration with parents from survey development to dissemination, with two parents being integral members of our research team. CONCLUSIONS: Our questionnaire was completed by parents who were not deterred from seeking help for their sick or injured children. Even for these parents, the lockdown changes to services created uncertainty about, and barriers to, accessing medical help for their children.

Impact of Digital Educational Interventions to Support Parents Caring for Acutely Ill Children at Home and Factors That Affect Their Use: Protocol for a Systematic Review.

BACKGROUND: Urgent and emergency care health services are overburdened, and the use of these services by acutely ill infants and children is increasing. A large proportion of these visits could be sufficiently addressed by other health care professionals. Uncertainty about the severity of a child's symptoms is one of many factors that play a role in parents' decisions to take their children to emergency services, demonstrating the need for improved support for health literacy. Digital interventions are a potential tool to improve parents' knowledge, confidence, and self-efficacy at managing acute childhood illness. However, existing systematic reviews related to this topic need to be updated and expanded to provide a contemporary review of the impact, usability, and limitations of these solutions. OBJECTIVE: The purpose of this systematic review protocol is to present the method for an evaluation of the impact, usability, and limitations of different types of digital educational interventions to support parents caring for acutely ill children at home. METHODS: The review will be structured using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and Population, Intervention, Comparator, and Outcome (PICO) frameworks. Five databases will be systematically searched for studies published in English during and after 2014: Medline, EMBASE, CINAHL, APA PsycNet, and Web of Science. Two reviewers will independently screen references' titles and abstracts, select studies for inclusion based on the eligibility criteria, and extract the data into a standardized form. Any disagreements will be discussed and resolved by a third reviewer if necessary. Risk of bias of all studies will be assessed using the Mixed-Methods Appraisal Tool (MMAT), and a descriptive analysis will be used to evaluate the outcomes reported. RESULTS: The systematic review will commence during 2021. CONCLUSIONS: This systematic review will summarize the impact, usability, and limitations of digital interventions for parents with acutely ill children. It will provide an overview of the field; identify reported impacts on health and behavioral outcomes as well as parental knowledge, satisfaction, and decision making; and identify the factors that affect use to help inform the development of more effective and sustainable interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/27504.

OC26 - Parents of young children in research: informants, consultants and collaborators.

UNLABELLED: Theme: ETHICAL ISSUES: dignity and humanity. INTRODUCTION: Patient and public involvement in research is recognised as best practice in the UK, as services developed with service users are more likely to meet their needs. In child health this often means engaging with parents of young children. AIM: To share experiences of engaging with parents of young children in research projects at varying levels of participation. METHODS: Methods include parents as participants, as parent panels and as research team members reflecting various steps on the participation ladder (Hart 1992). RESULTS: Parents report personal benefits and a range of different challenges when engaging in child health research which impact the management/delivery of research projects. CONCLUSION: Key elements of working with parents include time to plan involvement, building respect/mutual understanding, equal access to project activities, continual support for parents, reward and recognition. Research projects need to cost and plan for parents' engagement in research for it to be successful.