The development and evaluation of an interactive leaflet for children with acute respiratory tract infections.

Lead Research Organisation: University of Wales
Department Name: UNLISTED


We are trying to improve the way general practitioners and primary care nurses deal with coughs, colds and other common infections in children.
Research evidence has shown that antibiotics help very little for most of these infections, yet they continue to be widely used, and their overuse is fueling a concerning rise in antibiotic resistance. Parents find these illnesses worrying and many complain that their concerns are not adequately addressed when they constult.
We aim to address this problem through the development of a booklet for use in primary care consultations. The booklet, developed with help from parents and clinicians, will act as an information resource for the parent and a prompt to improve communication within the consultation. Clinicians will receive training in how to use it effectively.
We will evaluate use of this booklet in a randomised trial. Some clinicians will be asked to use the booklet when seeing children with a respiratory tract infection, and others will continue their usual practice. Parents will then be contacted by telephone to identify whether or not the child has re-attended or received antibiotics, and to assess other outcomes. This will allow us to determine whether use of the booklet is effective and safe.

Technical Summary

Aims & Relevance: Antibiotic resistance is a major threat to public health. The overuse of antibiotics contributes to this problem, and over 80% of antibiotic prescriptions come from general practitioners. Despite little evidence of benefit, children are frequently prescribed antibiotics for respiratory tract infections. They are at greater risk of being prescribed unnecessary antibiotics when they consult more than once for the same illness episode. GP‘s often leave carers with unrealistic expectations about the duration of these infections, and one in five children re-consult for the same episode. We aim to better inform carers, reduce re-consultations and therefore reduce antibiotic prescriptions, through training clinicians in the use of an interactive leaflet. Scientific Objectives: 1) To finalise the development of a complex intervention consisting of an interactive leaflet and brief training for clinicians in its use. This interactive leaflet will form the basis of individualised dialogue between clinician and carer and indeed older children. It will also be a take-home resource. It will be based on unique data we and others have recently generated about the natural history of acute respiratory tract infections. The goal is to set realistic expectations about illness duration and empower carers to safely manage these illnesses without unnecessary re-consultation and antibiotic. 2) To evaluate the effectiveness of this complex intervention in reducing re-consultations and antibiotic prescriptions. Plan: We are currently developing the leaflet and brief clinician training. We have completed literature reviews and development meetings and are proceeding with focus group work and input from a graphic designer. We will evaluate the intervention initially in a pilot study and then in a randomised controlled trial. Our team consists of staff from the Departments of General Practice at both Cardiff and Bristol Universities. Design & Methodology: After developing thinteractive leaflet and clinician training, a pilot study will be conducted in two GP practices. This will assess face validity and acceptability to clinicians and carers. Trial procedures will also be piloted in preparation for an RCT to evaluate its effectiveness. A cluster design has been chosen in order to minimise contamination. However we are aware of potential biases associated with this design and plan to minimise and measure these in a number of ways. Scientific and Medical Opportunities: This project will develop and evaluate a unique, interactive, simple, cheap, potentially widely applicable intervention capable of informing and empowering carers in the management of respiratory tract infections in their children. It has the potential to reduce primary care consultations and antibiotic prescriptions. The project will also provide an exciting opportunity to develop a broad range of health services and clinical epidemiological research skills including; qualitative and quantitative approaches, study design and implementation of a randomised controlled trial, data analysis and statistical methods, outcome measures, focus group work, process evaluation, scientific writing, and a PhD thesis. The training environment is one of the leading centres for the innovative study of antibiotic use and managing infections in primary care, and offers a broad critical mass in health services research.
Description Use of interactive booklet and training
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Title Interactive booklet 
Description We have developed an interactive booklet for use in primary care consultations that has been shown to reduce antibiotic prescribing for children with respiratory tract infections. 
IP Reference  
Protection Copyrighted (e.g. software)
Year Protection Granted 2007
Licensed No
Impact We have had many enquiries from NHS organisations and general practices about obtaining copies of the booklet. We are currently in discussion with the Royal College of GPs and others about acting as a supplier of the booklet.
Title Interactive booklet 
Description Interactive booklet for use in primary care consultations - see section on IP. More than 100,000 copies of the booklet have now been purchased by or sent to GP practices. 
Type Management of Diseases and Conditions
Current Stage Of Development Market authorisation
Year Development Stage Completed 2008
Development Status Under active development/distribution
Clinical Trial? Yes
Impact See IP section 
Description Antibiotic stewardship activities 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact I have been involved in a range of antimicrobial stewardship activities, including participating in the 'Antimicrobial Stewardship in Primary Care' group and groups preparing the UK response to European Antibiotic Awareness Day. I have also presented at the Welsh Antimicrobial Stewardship Forum.

The intervention that we developed through this MRC funding is being increasingly taken up be general practices throughout the UK.
Year(s) Of Engagement Activity 2009,2010,2011,2012