Quality of life of children and their caregivers during an AOM episode: development and use of a telephone questionnaire

Exploring the OTITIS Research Landscape Through a Scientometric Approach

Otitis media is a common health problem affecting people of all ages and significantly impacting public health and healthcare costs. Otitis media, a type of middle ear disease, is one of the most common types. This scientometric study aimed to provide an overview of the knowledge domain in otitis media research. Documents were retrieved from the Web of Science database. A scientometric study was then performed on a sample of 27,213 documents. This study found that research on otitis media has increased significantly in recent years, with an annual growth rate of 4.58%. The average age of the documents analyzed was 18 years, with an average of 21.88 citations and an average of 4.58 authors. The United States, the United Kingdom, and Japan ranked first to third in terms of number of publications. Still, the United States, China, and Sweden were in a better position in terms of impact on the research network. Co-occurrence word analysis showed that significant attention was given to topics such as chronic inflammation in autism, acute inflammation in otitis media, and increased fluid in the middle ear. This study highlights the need to prioritize and focus attention on otitis, particularly otitis media, due to its prevalence and impact on public health. The use of scientometric software, such as Biblioshiny and CiteSpace, provides a valuable means of assessing research trends and identifying important areas for future study in the field of knowledge.

The Impact of Early-Life Recurrent Otitis Media in Children on the Psychological Well-Being of Caregivers

AIM

Children with early-life recurrent otitis media (OM) will often endure pain, sleep disturbances, and other developmental setbacks that impact the surrounding family system. The aim of this study was to investigate the psychological well-being and family functioning of caregivers of children with early-life recurrent OM (rOM).

METHODS

Data from a longitudinal pregnancy cohort were used to categorize children into two groups: those with a history of recurrent OM (rOM group) and those without a history of rOM (reference group) by the age of 3 years. The psychological well-being of caregivers and the family functioning status were assessed using the Affect Balance Scale and the General Functioning Scale of the McMaster Family Assessment Device (FAD-GF), respectively, at the three-, five-, and eight-year follow-up appointments. Multiple linear regression models were used to analyze the data and were adjusted for potential confounding variables.

RESULTS

There were significant associations between having a child with an early history of rOM and the Affect Balance Scale of caregivers for the negative affects subscale at the three- (p < 0.001) and five- (p = 0.018) year follow-ups, and the Affect Balance subscale at the three-year (p = 0.007) and the five-year follow-ups (p = 0.047). There were no significant associations measured during the 8-year follow-up period for the FAD-GF.

CONCLUSION

The findings of this study further highlight the impact of caring for a child with rOM in early childhood on caregivers' psychological well-being in the first five years of a child's life. The impact, however, did not appear to influence the longer-term functioning of the family as a whole.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:1445-1449, 2024.

PANEL 3: Otitis media animal models, cell culture, tissue regeneration & pathophysiology

OBJECTIVE

To review and summarize recently published key articles on the topics of animal models, cell culture studies, tissue biomedical engineering and regeneration, and new models in relation to otitis media (OM).

DATA SOURCE

Electronic databases: PubMed, National Library of Medicine, Ovid Medline.

REVIEW METHODS

Key topics were assigned to the panel participants for identification and detailed evaluation. The PubMed reviews were focused on the period from June 2019 to June 2023, in any of the objective subject(s) or keywords listed above, noting the relevant references relating to these advances with a global overview and noting areas of recommendation(s). The final manuscript was prepared with input from all panel members.

CONCLUSIONS

In conclusion, ex vivo and in vivo OM research models have seen great advancements in the past 4 years. From the usage of novel genetic and molecular tools to the refinement of in vivo inducible and spontaneous mouse models, to the introduction of a wide array of reliable middle ear epithelium (MEE) cell culture systems, the next five years are likely to experience exponential growth in OM pathophysiology discoveries. Moreover, advances in these systems will predictably facilitate rapid means for novel molecular therapeutic studies.

The Impact of the COVID-19 Pandemic on Otitis Media

Otitis media is one of the most common diseases in children, with 80% of children experiencing it by the age of three years. Therefore, the resulting social burden is enormous. In addition, many countries still suffer from complications due to otitis media. Meanwhile, COVID-19 has affected many diseases, with otitis media being one of the most strongly affected. This review aims to find out how COVID-19 has affected otitis media and its significance. A series of measures brought about by COVID-19, including emphasis on personal hygiene and social distancing, had many unexpected positive effects on otitis media. These can be broadly classified into four categories: first, the incidence of otitis media was drastically reduced. Second, antibiotic prescriptions for otitis media decreased. Third, the incidence of complications of otitis media was reduced. Fourth, the number of patients visiting the emergency room due to otitis media decreased. The quarantine measures put in place due to COVID-19 suppressed the onset and exacerbation of otitis media. This has great implications for the treatment and prevention of otitis media.

The socioemotional challenges and consequences for caregivers of Aboriginal and Torres Strait Islander children with otitis media: A qualitative study

INTRODUCTION

Living with ear disease can have extensive impacts on physical, emotional and social well-being. This study explored otitis media (OM) and its management from the perspective of caregivers of Aboriginal and Torres Strait Islander children.

METHODS

Semi-structured interviews were conducted from 2015 to 2020 with caregivers of Aboriginal and Torres Strait Islander children with OM. Thematic analysis of transcripts was undertaken using a constructivist grounded theory approach through the leadership and the cultural lens of an Aboriginal community-based researcher.

RESULTS

Caregivers described OM as having profound impacts on their child's physical, developmental, and emotional well-being, with long waits for specialist treatment contributing to extra strain on families. Children's well-being suffered when OM was mistaken for poor behaviour and children were punished, with caregivers subsequently experiencing strong feelings of guilt. Concerns were conveyed about the social implications of having a sick child. The variable nature of OM symptoms meant that caregivers had to monitor closely for sequelae and advocate for appropriate treatment. Success in navigating the diagnosis and treatment of OM can be strongly impacted by the relationship between caregivers and health professionals and the perceived access to respectful, collaborative and informative healthcare.

CONCLUSION

OM may have substantial social and emotional consequences for children and their caregivers. A holistic understanding of the way in which OM impacts multiple facets of health and well-being, as well as recognition of challenges in accessing proper care and treatment, will aid families managing OM and its sequelae.

PATIENT OR PUBLIC CONTRIBUTION

Governing boards, managers, staff and community members from five Australian Aboriginal Medical Services were involved in the approval, management and conduct of this study and the wider clinical trials. The caregivers of Aboriginal and Torres Strait Islander patients at these services informed the interview study and guided its purpose.

Family reported outcomes, an unmet need in the management of a patient's disease: appraisal of the literature

BACKGROUND

A person's chronic health condition or disability can have a huge impact on the quality of life (QoL) of the whole family, but this important impact is often ignored. This literature review aims to understand the impact of patients' disease on family members across all medical specialities, and appraise existing generic and disease-specific family quality of life (QoL) measures.

METHODS

The databases Medline, EMBASE, CINHAL, ASSIA, PsycINFO and Scopus were searched for original articles in English measuring the impact of health conditions on patients' family members/partner using a valid instrument.

RESULTS

Of 114 articles screened, 86 met the inclusion criteria. They explored the impact of a relative's disease on 14,661 family members, mostly 'parents' or 'mothers', using 50 different instruments across 18 specialities including neurology, oncology and dermatology, in 33 countries including the USA, China and Australia. These studies revealed a huge impact of patients' illness on family members. An appraisal of family QoL instruments identified 48 instruments, 42 disease/speciality specific and six generic measures. Five of the six generics are aimed at carers of children, people with disability or restricted to chronic disease. The only generic instrument that measures the impact of any condition on family members across all specialities is the Family Reported Outcome Measure (FROM-16). Although most instruments demonstrated good reliability and validity, only 11 reported responsiveness and only one reported the minimal clinically important difference.

CONCLUSIONS

Family members' QoL is greatly impacted by a relative's condition. To support family members, there is a need for a generic tool that offers flexibility and brevity for use in clinical settings across all areas of medicine. FROM-16 could be the tool of choice, provided its robustness is demonstrated with further validation of its psychometric properties.

Impact of Pediatric COVID-19 on Family Health-Related Quality of Life: A Qualitative Study from Latvia

Information on family health-related quality of life (FHRQoL) among families of children with the coronavirus disease 2019 (COVID-19) is limited. This qualitative study explores the impact of pediatric COVID-19 on FHRQoL from the parents' perspective. Semi-structured interviews were conducted with parents (n = 20) whose children had tested positive for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Inductive thematic analysis revealed the following 10 themes that represented parents' perception of FHRQoL while taking care of a child with COVID-19: pediatric COVID-19 as a disease with many unknowns; emotional saturation; internal family relationships in the context of "a new experience"; routine household activities and daily regimen while family is in lockdown; plenty of free time; a wide social support network; social stigma associated with COVID-19; different options for work; savings and debts; challenges with family housing and transport availability. Our results show that parents experience multiple effects of pediatric COVID-19 with regard to FHRQoL.

Comparative Usability Analysis and Parental Preferences of Three Web-Based Knowledge Translation Tools: Multimethod Study

BACKGROUND

Connecting parents to research evidence is known to improve health decision making. However, guidance on how to develop effective knowledge translation (KT) tools that synthesize child-health evidence into a form understandable by parents is lacking.

OBJECTIVE

The aim of this study was to conduct a comparative usability analysis of three Web-based KT tools to identify differences in tool effectiveness, identify which format parents prefer, and better understand what factors affect usability for parents.

METHODS

We evaluated a Cochrane plain language summary (PLS), Blogshot, and a Wikipedia page on a specific child-health topic (acute otitis media). A mixed method approach was used involving a knowledge test, written usability questionnaire, and a semistructured interview. Differences in knowledge and usability questionnaire scores for each of the KT tools were analyzed using Kruskal-Wallis tests, considering a critical significance value of P=.05. Thematic analysis was used to synthesize and identify common parent preferences among the semistructured interviews. Key elements parents wanted in a KT tool were derived through author consensus using questionnaire data and parent interviews.

RESULTS

In total, 16 parents (9 female) with a mean age of 39.6 (SD 11.9) years completed the study. Parents preferred the Blogshot over the PLS and Wikipedia page (P=.002) and found the Blogshot to be the most aesthetic (P=.001) and easiest to use (P=.001). Knowledge questions and usability survey data also indicated that the Blogshot was the most preferred and effective KT tool at relaying information about the topic. Four key themes were derived from thematic analysis, describing elements parents valued in KT tools. Parents wanted tools that were (1) simple, (2) quick to access and use, and (3) trustworthy, and which (4) informed how to manage the condition. Out of the three KT tools assessed, Blogshots were the most preferred tool by parents and encompassed these four key elements.

CONCLUSIONS

It is important that child health evidence be available in formats accessible and understandable by parents to improve decision making, use of health care resources, and health outcomes. Further usability testing of different KT tools should be conducted involving broader populations and other conditions (eg, acute vs chronic) to generate guidelines to improve KT tools for parents.

Understanding Parents' Experiences and Information Needs on Pediatric Acute Otitis Media: A Qualitative Study

Background:

Acute otitis media (AOM) is the most common pediatric bacterial ear infection, affecting up to 75% of children younger than 5 years. Despite the high incidence of AOM in children, the condition presents a number of challenges to parents. The objectives of this study were to describe parents’ experiences of taking care of a child with AOM and to identify their information needs to manage their child with AOM.

Methods:

A qualitative, descriptive design was used to gain insight into information needs of parents’ of children with AOM. Participants were recruited from a specialized pediatric emergency department in a major Canadian urban center (Edmonton, Alberta). Individual semi structured interviews were conducted with 16 parents.

Results:

Seven major themes were identified and described: (1) frequency of AOM, (2) symptoms of AOM experienced by children and parents, (3) AOM symptom management strategies used by parents, (4) parent’s beliefs about AOM, (5) parent’s satisfaction with treatment prescribed by physicians, (6) the effect of AOM on family’s quality of life, and (7) parent’s information needs about AOM. Findings indicate that AOM has considerable negative outcomes for both children and families and that parents would benefit from having more evidence-based resources.

Conclusions:

This study provides important information around parents’ experiences and information needs for pediatric AOM. Identifying parents’ information needs and developing innovative and communicatively responsive educational approaches for parents are warranted that reflect patient-centered nursing care.

Toward Reduction in Antibiotic Use for Pediatric Otitis Media: Predicting Parental Compliance with "Watchful Waiting" Advice

"Watchful waiting" (WW) can reduce unnecessary antibiotic use in the treatment of pediatric otitis media (ear infection), but the utility of the strategy is impaired by underutilization and noncompliance. Guided by advice response theory (ART), the current study examines how parental compliance with WW and trust in the prescribing physician is predicted by evaluative and affective responses to the advice. Parents (N = 134) of at least one child aged 5 years or younger completed questionnaires that assessed responses to WW advice they received for their youngest child. Perceptions of the advantage from and capacity to undertake WW, the child's level of pain, and the tact (autonomy-granting politeness) of the health care provider predicted compliance and provider trust both directly and indirectly, through advice quality and negative affect. The study suggests modifications to ART that will extend its scope and provides practical guidance for health care providers seeking to improve parent compliance with WW advice.

Impact of Pediatric Acute Otitis Media on Child and Parental Quality of Life and Associated Productivity Loss in Malaysia: A Prospective Observational Study

BACKGROUND

Acute otitis media (AOM) affects both child and parental quality of life (QoL). Data on QoL associated with AOM in Malaysia is sparse, and the burden of indirect costs have not been previously reported.

OBJECTIVE

To determine the effect of pediatric AOM on child and parental QoL in Malaysia and its economic impact (indirect costs).

METHODS

We utilized a set of QoL questionnaires (PAR-AOM-QOL, OM-6, and EQ-5D) combined with questions addressing work/productivity loss and financial costs associated with caring for a child during his or her illness in an observational, multicenter, prospective study.

RESULTS

One hundred and ten AOM patients aged ≤5 years were included in the analysis. The majority of respondents were the patient's mother. Parental QoL was negatively affected for both emotional and daily disturbance scales, but the level of disturbance was low. Using OM-6, the greatest negative impact was on the child's QoL, followed by caregiver concerns, physical suffering, and emotional distress. Using EQ-5D, a moderately positive relationship between parents' emotional disturbance and daily disturbance, and a weak, negative correlation between parental emotional disturbance and parental health status was found. Parents with paid employment took an average of 21 h from work to care for their child, at an average cost of 321.8 Malaysian ringgit (US$97) in addition to their contribution to direct medical costs. Productivity losses whilst at work, uncompensated wage losses, and leisure time losses are also reported.

CONCLUSIONS

This study found that AOM is associated with some negative impact on parental QoL and significant economic impact at both patient and societal levels. The findings provide useful data on healthcare resource utilization and disease burden of AOM in Malaysia.

Incidence of acute otitis media in children below 6 years of age seen in medical practices in five East European countries

Background

Although acute otitis media (AOM) remains a major public health problem worldwide and brings economic burden on health care system and caregivers, little information is available about its epidemiology in Eastern Europe.

Methods

We conducted an epidemiological, prospective, observational, multi-centre cohort study (NCT01365390) in five East European countries (Estonia, Lithuania, Poland, Romania and Slovenia) between June 2011 and January 2013 to determine the incidence and clinical characteristics of AOM among children aged < 6 years during 1 year.

Results

AOM incidence was 160.7 cases (95 % confidence interval [CI]: 144.7–177.9) per 1000 person-years (PY) being the lowest in the < 1 year age group (92.3 cases [95 % CI: 59.7–136.2] per 1000 PY) and the highest in the 3– < 4 years age group (208.9 cases [95 % CI: 165.1–260.7] per 1000 PY). AOM incidence was similar across the countries, with the exception of Slovenia (340.3 cases [95 % CI: 278.3–412.0] per 1000 PY). There was a lower risk in breastfed children and a higher risk in those attending school/childcare or with allergies. AOM required 521 visits to the doctor. Antibiotics were prescribed for 276 (74.8 %) episodes with the lowest prescription rate in Estonia (51.4 %) and the highest in Romania (83.7 %). Complications were rare and hospitalisations occurred in 2 % of the cases.

Conclusions

The disease burden of AOM in Eastern Europe is relevant and public health initiatives to reduce it should be considered.

Trial registration

ClinicalTrial.gov NCT01365390.

The Impact of Childhood Acute Otitis Media on Parental Quality of Life in a Prospective Observational Cohort Study

Background and Objectives

Acute otitis media (AOM) not only affects childhood quality of life (QoL), but can also affect parental QoL. We adapted a previously published questionnaire on the effect of childhood recurrent ear, nose and throat infections on parental QoL for use with AOM and used it in an observational, multicentre, prospective study of children with AOM.

Methods

The AOM-specific parental QoL questionnaire grouped 15 items into emotional, daily disturbance, total and overall parental QoL impact scores. The questionnaire was assessed using item-convergent and item-discriminant validity criteria and internal consistency reliability; and then used with parents of children aged <6 years diagnosed with AOM at 73 practices in Germany, Italy, Spain, Sweden and the UK. Bivariate analyses explored the differences in mean parental QoL impact scores by various characteristics.

Results

The questionnaire demonstrated good to excellent internal consistency reliability for the various components (Cronbach’s α 0.82–0.97). There were 1419 AOM episodes among 5882 healthy children over 1 year, of which 1063 episodes (74.9 %) among 852 children had a questionnaire. Parents reported interrupted sleep (68.4 %), worry (51.0 %), altered daily schedule (44.6 %) and less leisure time (41.5 %) with a score ≥3 (1 = least to 5 = most impact). Factors that adversely affected parental QoL included: increased parental perception of AOM severity, younger child age and multiple AOM episodes.

Conclusions

The AOM-specific parental QoL questionnaire demonstrated good performance across five European countries. Parental QoL was affected by childhood AOM proportionally to severity, number of episodes and younger child age.

Electronic supplementary material

The online version of this article (doi:10.1007/s40261-015-0319-1) contains supplementary material, which is available to authorized users.

Otitis Media and Caregiver Quality of Life: Psychometric Properties of the Modified Danish Version of the Caregiver Impact Questionnaire

OBJECTIVE

Otitis media in children may have a considerable impact on caregiver quality of life. The disease-specific Caregiver Impact Questionnaire is designed to assess caregiver quality of life in relation to child otitis media. Assessment of the psychometric properties of this instrument is limited. This study assesses the psychometric properties of this instrument including validity, reproducibility, responsiveness, and interpretability.

STUDY DESIGN

Longitudinal validation study.

SETTING

Secondary care units.

METHODS

Analyses were based on data from 435 families. Validity was assessed using confirmatory factor analysis, internal consistency, and hypothesis testing. Test-retest reliability and measures of smallest detectable change were investigated in the assessment of reproducibility. Responsiveness was investigated by means of hypothesis testing and receiver operating characteristic analysis. An anchor-based distribution method was applied for determining minimal important change as perceived by the respondent.

RESULTS

Factor analysis confirmed the hypothesized 1-factor structure with an acceptable fit. Cronbach's alpha was .90. In the analysis of construct validity, 88.9% of the hypothesized correlations were correctly predicted. Intraclass correlation coefficient was 0.87 and smallest detectable change corresponded to approximately one-fourth of the scale. Responsiveness was found to be good and a change score of 13.8 represented minimal important change.

CONCLUSION

The modified Danish version of the Caregiver Impact Questionnaire is a valid and reproducible measurement tool that is also sensitive to measuring change in the current setting. A change score representing minimal important change as perceived by the respondent is proposed. Results of this study support the use of this instrument.

The impact of influenza-like illness in young children on their parents: a quality of life survey

Background

Influenza-like illness can cause excess paediatric morbidity and burden on parents.

Objectives

We determined the quality of life (QoL) impact of children’s influenza-like illness (ILI) on their parents.

Methods

We conducted a prospective cohort study in childcare centres and a general practice in Sydney, Australia. Using PAR-ENT-QoL, we measured QoL of parents of children aged 6 months–3 years before the 2010 influenza season, then again for parents of children with ILI (ILI group) using SF-12v2 Acute Form and PAR-ENT-QoL, and contemporaneously for parents of aged-matched children without ILI (non-ILI group).

Results

Of 381 children enrolled from 90 childcare centres, 105 developed ILI. PAR-ENT-QoL scores of the ILI group were significantly lower in the post-ILI follow-up interviews than at baseline (60.99 vs. 79.77, p < 0.001), and those of non-ILI group at follow-up interviews (60.99 vs. 84.05, p < 0.001). SF-12v2 scores of the ILI group were also significantly lower than those of non-ILI group: physical component summary (50.66 vs. 53.16, p = 0.011) and mental component summary (45.67 vs. 53.66, p < 0.001). Two factors were significantly associated with parental QoL: total time spent caring child during ILI and whether the child had severe ILI or not. Correlations between PAR-ENT-QoL and SF-12v2 scores were satisfactory.

Conclusions

Parents had significantly lower QoL while their child had ILI, compared with before ILI and with parents of children without ILI. The public health impact of ILI in children on the QoL in families is far from negligible. QoL measurement can complement economic evaluation of ILI disease burden and provide a more complete picture of impact.

Impact of children's influenza-like illnesses on parental quality of life: a qualitative study

AIMS

Influenza and influenza-like illness (ILI) in otherwise healthy children has considerable impact on their parents. This study explored the impact of children's ILI on parental quality of life (QoL).

METHODS

We conducted qualitative in-depth interviews with parents of children aged 6 months-3 years with severe ILI. Children from childcare centres in Sydney, Australia were followed through the 2010 influenza season. Questions covered child's symptoms, parents' experiences including medical care visits, impact on the family's daily routine, and emotional, physical and social well-being. Interviews were analysed using a modified grounded theory approach.

RESULTS

We conducted 21 interviews with 23 parents. Five main themes emerged: 'sudden changes in daily life', 'emotional impact', 'social isolation and relationship changes', 'importance of family and friend support' and 'interaction with the medical system'. Perceived practical and emotional support from family and/or friends and consultations with the doctor appeared to moderate the impact.

CONCLUSIONS

Severe ILI in children has a considerable impact on their parents' QoL, through disruptions of normal life routine, social isolation and stress in coping with the sick child. These impacts should be considered when introducing flexible workplace policies designed to minimise the impact on parental QoL. Prevention strategies such as vaccinating children against influenza may help alleviate this impact at a population level.

Condition-specific quality of life questionnaires for caregivers of children with pediatric conditions: a systematic review

PURPOSE

Childhood illness or disability can affect the quality of life (QoL) of the child's primary caregiver. Our aim was to identify, describe the content and systematically review the psychometric properties of condition-specific QoL questionnaires for caregivers of children.

METHODS

Medline, PsycInfo, Embase, CINAHL, and the Cochrane library databases were searched from 1 January 1990 to 30 June 2011. Articles related to the development and measurement of caregiver QoL were screened to identify condition-specific questionnaires. The characteristics of the questionnaires were extracted, and their psychometric properties were evaluated using the consensus-based standards for the selection of health measurement instruments checklist with 4-point scale.

RESULTS

We identified 25 condition-specific caregiver QoL questionnaires covering 16 conditions. Conditions included atopic dermatitis, asthma, diabetes, oro-facial disorders, and two acute illnesses. Questionnaires were developed predominantly in high-income countries. Questionnaires had the highest quality rating for content validity, followed by hypothesis testing. Methodological quality was satisfactory for criterion validity; fair in reliability and responsiveness; and poor in internal consistency and structural validity.

CONCLUSIONS

The increasing number of questionnaires developed over time shows improved recognition of the importance of caregiver QoL. There is a paucity of QoL questionnaires for caregivers of otherwise healthy children suffering from physical injuries and acute conditions associated with significant caregiver burden. Cultural validation of existing and new questionnaires in lower-income countries is necessary. Data collected by condition-specific questionnaires can assist clinicians and health economists in estimating caregiver burden and the types of healthcare services caregivers require and may be useful for healthcare administrators to evaluate interventions.