The role of felt or enacted criticism in understanding parent's help seeking in acute childhood illness at home: a grounded theory study

Background: Parents with young children often worry about whether or not to seek medical help for a sick child. Previous research identified parents’ anxieties surrounding help seeking from health services but did not explore or explain the underlying psychosocial processes taking place in families at these times. Objectives: This paper presents findings from a British grounded theory study on family management of acute childhood illness at home, which provide an explanation for parent’s helping seeking behaviours. Design: Glaserian grounded theory methodology was used for the study. Setting: The sampling sites for the study were in two towns in the East Midlands with population profiles close to the national average for the UK. Participants: Initial purposeful and later theoretical sampling resulted in a sample of fifteen families with children aged between 1 month and 8 years of age. Methods: Four sets of data collection took place between 2001 and 2007. Unstructured family interviews were conducted with adult family members and a draw, write or tell technique was used to interview any children over 4 years of age. Theoretical sensitivity and constant comparative analysis were employed to achieve theoretical saturation around a core category. Findings: Felt or enacted criticism teaches parents informal social rules which direct how they are expected to behave. Their desire to avoid such criticism of their moral status as ‘good’ parents creates significant hidden anxiety about when to seek medical help. This anxiety sometimes leads to late consultation with potentially serious consequences for their child’s health. Conclusion: The grounded theory indicates the need for significant investment in the training of nurses and other health professionals to reduce parents’ (and other patients’)experiences of felt or enacted criticism and the consequent hidden anxiety. When parents are worried about their child’s health, they need to be able to seek help from health professionals without fear of criticism. These conclusions are primarily limited to universal health care environments.