Acute bronchitis is a prevalent illness of the respiratory tract, which affects individuals in a wide range of forms. The causes can also be differential, such as viral, bacterial, or other forms of irritants present in the air. The given qualitative research study critique will focus on the article, which assessed lower respiratory tract illnesses among children in developing countries in order to assess the patterns of antibiotic use as well as the overall diagnosis. The purpose of the qualitative study is to understand how healthcare professionals in low-income countries use antibiotics when treating acute bronchitis. The research question is centered around exploring and determining the perceptions and practices among healthcare professionals and caregivers on acute bronchitis and other respiratory illnesses. The qualitative research design is fully justified because the desired outcome of the study is to gather as much information as possible with an in-depth analysis of various practices and perceptions. The research does not seek to identify numerical data but a rather insightful assessment of what and why certain practices are used when treating acute bronchitis, as well as the perceived role and efficacy of antibiotics for the illnesses of interest. The phenomenon or focus of the research includes broad-spectrum antibiotics and supportive medicine, which are overprescribed.
Due to the qualitative nature of the study, the sample size was comprised of two groups of interest. The latter involved “13 caregivers to U5s with recurrent LRT-illnesses and with 22 primary care health professionals” (Østergaard et al., 2018, p. 1). The sample was representative in regard to the research purpose and sampling criteria since all of them are related to children with acute bronchitis, and they are directly involved in the caregiving process for these children. The sample is selected on the basis of their experience in providing care, which means that their perceptions and practices are relevant to answer the questions posed by the study.
It is important to note that the participant characteristics were described in detail. It is stated: “Semi-structured standardized interviews were carried out with 13 caregivers (CGs) (11 mothers, 2 grandmothers) and 22 primary care consulting health professionals (HPs) in public health clinics (7 family physicians, 2 pediatricians, 5 nurses, 8 paramedics)” (Østergaard et al., 2018, p. 2). In other words, caregivers were solely mothers and grandmothers, whereas health professionals included paramedics, nurses, pediatricians, and family physicians.
The sampling was sufficient to achieve data saturation, but its adequacy is questionable. It is possible to argue that the caregiver sample was small, which is why researchers should have tried to increase it from 13 to around 20. The main reason is that the study would have equally diverse input from both caregivers and health professionals. However, the sample size is still sufficient to make valuable observations and provide insight into the patterns of antibiotic use.
Although the study staff was appropriately trained and there is no valid information to state otherwise, the impact of bias was still significant. The main reason is that “there is a risk of reporting bias, both from the caregivers and HPs, in that they may have provided statements that they think the study staff would like to hear” (Østergaard et al., 2018, p. 5). In addition, the process of language translation might have resulted in a loss of key nuances when it comes to the interview data.
In the case of data analysis, semi-structured interviews were used in the context of the FRESH AIR program, which enabled a quick and effective verification process. It is reported that “the data were analyzed for concepts following a coding strategy described by Corbyn and Strauss” (Østergaard et al., 2018, p. 7). When it comes to the data analysis method, it is stated that “a thematic coding framework, deductively based on the topic guide, was generated for the key themes and subthemes” (Østergaard et al., 2018, p. 7). In other words, the collected data were both verified on-site with relevant professionals, and the information assessment method was manual with the use of a coding tree.
It should be noted that all findings are supported by the narrative data. For example, when the use of antibiotics was addressed in the context of coughing, a health professional stated: “if a child has a cough and shortness of breath, usually depending on the child’s condition, I prescribe antibiotics” (Østergaard et al., 2018, p. 4). It is one of many pieces of narrative data provided for each theme and subtheme of the qualitative study.
The conclusions are clearly explained where the core findings are that antibiotics are overused, and many long-term respiratory illnesses are not diagnosed as such. The researchers recommend that in order “to reduce the apparent systemic under-diagnosis of asthma and the emerging antibiotic resistance, adequate training in LTR-illnesses and management for asthma/wheeze can be an essential contribution” (Østergaard et al., 2018, p. 6). In other words, the current practices are not adherent to the latest medical standards and diagnostic principles.
The study findings appear to be trustworthy, which is one can be confident in these assessments. The main reason is that the study is conducted with elements of accuracy, reliability, and validity in mind, and many other types of research support the findings. For example, one such study also states, “physicians were not only unfamiliar with national guidelines on the use of antibiotics and local AMR patterns but also had personal paradigm issues related to the physicians’ decision making” (Zhu et al., 2018, p. 1). Therefore, antimicrobial resistance is often overlooked by physicians in developing nations, and many patients with acute bronchitis are given antibiotics without any solid evidence of their efficacy.
The study contributes a major meaningful evidence that is applicable to the nursing practice. It emphasizes the importance of limited use of antibiotics for acute bronchitis, which is not caused by bacterial only. Considering the fact that antibiotics are not always effective at cough reduction among patients with acute bronchitis and factoring in the low level of awareness about antimicrobial resistance, the study adds more substantive data to closely evaluate the current nursing practices.
In conclusion, the quality rating for the study is ‘high/good quality’ because it provides a highly insightful interpretation of knowledge and data collected by linking them with the current academic literature. Participants drive the inquiry due to the semi-structured format of interviews, where more freedom to ensure depth of information. The researchers are fully aware of biases and the latter’s impact on analysis and interpretation, which is why it is outlined in the discussion section. The process of verification is properly ensured due to the context of the study taking place as a part of the program, where key documents and health records are accessible. The diligence factor can be noted since “for coding, each transcript was read and re-read by two researchers several times to understand and decide on the allocation of codes” (Østergaard et al., 2018, p. 7). The transparency level is high because all key data points are presented, and narrative data is illustrated in the form of quotes.
References
Østergaard, M. S., Kjærgaard, J., Kristensen, M. M., Reventlow, S., Poulsen, A., Isaeva, E., Akylbekov, A., & Sooronbaev, T. (2018). Recurrent lower respiratory illnesses among young children in rural Kyrgyzstan: Overuse of antibiotics and possible under-diagnosis of asthma. A qualitative FRESH AIR study. NPJ Primary Care Respiratory Medicine, 28(1), 1-8.
Zhu, E., Fors, U., & Smedberg, Å. (2018). Understanding how to improve physicians’ paradigms for prescribing antibiotics by using a conceptual design framework: A qualitative study. BMC Health Services Research, 18(1), 1-16.