Parents’ expectations for the management of pediatric diarrhea in the clinical setting: perspectives of parents and physicians in Bangladesh

Diarrheal diseases are a leading cause of morbidity and mortality in children globally, and antibiotics are often inappropriately used in the management of pediatric diarrhea. This study explores how parents' expectations influence the prescription of antibiotics for pediatric diarrhea in Bangladesh. We used qualitative methods to explore parents' expectations when bringing their child with diarrhea to hospital and how physicians perceive and manage expectations. We conducted interviews with 36 parents and 18 hospital physicians across three hospitals. Data analysis followed an applied thematic analysis framework. Parents expected a higher quality of care in the hospital setting, including diagnostic testing, medication, and psychosocial support. Most parents did not expect antibiotics as treatment for pediatric diarrhea, yet most parents expressed a belief that antibiotics were superior to other medications. Physicians recognized this parental belief about antibiotic superiority, but some mistakenly assumed parents universally expected antibiotics. Physicians stated that the most common form of managing parents' expectations is via educational counseling. Physicians' assumptions that parents expect to receive antibiotics may lead to inappropriate antibiotic prescription and be a source of frustration for both parties. Shared decision-making interventions can assist physicians in exploring and managing parent expectations to promote antibiotic stewardship.