Coming in hot: using emotional journey maps to examine parental perceptions associated with presentation of their child with fever to the emergency department in England

Abstract

Introduction: Paediatric emergency department (ED) attendances and admissions in England for fever are extremely common and are increasing, despite little evidence of increased risk and severity of fever-related presentations. Fever is a cause of great concern and anxiety for parents and carers, and these factors have a strong influence on decision-making across every step of a child's journey through the healthcare system. There remains a gap in evidence investigating the emotional influences of parental health-seeking behaviours for fever.

Objective: To explore the journeys taken by parents for children (0-18 years) with fever in England, from noticing a fever, to contacting primary care services, to ED attendance and subsequent discharge.

Design: Qualitative design, using a novel emotional journey map approach.

Participants: 11 parents who had taken their febrile child to hospital (2015-2023).

Methods: Emotional journey maps were co-produced with consenting parent participants during semi-structured Zoom interviews (2022-2023).

Results: Parents' anxiety, fear and uncertainty strongly influenced decision-making throughout their child's healthcare journey. The use of the emotional component in the journey maps helped to clearly visualise the factors that influenced feelings of frustration and negative experiences. Lack of care continuity, unclear fever guidance and exclusion from decision-making led to mistrust and strained relationships with healthcare professionals. Attendance at the ED was driven by uncertainty about illness severity, conflicting medical advice, barriers to primary care and confusing safety-netting, highlighting key areas for intervention.

Conclusions: Findings have significant potential to inform how and why parents seek support from different services and help to aid understanding of gaps in fever education and health services. These maps provide a powerful health service user experience tool and have significant potential to inform how and why parents seek different services and help aid understanding of gaps in fever education and health services.

Keywords: Child Health; Health services research; Qualitative research.

Figure 1. Example of the template used to map a parent journey shared during their interview. A&E, Accident & Emergency.

Figure 2. Example of parent journey touchpoints, Mo,3. GP, general practitioner; Mo, mother.

Figure 3. Journey map, Mo,11_01. Mo, mother.

Figure 4. Journey map, Mo,3. ED, emergency department; GP; general practitioner.