ORCID

Abstract

ContextBronchiolitis is a leading cause of infant hospital admission, placing seasonal pressure on paediatric services. Admission rates vary widely and are strongly associated with socioeconomic deprivation, reflecting differences in disease burden and healthcare utilisation.1 Despite rising admissions, PICU admissions have remained stable, indicating no increase in disease severity.1 Hospitalisation is therefore not inevitable and may reflect health-seeking behaviour. Evidence suggests that parental knowledge alone does not alter attendance, as these decisions are shaped by anxiety, perceived vulnerability and social norms.2 3 Parent champions have been proposed in bronchiolitis as an upstream intervention to address these influences.4 The study by Lee et al5 evaluates the impact of this approach.MethodsThe study used an opportunistic quasiexperimental design to evaluate the respiratory parent champions in the community programme. A cohort of children born between 2016 and 2023 in Cheshire and Merseyside was created using linked routine health records. Outcomes in 16 intervention wards were compared with 220 non-intervention wards. The primary outcome was monthly emergency hospitalisation for bronchiolitis-related illness, defined using ICD-10 codes. Programme effects were estimated using difference-in-differences with inverse probability of treatment weighting, with sensitivity analyses testing alternative specifications and pre-intervention trends, including COVID-19.FindingsThis quantitative study reported a reduction in emergency hospital admissions for children with bronchiolitis in areas where respiratory parent champions were implemented. Emergency admissions decreased by 128 per 100 000 children per month (95% CI, −43 to −214; p<0.005), indicating a statistically significant reduction, with the CI suggesting the true effect lies between 43 and 214 fewer admissions per 100 000 children per month.This reduction was associated with an estimated annual saving of £219 243. After accounting for the costs of employing parent champions, the net estimated saving was £101 283 per annum; however, the CI for this estimate ranged from −£44 196 to +£248 811, suggesting uncertainty around the economic impact.CommentaryThis study makes a valuable contribution by providing robust evidence for a community-based parent champion model aimed at reducing bronchiolitis admissions. It moves beyond qualitative evaluations of the peer support project by using a robust, pragmatic evaluation design grounded in routine NHS data.Previous qualitative research on education-based interventions for childhood respiratory illness shows that increasing parental knowledge alone is not sufficient to change behaviour.4 Further research has shown that parental consulting and clinician prescribing decisions are often driven by perceived safety under uncertainty, where seeking care or prescribing antibiotics is framed as the responsible option when managing risk in young children.2Lee et al5 findings sit within the broader body of evidence, highlighting the complex interplay between paediatric respiratory illnesses, healthcare utilisation, parental health-seeking behaviours and clinical decision making. The findings support the value of embedding peer-based community interventions and the potential for similar models being used to support parents’ decision-making for other common childhood conditions.However, the study focuses primarily on hospitalisation rates as the outcome of interest. While this is important for service planning, it leaves unanswered questions. Future research should focus on evaluating multi-component interventions, inclusive of education, peer support and clinician communication strategies. There is also a need for longitudinal and qualitative research exploring how parents interpret and act on advice over time and clinician-parent interactions.

Publication Date

2026-02-18

Publication Title

Evidence-based nursing

ISSN

1367-6539

Acceptance Date

2026-02-06

Deposit Date

2026-05-21

Keywords

Child Health, Epidemiology, Family Nursing, Nurses- Public Health, Public Health

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