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A randomized controlled trial of storytelling as a communication tool aimed at parents of children presenting to the emergency department with croup Open Access


Other title
storytelling, narrative, randomized controlled trial, croup, parent
Type of item
Degree grantor
University of Alberta
Author or creator
Hartling, Lisa
Supervisor and department
Klassen, Terry (Pediatrics)
Examining committee member and department
Dibden, Lionel (Pediatrics)
Johnson, David (Pediatrics and Physiology & Pharmacology)
Bishop, Ted (English and Film Studies)
Lacaze, Thierry (Pediatrics)
Lang, Eddy (Family Medicine)
Medical Sciences-Paediatrics

Date accepted
Graduation date
Doctor of Philosophy
Degree level
Background: Stories may be an effective tool to communicate with and influence patients because of their ability to engage the reader. Objectives: To develop story booklets and evaluate their effectiveness compared to standard information sheets for parents of children attending the emergency department (ED) with a child with croup. Methods: A systematic process was followed to develop and pilot-test the story booklets. Parents were randomized to receive story booklets or standard information sheets during their ED visit. The primary outcome of change in anxiety during the ED visit was assessed using the State Trait Anxiety Inventory, which was completed upon recruitment and at discharge. Follow-up telephone interviews were conducted at 1 and 3 days post-ED visit to gather information on secondary outcomes: symptoms, expected anxiety for future croup, satisfaction, regret, knowledge, return for medical care, and resource use. Telephone interviews were conducted every other day until symptoms resolved or until day 9. Outcomes were compared using independent-groups t-tests, Mann Whitney tests, or Chi-square tests. Results: There was no significant difference in the primary outcome of change in parental anxiety between recruitment and ED discharge. The story group (n=129) showed significantly greater decision regret regarding their decision to go to the ED than the comparison group (n=126) (p<0.001). The story group reported quicker resolution of symptoms: median days to no symptoms 3 versus 5; the survival distributions were significantly different (p=0.032). There were no differences for the remaining outcomes. Conclusions: This study provides preliminary evidence regarding the use of stories in the ED for an acute, self-limiting condition and contributes to a growing evidence matrix identifying when, where, and for whom storytelling may be most effective. Reasons for lack of significance for the primary and other outcomes may relate to choice of outcome, timing of outcome assessment, or disconnect between the intervention and needs of the end-user. Further research is needed to corroborate the significant findings and examine their underlying mechanism. An examination of risk of bias in a sample of pediatric trials demonstrates that there is room for improvement in the design, conduct, and reporting of research related to child health and provides direction for future research.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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