Background: Antibiotics are prescribed frequently for upper respiratory tract infections (URTIs) despite the fact that most of them do not require antibiotics. This over-prescription contributes to antibiotic resistance which is a major health problem. Physicians perceive that patients’ expectations influence their antibiotic prescribing practice. Methods: As the first phase of the thesis, we conducted a systematic review to determine the effectiveness of patient-oriented interventions to reduce unnecessary use of antibiotics for URTIs. As the second phase, we conducted a qualitative descriptive study to explore patients’ views about URTIs and identify ways they manage them by using semi-structured interviews based on Common Sense-Self-Regulation Model (CS-SRM). Results: Our systematic review included 14 studies which based on their interventions were classified into two major categories: delayed prescriptions and patient/public information and education interventions. Our meta-analysis revealed that almost all studies with delayed prescription significantly reduced use of antibiotics for URTIs. Our subgroup analysis showed that prescriptions that were given at a later time and prescriptions that were given at the index consultation had similar effects regarding antibiotic use. The small number of included studies in the patient/public information and education group did not allow us to make a definite conclusion on their effectiveness. For the qualitative study, 15 individuals were interviewed. almost all participants mentioned that they only visited their doctor if their symptoms got progressively worse and they could no longer self-manage URTI symptoms. When visiting a doctor, most participants reported that they expected to receive an examination and an explanation for their symptoms. Discussion: Patient-oriented interventions (especially delayed prescriptions) may be effective in reducing antibiotic use or prescription for URTIs in patients. Further research is needed to investigate the costs and feasibilities of implementing these interventions as part of routine clinical practice. Our participants reported good knowledge regarding the likely lack of benefit from antibiotics for URTIs. The results suggest a discrepancy between our participants’ reported reasons for visiting doctors and doctors’ perceptions about patients’ reason for their visit identified in previous studies. Focusing on interventions that facilitate the communication between patients and doctors, instead of providing more education to public may help in reducing the use of unnecessary antibiotics.

Hintergrund Subjektive Krankheitsannahmen beinhalten Annahmen über Symptome, emotionale Reaktionen, Verlauf, Konsequenzen und Kontrollierbarkeit einer Erkrankung. Aktuelle Studien zeigen, dass subjektive Krankheitsannahmen mit der Krankheitsverarbeitung und dem psychischen Wohlbefinden assoziiert sind. Bisher gibt es kein Erhebungsinstrument zur Befragung von Kindern, sodass hier oftmals nur der Bericht der Eltern verfügbar ist. Ziel der Arbeit Das Ziel ist die Entwicklung und psychometrische Überprüfung eines Puppeninterviews zur altersgerechten Erfassung subjektiver Krankheitsannahmen für Kinder ab 4 Jahren. Beschreibung von Durchführungsempfehlungen mit Indikation und Kontraindikation. Methode Das Puppeninterview zur Erfassung subjektiver Krankheitsannahmen wurde auf Grundlage des „Illness Perception Questionnaire“ (IPQ-R) und des „Berkeley Puppet Interviews“ entwickelt und an zwei Stichproben (n = 11 und n = 64) überprüft. Ergebnisse Die Anwendbarkeit, Verständlichkeit und Nützlichkeit des Puppeninterviews wurde für die Akut- und Nachsorgephase gezeigt, wobei sich die Krankheitsannahmen je nach Krankheitsphase unterscheiden können. Es zeigten sich erwartungskonforme Interskalenkorrelationen im Puppeninterview (z. B. Chronizität – Konsequenzen für die Lebensführung: r = 0,690, p ≤ 0,05), hypothesenkonforme Ergebnisse zur Konstruktvalidität (z. B. Chronizität – internale Kontrolle r = −0,711, p ≤ 0,05) und zufriedenstellende interne Konsistenzen. Mitunter besprachen die Kinder mit den Puppen mögliche Bewältigungsstrategien, was zu einer Entlastung beitrug. Schlussfolgerung Die Einschätzungen der Eltern können zukünftig durch eine zuverlässige Erhebung von subjektiven Krankheitsannahmen bei Kindern ab 4 Jahren ergänzt werden, um medikamentöse und psychosoziale Interventionen gezielt anzupassen. / Background Illness perceptions comprise assumptions about symptoms, timeline, consequences, controllability, and emotional responses of an illness. Recent evidence shows that illness perceptions are associated with coping and well-being. Until now, assessment is based on parental report only, since no instrument for the direct assessment of children is available. Objectives Development of a puppet interview for the age-appropriate assessment of illness perceptions in children up to the age of 4 years. Recommendations for the application (including indications and contraindications) and assessment of psychometric properties. Materials and methods The puppet interview was developed based on the Illness Perception Questionnaire (IPQ-R) and the Berkeley Puppet Interview and examined in two samples of patient–parent dyads (n = 11 und n = 64). Results The puppet interview is applicable (comprehensible, useful) in acute treatment and follow-up care. Illness perceptions may vary in different treatment phases. We saw confirming intercorrelation of scales (chronicity – consequences: r = 0.690, p ≤ 0.05) and adequate psychometric properties (construct validity: chronicity – internal control: r = −0.711, p ≤ 0.05, internal consistency). Some children even discussed potential coping strategies with the puppets. Conclusion Parental report can be complemented by a self-report measure of illness perceptions in affected children aged 4 years and older. This will allow for the further adaptation of medical and psychosocial treatment.