Disruptions to safety and adaptations experienced by parents and caregivers who administered prescribed medicines to children at home: a systematic review using a framework synthesis.

Background: Parents and caregivers are responsible for safely administering prescribed medicines to their children at home. This complex process relies on caregivers to be adaptive to any disruptions to this process that may diminish their ability to provide safe care to their children. Learning about the disruptions caregivers experience, alongside any adaptations to these disruptions, will inform improvements to healthcare systems. The aim of this review is to explore the experiences of disruptions to safety and any subsequent adaptations reported in research by parents and caregivers who administer prescribed medicines to children at home. Methods: This review followed the Cochrane-Campbell methodology for framework synthesis. Major healthcare databases (Embase, PyscINFO, CINAHL, Cochrane, PubMed) were searched to identify qualitative studies which reported the experiences of parents and caregivers who administered medicines to children at home. Quantitative studies were not included. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to assess the quality of included studies. Extracted data from studies was organised and interpreted using the Moments of Resilience framework. Results: 27,940 studies were identified and screened. Fifty-one studies were included in the review. The synthesis identified that caregivers experienced frequent disruptions from medicines, healthcare systems and family life that required adaptations to avoid causing harm to their children. Caregivers used a variety of short-term situated adaptations, that were supported by medium-term structural adaptations. However, these were not equally distributed across individuals and resources involved. There was a limited description of long-term systemic adaptations experienced by caregivers. Discussion: The use of adaptations by caregivers was well described and often involved significant effort from caregivers. The adaptive capability and capacity of caregivers was influenced by several factors such as family characteristics, access to resources and healthcare systems design. Future improvements to healthcare systems should reduce disruptions to avoid the need for adaptations entirely, alongside strengthening the ability of caregivers, professionals and healthcare systems to be adaptive to novel and unpredictable disruptions. Limitations include the variable quality of included studies, the lack of reporting of theoretical or cultural perspectives, and the influence of researchers on data and findings. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024487154, PROSPERO #487154.