Poor-tasting pediatric medicines: part 2. Exploring caregiver and healthcare provider values and preferences for a novel taste-blocker product to improve acceptability.

Abstract

Introduction: Improving the palatability of bitter-tasting medication for pediatric populations has long presented a challenge. Taste blockers are being researched as a potential solution; however, end-user perspectives and needs related to this concept have not been explored. The objectives of this research were 1) to understand current experiences of administering bitter-tasting medication; 2) the evaluation of a consumer-targeted product profile (CTPP) for a taste blocker including attributes such as form and duration of action; and 3) whether there is a need to support improved acceptability and adherence with a taste blocker taken before the bitter-tasting medication.

Methods: Our study consisted of simultaneous qualitative and quantitative phases, involving caregivers and healthcare providers with experience administering medications to children aged 2-17 years. Qualitative research was conducted with 120 caregivers and 92 healthcare providers using a range of methods. Focus groups (FGs) were conducted in Kenya, Nigeria and Zimbabwe (grouped as Sub-Saharan Africa (SSA) but not intended to be representative of the region as a whole) with caregivers of children who had taken medication for HIV, TB, pneumonia, or malaria (including for seasonal prevention) within the past 6 months. Telephone in-depth interviews (TDIs) were conducted with caregivers of children with chronic illnesses in the United States. Face-to-face in-depth interviews (IDIs) and TDIs were conducted with healthcare providers. The quantitative part of the study was conducted with n = 1,815 caregivers and n = 859 healthcare providers using face-to-face computer-assisted interviews (CAPI) in SSA, and via online panel research in the United States A CTPP was used as the stimulus for discussion. Participants were asked about their experiences in giving bitter-tasting medication to their children or patients, their perceptions of and willingness to try a taste blocker, and their preferences for specific product attributes.

Results: Participants described how bitter-tasting medications create challenges in multiple areas: for caregivers, children, their daily life and routines, healthcare providers, and children's perceptions of healthcare. In SSA, 28.9% of caregivers reported that their children always or regularly refused medication due to bitter taste, while 57.9% reported this in the United States. Another 36.2% and 29.1% respectively experienced this sometimes or occasionally. Over 80% of providers in all countries stated that bitter taste impacts adherence to both long and short-term medication. The preferred attributes of the taste blocker were a sweetened and flavored lollipop form with a maximum total duration of up to approximately 1h, and with a total taste block achieved as soon as possible. Overall, responses to the concept of the taste blocker were positive from caregivers and providers, with a perception that it would make administering bitter-tasting medication easier. Over 90% were positive about using or prescribing the taste blocker in SSA, while in the United States, over 90% of caregivers were positive about using it, as were over 70% of providers about prescribing it. Concerns centered around the duration of the absence of the sense of taste, and the effects this might have on children's appetite; there were also concerns that repeated taste blocking might have a long-term impact on children's sense of taste.

Conclusion: The results of the study indicate that there is a high perceived need for a taste blocker to aid in administering bitter-tasting pediatric medication. Concerns around duration and potential impact of long-term use must be addressed.