The interviewers collected respondents’ personal characteristics and their beliefs about colds. Our specific areas of interest were the causes and characteristics of the common cold and the effectiveness of palliative care. We computed frequency distributions, and since chi-square analysis revealed no differences in beliefs between parents of symptomatic children and symptomatic adults, data were combined.
Results
The average age of the respondents was 37 (±9.2) years (range = 18 to 64 years). Most were women (78%) and white (98%). They were well educated: 41% were college graduates, and an additional 34% reported some education after high school. Most were employed full time (64%) or part time (19%). Almost all of the respondents had insurance coverage for their current symptoms (97%). Symptom duration was 3.5 (±2.6) days in children and 5.0 (±3.5) days in adults at the time they contacted the clinic. Symptom severity was reported as mild in 11% of the respondents, moderate in 43%, and severe in 46%.
Fewer than half of the respondents thought viruses alone cause the common cold (Table 1); an additional 42% said that both viruses and bacteria had a role. Most respondents believed getting tired or run-down caused a cold; few believed getting wet or chilled caused a cold.
Most respondents believed colds resolve on their own Table 1, but they were evenly split on whether antibiotics help colds. Among those believing antibiotics were not helpful, most were emphatic in their belief. More than half believed too many people take antibiotics for a cold, but 22% did not know. Respondents believed colds typically last 7.6 days (±3 days) in both children and adults. Rest was overwhelmingly chosen as an effective method of palliative care for colds Table 2.
The perceived cause of colds was associated with believing antibiotics help colds (c2=19.57; P = .0002). Those reporting only viruses cause colds were less likely to believe antibiotics help colds; those believing both viruses and bacteria cause colds were more likely to believe antibiotics help colds. There was no relation between perceived helpfulness and overuse of antibiotics for managing cold symptoms.
Discussion
We found agreement and differences between patients’ perceptions and medical opinion regarding causes, characteristics, and care of uncomplicated colds. Respondents generally agreed with clinical trials demonstrating that getting wet or chilled does not cause a cold but getting tired and run-down does contribute. In this well-educated sample, some respondents (41.9%) believed bacteria were a cause of colds, which was strongly associated with considering antibiotics helpful. Although research studies suggest that a few colds have bacterial etiology,4 viral etiology is far more common. Treatment recommendations do not differ by cause, however, and antibiotics are consistently ineffective. Patients’ expectations influence both their satisfaction with their medical care and physicians’ prescribing behavior.29,36 Physicians can address these expectations to ensure patient satisfaction while limiting antibiotic use by those patients with uncompli- cated colds.
Consistent with reports from clinical trials and observational studies, most of the respondents (63%) believed rest and nonprescription medications relieved symptoms. Our result is similar to reported beliefs in a convenience sample of adults.30 However, 26% of our respondents did not consider nonprescription medications helpful, which provides an opportunity for physicians to discuss the usefulness of over-the-counter medications for relieving symptoms.
Despite the documented ineffectiveness of vitamin C and inhaling steam, more than two thirds of our respondents believed those treatments were helpful. These beliefs were more common in our respondents than previously reported by nonsymptomatic adults.30 Although zinc was originally considered helpful, recent more rigorous studies demonstrated a lack of effect.25-27 The zinc debate seems to have bypassed many respondents. Our results suggest partial knowledge of medical research results among patients.
Also consistent with results published in the medical literature, most of our respondents believed colds resolve on their own and generally last a week or more for both adults and children. Yet, they still called inappropriately early for medical care. Providers can reinforce the normal progression of a cold and encourage self-management of future symptoms.
Limitations
The study sample must be considered when evaluating our results. The respondents tended to be in very good health, well educated, employed, and fully insured for medical evaluation of cold symptoms. The results of our study may not reflect the beliefs of those patients evaluated in medical practices serving a less-affluent and less-educated population. Similarly, informational needs may not be consistent with our sample. Finally, the relation between patients’ beliefs about colds and their acceptance of medical intervention was not evaluated in our study.
Conclusions
The beliefs of those patients seeking medical care for uncomplicated colds generally paralleled medical research findings regarding cold characteristics and management, although some medical study results may not have reached some people. Our respondents were misinformed, however, about the primary cause of the common cold, the use of prescription medications for treating cold symptoms, and the effectiveness of some palliative care techniques. The tasks for health care providers are to educate and reassure the patient, offer options for symptom relief, and minimize antibiotic use for uncomplicated colds.