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Parents' preferences for nursery care when children are unwell: a discrete choice experiment
Fran E Carroll1, Hareth Al-Janabi2, Leila Rooshenas3
1Royal College of Obstetricians and Gynaecologists and Honorary Research Fellow, School of Clinical Sciences, University of Bristol, Bristol, UK.
Insights
Daycare policies significantly influence parents' decisions about sending mildly ill children to nursery. Implementing a
Area of Science:
- Pediatric Health
- Public Health Policy
- Behavioral Economics
Background:
- Preschool daycare attendance is linked to higher rates of respiratory and diarrheal illnesses in children.
- Parental employment pressures often compel parents to send marginally unwell children to daycare, despite risks of illness transmission.
Purpose of the Study:
- To investigate factors influencing parents' decisions to keep marginally unwell children home from daycare.
- To identify key elements of daycare policy and provision that affect parental choices regarding sick child attendance.
Main Methods:
- A discrete choice experiment (DCE) was employed to model parental decision-making.
- A best-worst scaling task assessed preferences for daycare policy modifications, including session flexibility, reimbursement, paracetamol use, and quiet room availability.
Main Results:
- Daycare paracetamol policies and the availability of a quiet room emerged as the most influential factors.
- A 'no paracetamol' policy could decrease the probability of sending a sick child to daycare from 62% to 25%.
- A dedicated quiet room could increase this probability from 34% to 53%.
Conclusions:
- Daycare policies, especially regarding medication administration like paracetamol before attendance, can significantly affect parental decisions.
- These policy choices have the potential to influence the spread of infectious diseases among young children in group care settings.
Background:
Pre-school children's daycare is associated with increased incidence of respiratory and diarrhoeal illnesses. While the incidence might be reduced if all unwell children were kept at home, parental employment pressures make this difficult when children are marginally unwell.
Methods:
A discrete choice experiment (DCE) was conducted to identify what aspects of daycare policy and provision would affect parents' decisions to keep marginally unwell children home. Prior qualitative research informed parameter choice. The DCE was accompanied by a best-worst scaling task examining preferences for four modifiable aspects of care: swapping unused daycare sessions, reimbursing unused sessions, daycare paracetamol policy and presence of a 'quiet room'.
Results:
Paracetamol guidelines and the presence of a quiet room had the strongest predicted influence on parents' decision-making. Conditional on assumptions about the set-up of the daycare, introducing a 'no paracetamol' policy would result in a fall from 62 to 25% in mean predicted probabilities of a parent sending a marginally unwell child to nursery, while introducing a quiet room would increase the mean probability from 34 to 53%.
Conclusions:
Daycare policy, particularly the use of paracetamol prior to attendance, could impact parents' decisions to send unwell children to daycare, potentially influencing the transmission of children's infectious illness.