Parental response to child's isolation during the SARS outbreak

Parenting in a Pandemic: Parental stress, anxiety and depression among parents during the government-initiated physical distancing measures following the first wave of COVID-19

Drawing on the tenets of family stress theory, the aim of this study is to examine parents' perceived stress, symptoms of anxiety, depression, and associated risk- and protective factors across demographic subgroups during in the first wave of the COVID-19 pandemic. Norwegian parents (N = 2868; 79.5% mothers) with >1 child under 18 years of age completed an online survey two weeks after the implementation of government-initiated distancing measures. The survey includes measures of COVID-related risk factors (parental stress, burnout, depression, anxiety, anger of parents towards children, difficulty working from home, and positive beliefs about worry) and protective factors (self-efficacy and social support). Mothers, parents living with more than one child, and parents with a psychiatric diagnosis reported greater levels of parental stress, more burnout, and more anger towards their children, as well as less social support. Almost 25% of the parents reported anxiety and depression that are clinically significant. Parents who followed distancing measures reported significantly higher distress. Anger of parents towards children explains 41% of the variation in parental stress. These findings indicate that parents have experienced symptoms of deteriorated mental health due to the COVID- 19 pandemic, including parental stress, anxiety, and depression. The study presents practical implications for meso- and macro-level policymaking and offers support to further the potential aims of public health and clinical interventions. Future studies to monitor long-term aversive mental health outcomes among parents are warranted.

The silver lining behind the dark cloud: Exploring the psycho-social factors impacting successful adaptation during the COVID-19 pandemic

While most studies have been reporting the psychological issues being faced by the public due to the global spread of coronavirus and sudden restrictions and changes accompanying it, the present study attempted to explore dynamic human experiences during the COVID-19 pandemic and resultant lockdown, so as to understand the psycho-social factors that acted as adaptive resources or as buffers to maintain a stable mental state amidst this crisis. In-depth telephonic interviews with 30 participants were conducted to explore their experiences in dealing with the COVID-19 pandemic and the lockdown. Thematic analysis performed to identify the positive and protective factors that helped people adapt in a healthy way revealed that although the initial response of the participants to the pandemic was “optimistic bias” followed by downplaying the seriousness of the issue, later they demonstrated increased realization and acceptance to the seriousness of the situation. Upon realizing the situation, their positive psychological resources acted as a buffer against the ill effects of the pandemic, and they used both cognitive and behavioral coping. The study clearly demonstrates that crisis in life is not just a source of stress, anxiety, and uncertainty but also an opportunity to test one’s psychological resources to learn and grow.

Challenges faced by families of critically ill patients during the first wave of the COVID-19 pandemic

OBJECTIVE

To understand how surrogates of critically ill patients adjusted to challenges that resulted from the COVID-19 pandemic.

METHODS

Participants (N = 62) were surrogates of critically ill adults with COVID-19 in the ICU at an urban, academic medical center from March to June 2020. Participants were recruited using convenience sampling and took part in one-time qualitative individual interviews via telephone. Qualitative data were analyzed using thematic content analysis.

RESULTS

Qualitative analyses yielded four types of challenges: Communication with the medical team, communication among family members, understanding and tracking medical information, and distress related to visitor restrictions. To adjust to challenges related to communication, participants developed routines for receiving updates from the medical team and providing updates to other family members. To adjust to the challenge related to comprehension, participants sought information from external sources such as family members in healthcare fields. To adjust to the challenge related to visitation, participants found some comfort in video calls with the patient.

CONCLUSIONS

Surrogates of critically ill patients with COVID-19 faced multiple types of challenges yet adjusted to those challenges.

PRACTICAL IMPLICATIONS

Future research should focus on ways to support the wellbeing of surrogates during times of restricted hospital visitation. Clinical trial registered at ClinicalTrials.gov (NCT03969810).

What are the mental health impacts of epidemics on relatives of people affected, and relatives of healthcare workers: What interventions are available to support them? A systematic review and narrative synthesis

BACKGROUND

Previous research has mainly focused on the impacts of epidemics on those people who are directly affected by the epidemic infection, or of healthcare workers caring for them. Less is known about the impact on mental health of their relatives, and potential interventions to support them.

METHODS

Systematic review and narrative synthesis.

OUTCOMES

28 studies were identified, sixteen quantitative and twelve qualitative. One involved health workers' relatives, and the rest covered relatives of directly affected individuals. We found considerable burden of mental ill-health in both groups. Among relatives of healthcare workers, 29.4% reported symptoms consistent with probable anxiety disorder and 33.7% with probable depression. Prevalence rates for probable anxiety disorder ranged from 24-42% and probable depression 17-51% for the relatives of affected people. One study found a 2% prevalence of PTSD and another found odds of PTSS were significantly higher among relatives of affected individuals compared with the general population. Only two intervention studies were identified and both were descriptive in nature.

INTERPRETATION

Available evidence suggests relatives of people affected by infective outbreaks report mental ill-health. Having a relative who died particularly increased risk. Good outcomes for relatives of affected individuals were promoted by practical and social support, public health guidance that recognises the caring role of relatives, and being supported to see the positives as well as negatives in their situation. Good outcomes for relatives of health workers were promoted by perceived effectiveness of protective equipment. High quality evidence on potential interventions to support relatives is lacking.

FUNDING

No external funding sought.

The Impact of Coparenting on Mothers’ COVID-19-Related Stressors

To test and explore whether more positive coparenting will significantly predict lower COVID-19-related stress across family configurations and dynamics and across both higher- and lower-income mothers, we developed and circulated an online survey among mothers from the U.S. and Canada. Coparenting was measured using the Coparenting Across Family Structures (CoPAFS) short form (27 items) scale, comprised of factors representing five coparenting dimensions: communication, respect, trust, animosity, and valuing the other parent. Items specific to COVID-19 stressors assessed the types of stressors each parent faced. The sample consisted of 236 North American mothers, mostly white (n = 187, 79.2%) and aged 30–50 years. The surveyed mothers reported a consistent and significant relation between more positive coparenting and less COVID-19-related stressors whether parents were living together or not, married or divorced, and with a lower or higher income level, suggesting the importance and centrality of positive coparenting as a key factor for family well-being. Coparenting was especially predictive among mothers who were never married and those with lower incomes.

Mental Health Multimorbidity among Caregivers of Older Adults During the COVID-19 Epidemic

OBJECTIVE

To investigate mental health status and associated factors among caregivers of older adults during the COVID-19 epidemic in China.

METHODS

From March 1 to 31, 2020, 916 caregivers of older adults participated in an online cross-sectional survey on the prevalence of anxiety, depression, and sleep problems. The seven-item Generalized Anxiety Disorder Scale (GAD-7) was administered to measure anxiety symptoms, the two-item Patient Health Questionnaire (PHQ-2) was used to assess depressive symptoms, and a self-developed questionnaire was used to assess sleep quality and duration. Six questions about COVID-19-related experiences were used to assess community-level infection contact and the level of exposure to media information. The prevalence rates of anxiety, depression and sleep problems were computed. The Wald χ2 were applied to compare the differences between subgroups. Multiple logistic regression analyses were performed to investigate factors associated with anxiety, depression, sleep problems, and multimorbidity.

RESULTS

The prevalence rates of anxiety, depression, and sleep problems were 46.8%, 29.8%, and 10.8%, respectively. Approximately 263 participants (28.7%) presented with two or more mental health problems. Being female (OR, 2.254; 95% CI, 1.510-3.363), having community-level COVID-19 contact (OR, 1.856; 95% CI, 1.189-2.898), and having a mental disorder (OR, 3.610; 95% CI, 1.644-7.930) were associated with increased risk of multimorbidity among caregivers. Caregivers who preferred positive information (OR, 0.652; 95% CI, 0.472-0.899) had reduced risk of multimorbidity.

CONCLUSION

Anxiety and depression were common among caregivers of older adults during the COVID-19 epidemic. Being female and having community-level COVID-19 contact were independent risk factors for experiencing multiple mental health problems. Preexisting mental disorders increased the risk of multimorbidity among caregivers, while enhanced access to positive media information decreased the risk of multimorbidity.

A scoping review on psychosocial consequences of pandemics on parents and children: Planning for today and the future

The COVID-19 worldwide pandemic has forced individuals into an unnatural way of life. Families with children experience unique stressors, such as school closures, disrupted childcare arrangements, requirement of parents to uptake additional responsibilities such as homeschooling, possible financial strain, and lack of breathing space between family members. The adjustments required of parents and children during a pandemic presumably impacts the psychosocial wellbeing of parents and children in different ways. To better under the psychosocial consequences of pandemics on parents, children, and youth, this scoping review used Arksey and O'Malley (2005) five-stage framework to examine the existing research literature on Severe Acute Respiratory Syndrome (SARS), Influenza Type A virus (H1N1), and COVID-19 to answer the following two research questions: (1) What are the psychosocial consequences of pandemics on parents of children and youth? (2) What are the psychosocial consequences of pandemics on children and youth? With the application of inclusion criteria, 29 articles were selected for analysis. Four major themes, including sub-themes emerged: 1) Each family members' emotions influence one another; 2) Parents experience greater levels of psychosocial problems than adults without children; 3) During a pandemic, parents require informal (social) and formal (specialized professional) support and; 4) Psychosocial consequences of pandemics on children/youth are understudied, indicating the need for more research on children/youth under the age of 20 years. Clinical prevention and intervention suggestions to support the psychosocial wellbeing of parents, children and youth during a pandemic are discussed.

“Now We Are All in the Same Boat. At the Same Time, We Are Not.” Meaning-Making and Coping Under COVID-19 Lockdown in Norway

On March 12, 2020, Norway went on lockdown to handle the COVID-19 outbreak. Near overnight, people faced a new and unfamiliar situation, with restrictive measures in place, extensive uncertainty and the closing down of much of society. The present study explores the meaning-making and coping in everyday life of 16 participants interviewed early in the pandemic. Norway, compared to many other settings in the world, is a privileged context. Nonetheless, participants struggled with this breach with their normal lives. The participants spoke of adapting to the new normal, how the concept of time had changed, how they handled socialisation, dealing with restricted freedom, and imagining the future. Actively drawing on communal coping, as well as problem-focused and emotion-focused individual coping strategies, participants’ accounts illustrate the on-going process of making meaning of their new lives under lockdown. In our discussion, we synthesise various coping processes that the participants made use of in their handling of the new situation. Even though the COVID-19 pandemic is a shared stressor, it influences people differently, and our research contributes with valuable insights into this variation. The recognition of different meaning-making and coping strategies is crucial, as it can constructively inform the development of political and social responses to the pandemic that actively encompasses the variation in individual experiences and ramifications.

Review: The mental health implications for children and adolescents impacted by infectious outbreaks - a systematic review

BACKGROUND

This systematic review synthesized available research on the psychological implications for children and adolescents who either were directly or indirectly exposed to an infectious outbreak. On this basis, the current paper aims to provide recommendations for future research, practice and policy regarding children during pandemics.

METHOD

A total of 2195 records were retrieved from the PsycINFO, SCOPUS and MEDLINE databases, and three from Google Scholar.

RESULTS

Including only those papers that focused on children or adolescent's mental health in association with respiratory infectious outbreaks, 11 articles were identified. The majority of research utilized qualitative or retrospective hospital record data. Children and adolescents reported fear and anxiety, as well as disruptions to their day to day routines as a result of outbreaks. However, children were also able to demonstrate resilience during outbreaks with the right support.

CONCLUSIONS

Children's psychological response to the outbreak appeared to be largely attributed to how their parents, healthcare providers and the media communicated the event. Recommendations for policy, practitioners and researchers concerning the current COVID-19 outbreak concludes the paper.

Coping Styles, Mental Health, and the COVID-19 Quarantine: A Nationwide Survey in Poland

Background: The outbreak of the novel coronavirus COVID-19 that began from March 2020 is yet to be contained. Consequences of the ongoing pandemic may have a negative impact on the mental health of affected individuals. This particularly refers to those quarantined. Since the COVID-19 pandemic is currently one of the biggest health issues worldwide, a higher demand emerges for research concentrating on the worsening of psychological well-being among the general and the quarantined population, as well as on individual coping strategies that may moderate the occurrence of psychopathologies. Method: Data were collected within the first weeks of the COVID-19 pandemic in Poland. Participants represented quarantine (+) and quarantine (-) groups. Quarantine (+) group, different from quarantine (-), consisted of people who experienced it themselves or someone close to them did after contacting an infected individual. To measure psychopathological symptoms a General Health Questionnaire (GHQ-28) was used. For measuring PTSD symptoms, the Impact of Event Scale-Revised (IES-R) was used. This study followed the coping strategies manifested among the participants using the MiniCope questionnaire. Results: A total of 2,036 individuals participated in this study. Quarantine (+) individuals had significantly higher total and subscales GHQ-28 scores (anxiety, insomnia, and somatic symptoms) as well as a higher IES-R arousal score. The quarantine (+) individuals were more likely to use self-distraction as a coping strategy. This research identified positive and negative correlations between presented coping styles and manifested psychopathology. Conclusion: This nationwide study suggests occurrence of negative effects on mental health due to the COVID-19 pandemic and quarantine. It is observed on most of the measured psychopathological symptoms. The present research provides a line of action that should be followed in the future in case of another epidemic and in the event restrictions like quarantine have to be introduced again.

The Role of Coping Strategies in Maintaining Well-Being During the COVID-19 Outbreak in South Korea

The COVID-19 pandemic continues to pose an unprecedented challenge for the world as people strive to cope with this significant threat to their well-being. This intensive longitudinal study of the first 94 days of the COVID-19 outbreak in South Korea (Phase 1: initial outbreak, Phase 2: intense social distancing) examined individuals’ changes in well-being, in relation to their use of coping strategies and fear of infection. A sample of 10,464 South Koreans participated in surveys during Phase 1 and Phase 2, resulting in 35,846 observations. Multilevel growth models revealed a decrease in well-being while different coping strategies moderated the individual rate of change in well-being. Although preventive measures were associated with a greater decrease in well-being, cognitive appraisal and behavioral strategies predicted stable well-being during the pandemic. Coping strategies further mediated the association between fear of infection and deterioration of well-being.

Thematic Analysis of Parent-Child Conversations About COVID-19: "Playing It Safe"

Caregivers have primary responsibility for teaching their children self-protective behaviors, including those behaviors recommended by the Center for Disease Control (CDC) to prevent the spread of COVID-19. Parents have an important role in scaffolding adherence to the CDC recommendations and in managing stress and regulate their emotions to adaptively cope during uncertain times like those facing communities nationwide. The present study is a qualitative, thematic analysis of parent-reported (n = 210; 64.8% female; average age = 39.33; 14.3% ethnic/racial minority) interactions with children (focal child age: 25.2% birth to 5 years old, 36.7% 6 to 11 years old, 37.6% 12 to 18 years old) about topics associated to COVID-19-related viral transmission suppression guidelines and stress/coping behaviors. Themes included discussions about personal and social hygiene, and parent reported sources of child stress, and child stress management efforts. Findings from our thematic analysis indicate parents are motivated to make scaffolding personal hygiene fun and engaging, signaling a positive, developmentally appropriate native approach to their role as sources of coping socialization. These findings also underscore the importance of providing information to parents in ways that can be translated to children in developmentally appropriate conversations about viral transmission suppression activities and stress management during disasters.

Exploring the impacts of COVID-19 related social distancing on loneliness, psychological needs and symptomatology

Loneliness may be a consequence of social distancing, a measure imposed by several governments to try to reduce the contagion of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2). Despite being necessary, this measure may have thus caused a rise in mental health issues, leading to higher psychological distress and symptomatology. Thus, it is also important to explore how loneliness relates to the regulation of psychological needs. This study aims to explore the relationships between loneliness, symptomatology, and the regulation of psychological needs. 142 individuals (M age=32.7, SD=10.9), answered self-report questionnaires in a cross-sectional design. Results show that loneliness is positively correlated with symptomatology and difficulties in the regulation of psychological needs, with these relationships being mediated by psychological distress and psychological well-being. We discuss our results with a focus on loneliness and related psychopathological symptomatology, as they seem to be core factors in the regulation of psychological needs.

COVID-19-related anxiety in people living with HIV: an online cross-sectional study

Background/aim

The emergence of the coronavirus disease 2019 (COVID-19) outbreak has had an enormous emotional impact on some vulnerable groups, such as people living with human immunodeficiency virus (HIV) (PLHIV). This study was planned with the aim of assessing the anxiety levels of PLHIV and the sources of their anxiety.

Materials and methods

A web-based questionnaire was sent to PLHIV using the virtual snowball sampling method. The questionnaire included questions about sociodemographic status, information about HIV infection, and the Beck Anxiety Inventory (BAI). Additionally, some opinions of the participants about COVID-19 were asked.

Results

A total of 307 respondents, with a median age of 33 years, from 32 different cities, participated in the study. More than half of the respondents reported the belief that COVID-19 was not sufficiently well-known by the medical community and nearly 45% believed that they would have more complications if they contracted COVID-19. One-fourth of the participants had anxiety. Having a preexisting psychiatric disorder, perceiving that they were practicing insufficient preventive measures, not being sure about the presence of any individuals with COVID-19 in their environment, and living with a household member with a chronic disease were found to be the risk factors of PLHIV for having anxiety during this pandemic. The BAI scores were correlated with the patient-reported anxiety levels about the spread of COVID-19 in Turkey, acquiring COVID-19, transmitting COVID-19 to another person, and transmitting HIV to another person. Among the stated conditions, the most common concern was the spread of COVID-19 all over the country, while the least common was transmitting HIV to someone else.

Conclusion

The results revealed that a significant proportion of the sample had anxiety, and the findings were essential for developing evidence-based strategies for decreasing the anxiety of PLHIV, especially for those who had risk factors and to provide them with better health care during this pandemic or other pandemic-like crises.

Child and Family Outcomes Following Pandemics: A Systematic Review and Recommendations on COVID-19 Policies

Objective

A systematic review of mental health outcomes and needs of children and families during past pandemics was conducted based on the PRISMA protocol. The objectives were to evaluate the quality of existing studies on this topic, determine what is known about mental health outcomes and needs of children and families, and provide recommendations for how COVID-19 policies can best support children and families.

Methods

Seventeen studies were identified through a search of PsycINFO, PubMed, Scopus, Web of Science, and Google Scholar.

Results

Studies examining child outcomes indicate that social isolation and quarantining practices exert a substantial negative impact on child anxiety, post-traumatic stress disorder, and fear symptoms. Potential risk factors such as living in rural areas, being female, and increasing grade level may exacerbate negative mental health outcomes for children. Studies examining parental and family outcomes indicate that parents experience high stress, anxiety, and financial burden during pandemics. The age of the parent and family socioeconomic status (SES) appeared to mitigate negative outcomes, where older parents and higher SES families had lower rates of mental health problems. Parents’ fear over the physical and mental health of their children, concerns over potential job loss and arranging childcare contributes to elevated stress and poorer well-being.

Conclusions

Findings from this review suggest current gaps in COVID-19 policies and provide recommendations such implementing “family-friendly” policies that are inclusive and have flexible eligibility criteria. Examples include universal paid sick leave for parents and financial supports for parents who are also frontline workers and are at an elevated risk for contracting the disease.

Urban Parks as Green Buffers During the COVID-19 Pandemic

In many parts of the world, concerns about the COVID-19 pandemic and city quarantine policy have led to a general decline in the physical and mental health of residents due to insufficient social interaction. These adverse effects can cause potential public health risks. Ways to alleviate the adverse impact of the pandemic and meet social interaction needs must be widely addressed. This survey was conducted from 1–5 April 2020; it collected 386 responses from residents of Chengdu, China, during the pandemic based on an online survey questionnaire. The results indicate that most of the residents believe their health status is poor, and that they do not experience adequate social contact with others. Most of the respondents indicated no difference in mental health, while a few reported differences in their physical health and social interaction levels. Visiting urban parks can significantly improve overall health and assist in meeting individuals’ social interaction needs. Although residents have reduced the frequency of visits during the pandemic, even once a week can be beneficial. This paper emphasizes the critical role of urban parks during the pandemic period from the perspective of the urban building environment. The conclusion affirms that urban parks and large outdoor, open spaces can provide residents with a place for safe outdoor activities and social interaction in a green environment during a pandemic, as well as serve as a buffer area to maintain favorable health and quality of life.

The Mental Health Burden of the COVID-19 Pandemic on Physical Therapists

We evaluated the mental health burden of coronavirus disease (COVID-19) on physical therapists, including their stress and anxiety levels, who were at risk of developing psychological distress and other mental health symptoms. A questionnaire survey was conducted with physical therapists of three university hospitals in South Korea on 10 April 2020. The questionnaires evaluated the presence of anxiety and depression in the respondents. Among the 65 physical therapists who completed our survey, 21 (32.3%) and 12 (18.5%) physical therapists reported having symptoms of anxiety and depression, respectively. If a physical therapist was living with a ≤6-year-old infant or child, the possibility of the presence of anxiety was significantly higher. The risk of depression among those who were in their 30 s and 50 s was significantly higher than among those in their 20 s. Thus, physical therapists living with a ≤6-year-old infant or child and those in their 30 s and 50 s need special attention.

Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: practical considerations for the COVID-19 pandemic

INTRODUCTION

Emerging infectious disease outbreaks, such as the present coronavirus disease 2019 (COVID-19) pandemic, often have a psychological impact on the well-being of the general population, including survivors and caregivers. Our study aimed to synthesise extant literature regarding the combined psychological responses and coping methods used by the general population in past outbreaks.

METHODS

We conducted a narrative synthesis of the published literature over the last two decades with a quality appraisal of included articles that reported both psychological responses and coping strategies within infectious disease outbreaks.

RESULTS

A total of 144 papers were identified from the search, 24 of which were included in the review. Overall, 18 studies examined the psychosocial responses of the general population towards the severe acute respiratory syndrome epidemic, four studies focused on the Ebola epidemic and two studies covered the H1N1 outbreak. Common themes in psychological responses included anxiety/fears, depression, anger, guilt, grief and loss, post-traumatic stress and stigmatisation, but also a greater sense of empowerment and compassion towards others. Coping strategies adopted included problem-focused coping (seeking alternatives, self- and other-preservation), seeking social support, avoidance, and positive appraisal of the situation.

CONCLUSION

Amid the range of psychosocial responses seen in past infectious disease outbreaks, practical considerations for the current COVID-19 pandemic need to focus on the individual in the context of the larger social environment, with an emphasis on raising awareness of the range of possible psychosocial responses, access to psychological help, self-care, empowering self-support groups and sustained engagement with updated, reliable information about the outbreak.

Infection Control and the Need for Family-/Child-Centered Care

Patient- and family-centered care (FCC) has become central to the delivery of medical care over the last 20 years and has been shown to improve patient outcomes. Infection control practices have the potential to greatly influence family centeredness and care providers, and hospital personnel must consider the potential impacts of isolation and the use of personal protective equipment (PPE). Approaching infection control with the perspective of FCC requires balancing patient safety and overall patient well-being. In this chapter, authors consider infection control and the benefits of FCC, family and sibling visitation, the use of playrooms, animals in healthcare settings including animal-assisted interventions, the potential adverse effects of infection control practices, and strategies to mitigate these impacts.

Murthy AR, Krasilovsky AM. Behavioral Health Support for Patients, Families, and Healthcare Workers

During the 2014–2016 Ebola outbreak in West Africa, over 850 healthcare workers contracted Ebola, and over 500 died. These tragic numbers underscore the need for strict adherence to infection control precautions when caring for patients with Ebola and other diseases that are both highly infectious and potentially fatal. In addition to the use of personal protection equipment (PPE), such measures include source isolation of infected patients. In the process of confining infectious pathogens, however, it is essential that health systems do not overlook the psychological needs of patients nor that of the medical staff who care for them. This chapter is divided into two sections. The first explores the experiences of patients cared for in source isolation, highlighting the possible iatrogenic psychological consequences of treatment in a biocontainment unit. Strategies for mitigating the potentially harmful psychological effects of isolation are reviewed, including considerations for children. The second section considers the experiences of healthcare workers. The discussion outlines the psychological impact of treating patients with infectious diseases, risk factors for emotional distress, and strategies to promote psychological well-being and resilience.

Coverage and parental perceptions of influenza vaccination among parents of children aged 6 to 23 months in Hong Kong

BACKGROUND

The impact of influenza on young children can be severe and even fatal. Influenza vaccination (IV) has been shown to be effective in reducing complications of influenza among children. This study investigated the prevalence and factors of IV among children aged 6-23 months in Hong Kong.

METHODS

A sample of 401 Chinese parents of children aged 6-23 months were interviewed at local Maternal and Child Health Centers. Socio-demographic information, variables related to Health Belief Model, including perceptions about the child's chance of contracting influenza, perceived harm of influenza on children, perceived benefits and side-effects of IV, having received recommendations from health professionals to uptake IV, and IV behaviors of the children were measured. Multivariate analysis was used to examine factors associated with IV behaviors of children.

RESULTS

Only 9% of the children had ever been vaccinated. Among those parents who had heard of IV (92.0%), substantial proportions perceived that IV could reduce the risk of influenza-induced complications (70.5%), hospitalization (70.5%) and death (65.9%). Relatively few of the participants believed that IV had no side effects (17.1%) and even less had been recommended by health care professionals to uptake IV (10.6%). Results from multivariate analysis showed that physician recommendations were associated with a higher likelihood for IV among younger children, whilst parental perceptions of the side effects of IV was associated with a lower likelihood for IV.

CONCLUSION

The prevalence of IV among children aged 6-23 months in Hong Kong was very low. Promotion of IV with the component of physician recommendations and parents' knowledge about IV safety for this group is warranted.