Optimising decision making on illness absenteeism due to fever and common infections within childcare centres: development of a multicomponent intervention and study protocol of a cluster randomised controlled trial

Optimizing decision-making among childcare staff on fever and common infections: cluster randomized controlled trial

BACKGROUND

Children 0-4 years attending childcare are more prone to acquire infections than home-cared children. Childcare illness absenteeism due to fever is mostly driven by fear towards fever in childcare staff and parents. This may cause high childcare absenteeism, healthcare service use, and work absenteeism in parents. This study evaluates a multicomponent intervention targeting determinants of decision-making among childcare staff on illness absenteeism due to fever and common infections.

METHODS

The multicomponent intervention was developed based on the Intervention Mapping approach and consisted of (i) an educational session, (ii) a decision tool, (iii) an information booklet and (iv) an online video. The intervention was evaluated in a cluster randomized controlled trial in Southern Netherlands. Nine centres received the intervention and nine provided childcare-as-usual. Primary outcome measure was the percentage of illness absenteeism on cluster level, defined as number of childcare days absent due to illness on total of registered childcare contract days in a 12-week period. Secondary outcome measures included intended behaviour, attitude, risk perception, knowledge and self-efficacy of childcare staff. Outcomes were analyzed using linear mixed models accounting for clustering. Knowledge was descriptively analysed.

RESULTS

Overall illness absenteeism was comparable in intervention (2.95%) and control group (2.52%). Secondary outcomes showed significant improvements in intervention group regarding intended behaviour, two of three attitude dimensions. Knowledge increased compared with control but no differences regarding self-efficacy.

CONCLUSION

The intervention was not effective in reducing illness absenteeism. However, the intervention improved determinants of decision-making such as intended behaviour, attitude, and knowledge on fever.

TRIAL REGISTRATION

NTR6402 (registered on 21 April 2017).

Inter-Regional Differences in Travel Time to the Nearest Nursery for Children with Mild Acute Illness in Japan

Access to day-care services for children with mild acute illness is important for working parents, because infants and toddlers often suddenly become ill, and most Japanese nursery schools do not accept children with even mild illnesses. Actual travel time to nurseries providing such day-care services is one of the indicators for measuring accessibility. However, this variable has not been well analyzed in previous work. To clarify practical access to such nurseries, this study used a car navigation algorithm to calculate the percentage of the population of children in Japan who can access nurseries providing services for children with mild acute illnesses within 15 to 30 minutes and compared this with the proportion of children living within a linear distance of 10 km of such nurseries. Of the 4,987,706 children younger than 5 years in 2015, 51.7% lived in areas from which the nearest nursery for children with mild acute illness was accessible within 0-15 minutes by automobile. In addition, 81.5% lived within 0-30 minutes of such nurseries, and the same percentage (81.5%) lived within a linear distance of 10 km of such nurseries. Both calculation methods (travel time and linear distance) showed inter-regional differences in accessibility, and the proportion of children with access to these nurseries was higher in heavily populated regions (e.g., Kanto and Kinki) than in less populated regions (e.g., Hokkaido and Tohoku). Children and caregivers throughout Japan should have equal access to these nurseries, because the national government subsidizes such services.