title: Immunisation uptake, services required and government incentives for users of formal day care.
abstract: OBJECTIVE
  To determine immunisation uptake in children attending formal day care prior to the introduction of certificates (state) and parent incentives (federal), and to document parent and child carers' attitudes to these strategies.
  
  
  METHODS
  In 1997, 60 child care centres and 300 family day carers in suburban Melbourne were randomly sampled. Immunisation dates, service use and preference, and views on government incentives were obtained from parents of children under three years of age.
  
  
  RESULTS
  From 2,454 eligible children, information was obtained for 1,779, of whom 84% (95% CI 82-86) were completely immunised. Low income (OR 1.8, 95% CI 1.2-1.9, p < or = 0.001) and larger family size (OR 1.8, 95% CI 1.2-2.7, p = 0.002) and only ever using a doctor (OR 1.6, 95% CI 1.1-2.3) was associated with incomplete immunisation. Main reasons for delaying immunisation were occurrence of minor illness and work commitments. Families would prefer immunisation services at Maternal and Child Health visits (39%), evening sessions (22%) and at day care (22%). Immunisation uptake could increase to 94% if those receiving Childcare Assistance (67%) immunised their children on time but would increase to 87% if these incentive only motivated those for whom Childcare Assistance was essential (15%). While 98% of day care co-ordinators and 71% of family day care co-ordinators documented immunisation status at commencement of child care, only 51% and 33% respectively regularly updated this information.
  
  
  CONCLUSIONS
  Providing client-focused, flexible immunisation services and government incentives and legislation may work together to boost immunisation levels for those in formal child care.
authors.affiliation: Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria. bond@cryptic.rch.unimelb.edu.au
authors.forename: L
authors.initials: L
authors.lastname: Bond
authors.forename: T
authors.initials: T
authors.lastname: Nolan
authors.forename: R
authors.initials: R
authors.lastname: Lester
mesh_terms: D000328:Adult; D002656:Child Day Care Centers / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007182:Income / Q000706:statistics & numerical data; D007223:Infant; D008297:Male; D009042:Motivation; D020380:Needs Assessment; D010290:Parents / Q000193:education / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014739:Victoria