title: Factors influencing parents' decision-making when sending children with respiratory tract infections to nursery.
abstract: Many families rely on formal day care provision, which can be problematic when children are unwell. Attendance in these circumstances may impact on the transmission of infections in both day care and the wider community.
  
  
  
  Thirty-one semi-structured interviews were conducted to investigate how parents make decisions about nursery care when children are unwell. Topics for discussion included: illness attitudes, current practice during childhood illness and potential nursery policy changes that could affect decision-making.
  
  
  
  A combination of illness perceptions and external factors affected decision-making. Parents: (i) considered the severity of respiratory and non-respiratory symptoms differently, and stated that while most other contagious illnesses required nursery exclusion, coughs/colds did not; (ii) said decisions were not solely based on nursery policy, but on practical challenges such as work absences, financial penalties and alternative care availability; (iii) identified modifiable nursery policy factors that could potentially help parents keep unwell children at home, potentially reducing transmission of infectious illness.
  
  
  
  Decision-making is a complex interaction between the child's illness, personal circumstance and nursery policy. Improving our understanding of the modifiable aspects of nursery policies and the extent to which these factors affect decision-making could inform the design and implementation of interventions to reduce the transmission of infectious illness and the associated burden on NHS services.
authors.affiliation: Centre for Academic Primary Health Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK.
authors.forename: Fran E
authors.initials: FE
authors.lastname: Carroll
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Leila
authors.initials: L
authors.lastname: Rooshenas
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Owen-Smith
authors.affiliation: Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Hareth
authors.initials: H
authors.lastname: Al-Janabi
authors.affiliation: Centre for Academic Primary Health Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK.
authors.forename: Sandra
authors.initials: S
authors.lastname: Hollinghurst
authors.affiliation: Centre for Academic Primary Health Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK.
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Hay
mesh_terms: D000328:Adult; D002656:Child Day Care Centers; D002675:Child, Preschool; D003657:Decision Making; D004739:England; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009724:Nurseries, Infant; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D012141:Respiratory Tract Infections / Q000523:psychology*; D012959:Socioeconomic Factors
keywords: children; communicable diseases