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优化儿童保育中心因发烧和常见感染导致的因病缺勤决策:多组分干预措施的制定及一项整群随机对照试验的研究方案

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.

作者信息

Peetoom K K B, Crutzen R, Bohnen J M H A, Verhoeven R, Nelissen-Vrancken H J M G, Winkens B, Dinant G J, Cals J W L

机构信息

Care and Public Health Research Institute Department of Family Medicine, Maastricht University, Maastricht, The Netherlands.

Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, The Netherlands.

出版信息

BMC Public Health. 2017 Jul 26;18(1):61. doi: 10.1186/s12889-017-4602-3.

Abstract

BACKGROUND

Evidence has shown that children 0-4 year-old attending childcare are prone to acquire infections compared to children cared for at home, with fever being the most common symptom. Illness absenteeism due to fever and common infections is substantial and mostly driven by unrealistic concerns and negative attitude towards fever of both childcare staff and parents, resulting in illness absenteeism from childcare, work absenteeism among parents and healthcare service use. The objective of this study is to optimise decision making among childcare staff on illness absenteeism due to fever and common infections in childcare. Underlying determinants of behavioural change were targeted by means of a multicomponent intervention.

METHODS

A multicomponent intervention was developed to improve decision making, using the stepwise approach of Intervention Mapping, and in close collaboration with stakeholders and experts. The intervention consisted of 1) a two-hour educational session on fever among childcare staff; 2) an online video for childcare staff and parents emphasising key information of the educational session; 3) a decision tool for childcare staff and parents in the format of a traffic light system to estimate the severity of illness and corresponding advices for childcare staff and parents; 4) an information booklet regarding childhood fever, common infections, and self-management strategies for childcare staff and parents. The multicomponent intervention will be evaluated in a cluster randomised trial with a 12-week follow-up period and absenteeism due to illness (defined as the percentage of childcare days absent due to illness on the total of childcare days during a 12-week period) as primary outcome measure. Secondary outcome measures are: incidence rate and duration of illness episodes, knowledge, attitude, self-efficacy, and risk perception on fever and common infections of childcare staff and parents, healthcare service use in general and paracetamol use, and work absenteeism of parents.

DISCUSSION

This study aims to develop a multicomponent intervention and to evaluate to what extent illness absenteeism due to fever and common infections can be affected by implementing a multicomponent intervention addressing decision making and underlying determinants among childcare staff and parents of children attending daycare.

TRIAL REGISTRATION

NTR6402 (registered on 21-apr-2017).

摘要

背景

有证据表明,与在家照料的儿童相比,0至4岁入托儿童更容易感染疾病,发热是最常见的症状。因发热和常见感染导致的缺勤情况很严重,这主要是由于托育工作人员和家长对发热存在不切实际的担忧和消极态度,从而导致儿童缺勤、家长旷工以及医疗服务的使用。本研究的目的是优化托育工作人员对托育机构中因发热和常见感染导致的缺勤情况的决策。通过多组分干预针对行为改变的潜在决定因素。

方法

采用干预映射的逐步方法,并与利益相关者和专家密切合作,制定了一项多组分干预措施以改善决策。该干预措施包括:1)为托育工作人员举办一场关于发热的两小时教育课程;2)为托育工作人员和家长制作一个强调教育课程关键信息的在线视频;3)为托育工作人员和家长提供一个交通信号灯系统形式的决策工具,用于评估疾病的严重程度以及为托育工作人员和家长提供相应建议;4)为托育工作人员和家长提供一本关于儿童发热、常见感染及自我管理策略的信息手册。将在一项整群随机试验中对该多组分干预措施进行评估,随访期为12周,将因疾病导致的缺勤情况(定义为12周期间因疾病缺勤的托育天数占总托育天数的百分比)作为主要结局指标。次要结局指标包括:疾病发作的发生率和持续时间、托育工作人员和家长对发热和常见感染的知识、态度、自我效能感和风险认知、一般医疗服务的使用和对乙酰氨基酚的使用,以及家长的旷工情况。

讨论

本研究旨在开发一种多组分干预措施,并评估通过实施一项针对托育机构中儿童的托育工作人员和家长的决策及潜在决定因素的多组分干预措施,能在多大程度上影响因发热和常见感染导致的缺勤情况。

试验注册

NTR6402(于2017年4月21日注册)。

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