Parents’ preferences for nursery care when children are unwell: a discrete choice experiment

Fran E. Carroll, Hareth Al-Janabi, Leila Rooshenas, Amanda Owen-Smith, Sandra Hollinghurst, Alastair D. Hay

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Background: Pre-school children’s daycare is associated with increased incidence of respiratory and diarrhoeal illnesses. While the incidence might be reduced if all unwell children were kept at home, parental employment pressures make this difficult when children are marginally unwell.

Methods: A discrete choice experiment (DCE) was conducted to identify what aspects of daycare policy and provision would affect parents’ decisions to keep marginally unwell children home. Prior qualitative research informed parameter choice. The DCE was accompanied by a best-worst scaling task examining preferences for four modifiable aspects of care: swapping unused daycare sessions; reimbursing unused sessions; daycare paracetamol policy; and presence of a ‘quiet room’.

Results: Paracetamol guidelines and the presence of a quiet room had the strongest predicted influence on parents’ decision-making. Conditional on assumptions about the set-up of the daycare, introducing a ‘no paracetamol’ policy would result in a fall from 62% to 25% in mean predicted probabilities of a parent sending a marginally unwell child to nursery, while introducing a quiet room would increase the mean probability from 34% to 53%.

Conclusions: Daycare policy, particularly the use of paracetamol prior to attendance, could impact parents’ decisions to send unwell children to daycare, potentially influencing the transmission of children’s infectious illness.

Keywords: nursery; daycare; children; infectious illness; communicable diseases; preferences; choice experiment
Original languageEnglish
Article numberfdy215
JournalJournal of Public Health
Early online date20 Dec 2018
Publication statusE-pub ahead of print - 20 Dec 2018


  • nursery
  • daycare
  • children
  • infectious illness
  • communicable diseases
  • preferences
  • choice experiment


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