Aim: We surveyed users of sick child care services about the benefits of and issues regarding such care, in order to obtain an insight into its practice.

Methods: The study subjects comprised a total of 144 parents whose children had used any of the 15 sick child care facilities in Prefecture A in 2015. These parents consented to participate in the study. Using a quantitative and qualitative method, we surveyed them about their usage of sick child care, care-related requests, as well as perceived benefits and difficulties.

Results: Sick child care was used mainly by children from either double-income nuclear families (n=123) or single-mother households (n=12) because of infectious diseases. The systems for reducing care fees were utilized by 58% of the single mothers. Subjects viewed the following factors as the benefits of sick child care: 1) a sense of ease achieved through appropriate and professional childcare, 2) being able to work free from anxiety, 3) a reduced burden on children and their normal development, and 4) child raising support for parents. On the basis of difficulties in utilizing sick child care, parents desired improvement in care services, such as an increase in the number of both care facilities and days such care is available, and the capacity to accept children.

Conclusions: The results of this study suggest that, to facilitate sick child care based on the needs of care service users, there is a need to increase the number of care facilities, and expand the capacity to accept children.

The Japanese government is adopting new systems for child rising in order to respond to changes in the child raising environment resulting from the expansion of women’s societal roles and the trend toward nuclear families [1]. These systems aim to provide a wide range of child raising support, including improvement in parents’ employment situation in a manner enabling them to manage work and child raising. In particular, as sick children may hinder their mothers from managing work and child raising, the government is promoting the systems for sick child care [2]. Sick child care is a form of nursing care provided temporarily for sick children when they cannot be cared for by their parents at home. In 2012, approximately 490,000 sick children used a combined total of 1,102 sick child care facilities as supporters of working mothers [3]. The role of sick child care is not only to fill in for working parents by looking after their sick children, but also to meet the children’s needs [4]. Patents are able to benefit from sick child care in terms of both work and child raising, and such care is also beneficial for their children [5,6]. Most of these parents view this type of care as helpful in child raising [6,7]. On the other hand, there have been reports on dissatisfaction with the sick child care systems and care fees, as well as on parents’ anxiety about infection [7-9].

Against this background, we surveyed users of sick child care about the benefits of and issues regarding such care in order to obtain an insight into its practice.

Study design: Mixed methods research: The study subjects comprised parents whose children had used any of the 15 sick child care facilities in Prefecture A between October and November 2015. These parents consented to participate in the study. In this prefecture, care fees are reduced for families receiving welfare support, those exempt from municipal tax, and those exempt from income taxes. It is possible for service users to utilize sick child care facilities located in municipalities other than their home municipality in accordance with the specified municipal agreement.

As the demographic variables of the subjects, we investigated their age, type of household, employment situation, and monthly household income. We did not survey their residential areas because many municipalities of the studied prefecture had only one sick child care facility. In addition, we investigated the subjects’ usage of sick child care (e.g., age and diseases of their children, as well as the costs of and reasons for using such services), annual number of times using care services, whether or not they had ever been unable to use sick child care, and actions taken in such circumstances. We used 15 items regarding the benefits of sick child care (assistance for work, child raising support, and benefits for children), and 14 items regarding care-related requests. Each of these items had 4 possible responses. Furthermore, the subjects were asked to freely write down their opinions and requests concerning sick child care.

We obtained written consent from the managers of the 15 above- mentioned nurseries. Staff members of these nurseries then distributed a form describing the study, questionnaire, and self-addressed envelopes to the subjects. A response to the questionnaire was interpreted as having consented to participate in the study. In addition, to calculate the response rate, we asked each investigated facility to count the number of questionnaires completed in the facility.

Missing quantitative values were handled according to each question item. Using SAS9.2, we performed exploratory factor analysis and the Wilcoxon signed-rank test. Subjects using and not using the systems for reducing care fees were classified based on their payment of these fees. For qualitative data analyses, the statements in the collected questionnaires were repeatedly reviewed, classified depending on their meaning, and encoded while maintaining the main points of these statements. The encoded data were labeled according to their similarities, based on which the data were divided into subcategories, categories, and core categories. To ensure data reliability, all analyses were performed by 4 researchers.

The study objective/methods and ethical considerations were explained to the above-mentioned managers in written and oral forms, as well as to the study subjects using a request form. The study was conducted with the approval of the ethical review board to which the investigators belonged (27-02).

Subjects: We distributed a questionnaire to 345 individuals whose children had used any of the 15 nurseries for sick children in Prefecture A, and collected completed questionnaires from 144 of these parents (response rate: 41.74%). All collected questionnaires were analyzed.

Quantitative data: Of all subjects, 134 were mothers; 92 and 34 were in their 30s and 40s, respectively (Table 1). Single mothers and those from double-income nuclear families numbered 12 (including 1 subject living with their parents) and 123, respectively. Subjects in full- and part-time positions numbered 71 and 55, respectively. The average daily working time was 7.96 hours (SD=1.69). In addition, 84 subjects worked on weekends, and 13 were night-time workers. The percentage of those whose monthly disposable income was less than 300,000 yen was significantly higher for single mothers (91.67% [n=11]) than people from double-income households (19.33% [n=23]) (P<0 n=7]) n=34])>

The average number of times using sick child care during the previous year was 4.42 (SD=4.34). Most recently, the average number of days using sick child care was 1.89 (SD=1.26), with the average number of hours using it per day being 8.09 (SD=1.32). The mean age of the children using care services was 3.07 years (SD=1.9). Among these children, 89 and 79 were male and female, respectively. In addition, 24 parents each placed 2 children in sick child care at any one time. Common diseases included a cold (n=63), pertussis (n=12), and vomiting or diarrhea (n=11). Most children had infectious diseases. The major reason for using sick child care was because of work (n=142). A total of 97 subjects arrived at their workplace late or had to leave early when using sick child care. Furthermore, 141 subjects desired to continue using such care ( Table-2).

During the previous year, 57 subjects had been unable to use sick child care at least once, with the average annual number of times it was unavailable being 2.51 (SD=5.42). The reasons for sick child care being unavailable were the maximum capacity of children had been reached (n=44), and financial issues (n=1). The actions taken when sick child care was unavailable included: 1) taking the day off from work (n=64 [48 mothers and 16 fathers]), 2) placing children in the care of their grandparents (n=15), and 3) making children stay at home alone (n=5).

A polychoric correlation matrix was created for the 15 items regarding the benefits of sick child care in order to facilitate the interpretation of these items. The data obtained from these items were then subjected to exploratory factor analysis (unweighted least squares, promax rotation) (Table 3), which led to the extraction of the following 3 factors: 1) a sense of ease achieved through using sick child care, 2) parents’ relief, and 3) benefits for children. Both the scale used and these 3 factors showed a polychoric ordinal alpha coefficient of ≥0.72, and an item-total correlation coefficient of ≥0.43, which established the scale’s reliability. Significant differences were noted in the scores for these 3 factors (P<0>