Abstract
INTRODUCTION: This qualitative study explored factors associated with childcare affecting antibiotic use in a lower socioeconomic, culturally diverse community. Little is known about the knowledge, attitudes and behaviours of parents and childcare providers that influence childhood antibiotic use at a local level. METHODS: Parents and childcare workers from the Fairfield Local Government Area of Sydney were sampled to maximise diversity, including English speakers and those preferring other languages. Recruitment was hampered by the COVID-19 epidemic. Semi-structured telephone interview transcripts were thematically analysed. RESULTS: Eighteen childcare staff and 20 parents were interviewed, drawn from 7 participating childcare services. Interview findings were grouped under two major themes: the culture regarding antibiotic use and the regulatory and administrative environment of childcare centres. Interview responses demonstrated interaction between themes and provided insights into the knowledge, attitudes, and behaviours of staff and parents/carers in relation to antibiotic use. DISCUSSION: The determinants of high use of antibiotics in childcare in a multicultural community are multifactorial, inter-related and complex. The two interacting themes, cultural factors and regulatory/administrative environment, appear to capture these determinants. The study did not find evidence of explicit pressure on parents to obtain antibiotics for children. However, the themes described appear to work together to increase antibiotic prescriptions. Parents and care providers expressed beliefs in antibiotic efficacy for numerous conditions, contrary to scientific knowledge and public health messaging. Respondents were not aware that antibiotic use in the region is unusually high. The regulatory and administrative context determining childcare attendance during illness does not seem to overtly drive antibiotic seeking behaviour. However, parents expressed an imperative to work which appeared to drive adoption of strategies perceived to shorten illness, including using antibiotics. These factors may also increase doctor attendance seeking certificates to facilitate early return to childcare. Doctor attendance may increase antibiotic prescriptions. These issues deserve further investigation which should also include doctors' perspectives.