Survey of Pediatricians' Interests and Experiences Regarding Childcare Issues
BACKGROUND
The health and safety of young children is a major concern not only for parents but for their childcare providers. As young children often spend a number of hours every week with their childcare providers, childcare providers must utilize health-promoting and safety protocols such infection control measures, immunization reviews, and hand washing education. In order to assist childcare providers with these important health and safety issues, the State of New Jersey, in collaboration with the American Academy of Pediatrics-New Jersey Chapter (AAP-NJ), received a grant to implement a Child Care Health Consultant (CCHC) program. As part of this program, CCH Consultants advise and train childcare providers on health and safety topics. Pediatricians and other primary care physicians may also have a role in assisting childcare providers with health and safety issues.
PURPOSE
To assess the level of interest and involvement of pediatricians with health-related childcare issues; the New Jersey Academy of Pediatrics (AAP-NJ) surveyed its members on several issues:
• How often pediatricians offer advice or guidance about childcare to parents a and providers.
• What types of information they provide.
• How they formulate their opinions about childcare.
• What types of childcare they recommend for various ages.
• Their level of involvement with childcare providers.
• Their level of interest in learning more about health-related childcare issues.
METHODS
To survey its members, AAP-NJ developed a self-administered mail questionnaire. The survey was sent to all 1,388 members. Follow-up post cards were mailed to the non-respondents, with a second survey mailed to all remaining non-respondents.
Of the 1,388 surveys administered by AAP-NJ to its members, 238 pediatricians participated yielding a response rate of 1 7. 7 percent.
The completed questionnaires were given to the Center for State Health Policy for data entry, cleaning, and analysis.
DISCUSSION
Pediatricians do discuss childcare issues with parents, especially when parents request information. To a more limited extent, pediatricians also interact with childcare providers. Although most physicians usually recommend friends and social networks as a source of information, they do have distinct childcare preferences based on the child's age. Their recommendations are based more on personal experience and parental feedback with reliance on interaction with childcare providers and professional literature; however, pediatricians indicated that written material was the favored venue or format to receive CME on health-related childcare issues.
Most pediatricians have engaged in only a few activities with childcare providers over the last three years. By far, the most prevalent of these activities is telephone consultation and providing linkages to community resources. The most significant barrier to their involvement was lack of time and not knowing how to get involved. Practice-related barriers such as malpractice and inadequate reimbursement were mentioned by about half of the respondents as at least occasionally preventing their involvement.
Several limitations to these findings should be considered. First, the response rate was less than optimal. Typically, mail surveys generate about a 30 percent response rate depending on the sampled population. Since all members of AAP-NJ were surveyed, the 17.7 percent response rate does generate a potential response bias. Specifically, the concern is that the more active and involved pediatricians are, the more likely they are to respond to the survey than their less involved counterparts.