Theme: parents’ health-seeking behaviour
Efforts to maintain children’s health
Vaccination, providing healthy food and dietary supplements, maintaining hygiene, maintaining physical activity at all times, and obtaining sufficient rest are methods used by parents in this study to keep their children healthy.
“The first, er, most basic thing, is a vaccination.” (P02, female, 36).
“The first thing is, of course, a balanced diet, making sure to get the right nutrients, maintaining hygiene… then… um, consider incorporating physical activity for children, then… take care of psychological well-being.” (P03, female, 33).
Looking for trustworthy health information
Parents acknowledged that digital media, especially the internet and its social media platform, were the most accessible source of information related to children’s health, while other mass media, such as television and print media, were rarely used. However, parents evaluate the collected information across the platform, compare it with their own experiences and the experiences of their children and relatives, and only absorb the information necessary for the child’s situation. Information from an expert, on the other hand, such as a licensed health practitioner or paediatrician, was considered the most trustworthy.
“From the internet, from Google, and websites.” (P06, female, 33).
“If it’s from… the hospital, I take it, but sometimes… from the internet, I still compare.” (P08, male, 39).
Parents’ role during children’s illness
Parents with higher levels of education in this study were more likely to give their children over-the-counter medicines, such as paracetamol, at the onset of mild illnesses before seeking medical care when symptoms progressed. In contrast, parents with lower levels of education were more likely to take their children to a health facility immediately.
“At first, we took her temperature and gave her medicine at home, as we always do. After a few days, when her condition was still the same, we took her to the hospital.” (P08, male, 39).
“The fever was at night… I was confused anyway, madam. I took her to the 24-hour clinic.” (P11, female, 31).
Male participants in this study admitted that their child’s mother played a greater role while their child was ill.
“I forget the details because her mother was still there at that time, so she took all the care of her.” (P04, male, 50).
Preference for medical facility
While other parents with middle- and higher-income levels had no preference for using public and private health facilities, P07 (female, 41) had a specific preference for a particular healthcare facility and thus only went to one private hospital strategically positioned downtown.
“When I go to the doctor, I try to use the same health facility to ensure continuity of care. The medical record could be a useful resource in case of emergencies.”(P07, female, 41).
Low-income parents still choose to take their sick children to their preferred health facility, even if they have to pay, while they can get free treatment at the community health centre.
“If I have money, I take her straight to a private doctor’s practice; otherwise, I go to the community health centre. I actually dislike going to the community health centre the most.The people who give treatment are chaotic. The people who examine her… they’re assistants.Apart from the doctor, there are assistants. If it’s in a private doctor’s practice, it’s directly with the doctor.” (P11, female, 31).
Theme: parents’ knowledge
Parents’ knowledge of pneumonia and pneumonia diagnosis
We asked the parents what they knew about the terminology “pneumonia,” the most common LRTI, and how a doctor can diagnose it. According to our key informants, neither the school nor the community health centre ever provided educational sessions for parents in school on the topic of pneumonia.
As doctors, P01 and P02 have the most comprehensive knowledge about pneumonia, its etiology, and how to diagnose it. P06 and P07 described it as a disease in the lung, with fever and cough as symptoms. P09 mentioned that the cough is perhaps chronic. P03 stated that the etiology of pneumonia is an infection, and P08 mentioned that the disease is related to lifestyle. Other parents could not elaborate on the term.
“Um, technically, I don’t know.” (P04, male, 50).
“I don’t really know.” (P05, male, 37).
P04 could not explain how to diagnose pneumonia, and P09 mentioned spirometry as a tool to diagnose pneumonia; other parents (P03, P05, P06, P07) managed, on their terms, to conclude that doctors have to do a thorough review of medical history, perform a physical examination, and order a diagnostic test as for other diseases. For P08, he believed a chest X-ray was more reliable than a blood test. Microbiology procedures were mentioned by P01, P02, P07, and P08.
Theme: parents’ previous experience
Parents’ response to children’s previous illness
Fever, cough, and runny nose were common illnesses mentioned by the parents, and four parents had experienced children suffering because of LRTI: bronchopneumonia (P08), pneumonia (P02), and tuberculosis (P05, P09).
In addition to COVID-19, other health conditions that cause parental concern are dengue fever, typhoid fever, acute hepatitis, hand-mouth-foot disease, severe upper respiratory tract infection, febrile seizures, chronic disease, breathing difficulty, and digestive problems. For P09, he considered all diseases dangerous.
“For me, all diseases are dangerous. The important thing is to take appropriate action. Act quickly. Do not underestimate it. Cough, but if it is not healed, maybe blood comes out or something, that will be, so…, so…, um, that is also a scourge for parents. For me, all illnesses are dangerous.” (P09, male, 37).
All parents were sad and concerned when their children were unwell, especially when they had to be hospitalised.
“That’s sad, Doc, sad, I’ve never had any experience of hospitalisation like that. So I was worried too, Doc, at the time. Worried and also very sad.” (P03, female, 33).
Parents’ responses to informed consent in medical procedures
None of the parents refused the proposed medical treatment during informed consent process. P04 and P13 believed that informed consent was required only for major medical procedures.
“Well, as far as I know, informed consent is only for critical things.I don’t think I’ve ever signed for an intravenous drip.Ha ha [laugh].” (P04, male, 50).
Parents’ responses to informed consent in medical procedures were varied. Unlike P06, who tended to sign it without asking for more information during her child’s ankyloglossia surgery, other parents took longer to decide; P07 even sometimes sought a second opinion.
“I was in a hospital room at the time, and I was a bit panicked, so yeah, I obeyed the doctor and then signed it. Actually, after I left the room and started to search, I felt that something was a bit wrong, but it had already happened.” (P06, female, 33).
“Sometimes, for example, I will still seek a second opinion if it can still be postponed. Maybe I will still be in the hospital, but I will contact another doctor, or I will ask what I should do if the situation is like this with this condition.”(P07, female, 41).
However, parents suggested that although doctors sometimes did not provide an elaborate explanation, every patient should use the time given prudently to read the information sheet thoroughly and ask for more information if necessary before signing and thus giving consent.
Experience related to medical procedures in healthcare facilities
Most parents had good experiences while their children were getting treatment from the healthcare provider; P09 often requested the doctor who treated his son to do a blood test for his reassurance.
“Even though the doctor may not recommend it, I asked, ‘Doc, um, can you order a lab test? That’s part of, um, my mitigation to make sure my child doesn’t have typhoid, or dengue haemorrhagic fever, or any disease that can be checked from the blood.” (P09, male, 37).
At a younger age, children’s response to medical procedures was crying. P01’s child cried hysterically because of nasopharyngeal swab procedures for COVID-19 diagnosis. Older children, such as children of P02, P04, and P09, participated reasonably throughout the same process, although admited that it was initially unpleasant. Although somewhat concerned, the parents stated that the nasopharyngeal and oropharyngeal swab was mandatory to get an accurate diagnosis of COVID-19, so they were willing to let their children have it.
“It was because of COVID, Doc. We wanted to know if this child could be isolated with his father or sent to another home, so we needed to know if she was positive or not, so whether we like it or not, we had to do it.” (P01, female, 33).