Understanding the Impact of Public Health Advice on Paediatric Healthcare Use During COVID-19: A Cross-sectional Survey of Parents

Background: Hospital avoidance during the COVID-19 pandemic has been reported with a significant decrease in attendance at emergency departments among paediatric populations with potential increased morbidity and mortality outcomes. The present study sought to understand parents’ experiences of healthcare during the initial public health stages of the COVID-19 pandemic. Methods: A cross-sectional survey of parents of children under the age of 16 (N = 1044). The survey collected demographic information to profile parents and children, capture relevant health information such as pre-existing conditions and/or chronic illness or disability, and health service usage during the pandemic. Descriptive statistics, chi-square tests and regression analyses were used to determine the factors that influenced avoidance and hesitancy. Results: 23% of parents stated that they were much more hesitant to access health services upon implementation of the initial public health restrictions. Parents with a higher perception of risk of their children contracting COVID-19 ( χ2 (3) =33.8618, p < 0.000), and stronger levels of concern regarding the effects of COVID-19 ( χ2 (3) =23.9189, p < 0.000) were more likely to be hesitant. Stress also appeared to be a factor in hesitancy with higher than normal stress levels significantly associated with hesitancy (RRR= 2.31, CI: 1.54 - 3.47), while those with severe/extremely severe stress were over three times more likely to be hesitant (RRR:3.37, CI:1.81 - 6.27). Approximately one third of the sample required healthcare for their children during the public health restrictions to delay the spread of COVID-19, however, one in five of these parents avoided accessing such healthcare when needed. Of those that required healthcare, parents who avoided were more likely to report that the services were needed more by others ( χ2 (1) 20.3470, p <0.000). Those who felt that the government advice was to stay away from health services were 1.7 times more likely to be much more hesitant (RRR:1.71, CI; 1.10 – 2.67). Conclusion The misinterpretation of government public health advice, stress and the perception of risk each contributed to parental avoidance of or hesitancy to utilize healthcare services during the public health measures imposed to combat COVID-19.