Factors Determining in the Selection of Pediatrics Health Care Service in Chennai, India

Background: Parents can choose their children's healthcare center; however, the healthcare business struggles to meet the growing health demands of vulnerable groups. Pediatricians now prioritize parental interests to improve their services and healthcare. This study also determined the association of sociodemographic variables with factors influencing the parent's decision


INTRODUCTION
Evaluating patient satisfaction has become increasingly important in assessing the quality of healthcare. 1 Favorable health care outcomes, including increased treatment adherence, improved clinical results, and reduced health care utilization, are linked to a positive performance on patient experience metrics. 2 In pediatrics, it is common for health legislation and policies to require the involvement of a parent, legal guardian, or surrogate decision maker in treatment decisions when the child is below the legal age of majority, lacks the ability to make independent health decisions, or requires help in giving consent or assent. 3,4rents expect their child will receive medical care of a satisfactory standard and access the most effective treatment options in order to achieve a cure and secure a healthy future. 5It is crucial for health systems to be flexible in meeting the needs of the populations they serve, and addressing the growing health needs of children calls for a systemic approach to enhance child health and ensure accessibility to healthcare services within this population. 6The accessibility of healthcare involves a multifaceted interplay between individuals and the healthcare system, encompassing the identification of healthcare needs and their subsequent fulfillment. 7cording to previous studies, parents have expressed a desire to be involved in decisions about their child's health care in different ways and to different extents, with this desire potentially changing. 8][10] Other factors that contribute to influence include the type of illness, its acute or chronic nature, the severity of the condition, and the parents' prior experiences with health services. 10he intricacy of health-related decisions has heightened because of enhanced multidisciplinary practice and increased utilization of advanced treatment methods. 10,11e selection of a pediatrics general practice by parents for their first or subsequent visits heavily relies on their expectations of the services provided.Initially, identifying parents' expectations of a pediatrics general practice is crucial in order to deliver personalized primary care services to both children and parents. 12Currently, there is a lack of comprehensive understanding of the decision-making process employed by parents and families when seeking pediatrics healthcare.The current study seeks to fill this gap in the literature.With this background, we carried the current study to determine the factors influencing the parent's decision to choose the hospital for their children's health care.This study also determined the association of sociodemographic variables with factors influencing the parent's decision.

METHODOLOGY
A cross-sectional study was carried out for parents of children aged 0 to 13 years who sought outpatient services in paediatric department at a private tertiary care hospital in Chennai from July 2023 to October 2023.Grandparents, caregivers and relatives of the children, were excluded.

Sample size calculation and sampling method:
Based on the study by Khoo et al. at two urban pediatrics general practice centers in Malaysia by 2021, in which the mean score of doctors attempt to explain my child's problem was 4.66 ± 0.53. 12, the sample size was calculated as 133 using the formula, n=3.84* (S.D) Data collection Tool & Procedure: Data was collected by semi structured questionnaire.Questionnaire was translated into Tamil language, and content validity has been checked with expert member.Questionnaire consist of two parts, The first section of the questionnaire comprised demographic information, including parental age, gender, highest level of education, monthly household income (modified Kuppusamy Scale) 23 , occupation, as well as the age and gender of the children.
The second section of the questionnaire contained evaluations of crucial factors affecting pediatric care services.Five essential factors in the decisionmaking process, including consultations, facilities and services, fees and charges, social media engagement, and doctors' attitude was framed, and evaluated using a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).

Data analysis:
The data was entered into MS Excel and analyzed using IBM SPSS Statistics for Windows, version 20.0.Continuous variables were reported as mean and standard deviation in the descriptive statistics, while categorical variables were expressed as frequencies and percentages.Deciding factors responses was categorized into two groups (i.e.) Agreed and Disagreed, by adding agree, strongly agree and neutral groups under agreed groups.Disagree and strongly disagreed groups under disagreed groups for further application of statistical procedures.Chi-square test at 95% confidence interval was used to observe statistical significance between the categorial variables.

RESULTS
In the present study, mean age group of the study population is 29±4, among them 69% were female and 31% were male.Most of them were homemakers (51.4%) and belongs to lower class (52.7%).Majority of them completed their undergraduate degree (44.5%).Parents with children in the age group of 1-3 years (34.2%) are most frequently utilized the health care services (Table -1).
Table -2 shows, most of the participants are preferring the health care services due to less waiting time (78%), consultation privacy (77.4%), doctors listened to their complaints patiently (77.4%), polite behavior of staff (76.7%), doctors explained health information in mother tongue (71.2%), availability of doctors on public holidays (63.7%).Majority of them (80.9%) agreed that hospital has universal precautions and sterilized equipment's in paediatric OPD.Only 50% of the study participants felt that easy OP registration process, clean and comfortable waiting room, easy accessibility of the hospital, and hospital was equipped with interactive technology such as floor based virtual playground and sufficient parking area.
Table-3 reveals that when compared to male particifemale participants are interested in checking hospital updated web page, and influenced by positive reviews over social media it shows statistically significant (p-0.05& p-0.009).Most of the them in the age group of 31-40 years reported that hospital has collected reasonable treatment charges when compared to other age groups, it shows statistically significant (p-0.035).Upper middle class participants were attracted by hospital equipped with interactive technology such as floor based virtual playground and transparent billing charges when compared to other income groups, it shows statistically significant (P-0.046& p-0.04) lower middle class attracted by sufficient parking area when compared to other income groups, it shows statistically significant (p-0.012),upper class inspired by positive reviews over media when compared to other income groups, it shows statistically significant (P-0.000).

DISCUSSION
In this study, higher participants parents belong to the gender female, when compare to male, similar findings noted in the cross-sectional study Khoo et al.
at two urban pediatrics general practice centers in Malaysia by 2021, in which the study respondents comprised 66.4% of women and 33.6% were men. 12ciodemographic variables influenced the selection of a healthcare center by parents, including younger age, female gender, monthly income, and higher educational status.Parental income levels influence the choice of accessing child healthcare services, same observed by the studies conducted by Khoo et al. and Goff et al. 12,17 The findings of a study conducted by Rosati et al. in 2018 revealed that parents with a higher level of education showed a higher inclination towards participating in shared decision-making with their healthcare providers, in contrast to those with lower levels of education. 18The results our study is consistent with these findings.
To decide the pediatrics hospital, over 50% of the parents strongly agree on elements such as positive reviews about hospital over media, universal precautions followed and sterilized equipment used in the department, and patient listening of the doctor.In order to decide the paediatric hospital, over 40% of the parents strongly agree on elements such as response of doctor for the queries regarding child's health and staff's polite behavior.
A study conducted by Davis et al. in 2005, parents considered several factors when deciding the pediatric health center.These factors included short waiting time, off-hours service, walk-in clinic availability, effort made to explain the child's problem, treatment plan effectiveness, recurrence of the problem, doctors' engagement on social media, and doctors' appearance. 13A study conducted by Boutopoulou et al. in Greece examined parental satisfaction regarding their child's hospital care.They observed that the key factors contributing to parental satisfaction were the adequacy of care, effective pain management, parental involvement in care, establishment of trust, and staff attitudes. 14Wun et al. conducted a study that employed both qualitative and quantitative methods, revealing that the most significant factors in doctor selection were the proximity of the clinic's location and the fees and charges of the hospital 15 which are almost identical to this present study.
According to this study the availability of doctors even during public holidays were agreed by 32.9% of parents, it is contradicted with previous study by Samman K, et al, as there is unavailability of primary care physician in holidays hence parents prefer for clinics, it is appreciable that doctors are providing selfless services . 22 Parish O et al and Polakova K et al study there is lack of medical information provided to parents which interfere in decision making and it also negatively impact the child health, 24,25 but according to our findings doctors are always willing to provide medical information related to child health which facilitates in decision making among parents.
According to our findings, the factors that are influencing the parent's decision to choose the hospital for their children's health care are facilities and services of the hospital, fees collected as well as social media engagement.Health care providers should consider improvements in "facilities and services" to enhance their competitiveness and desirability in the present, but it is also important to prioritize fundamental elements like effective communication with healthcare professionals, provision of information, involvement in decision-making, physical comfort, emotional support, and seamless care transitions. 16mily-centered care and services are integral part to promote user involvement, as they aim to facilitate personalized health care planning for both the child and the entire family. 19As per previous report, it is vital to engage in ongoing role negotiation and maintain open communication with parents in order to provide family-centered care and services, but at present there appears to be a lack of sufficient inclusion of these elements in clinical settings. 20e decision-making process for parents regarding pediatric healthcare is not isolated, as they contemplate their options, draw from experiences, and make the most suitable choice in each specific situation. 6he association between a robust primary care system and improved population health outcomes is well-established, yet it is crucial to address the significant limitations posed by access issues faced by certain population subgroups and the practical considerations of parents. 21

LIMITATIONS
Used convenience sampling which may lead to selection bias, potentially compromising the accurate capture of different views between parents.Selfreported data on healthcare service provided by hospital providers collected at a single point in time in a private tertiary care hospital, hence generalizability can be compromised.

CONCLUSION
The factors that are influencing the parent's decision to choose the hospital for their children's health care in this study are facilities and services of the hospital, Fees collected as well as social media engagement over media.The sociodemographic variables that are influencing the parent's decision to decide such health care center are parents' age, gender, monthly income, and educational status.While parents may not can evaluate all aspects of care and treatment, their viewpoints can significantly contribute to the interpersonal dimension of care, communication, information, and care organization.Although these findings offer insights into potential approaches for reorganizing the provision of clinical service to better accommodate the needs of low-income and multiethnic populations, it is crucial to acknowledge that the design process of health care services is inherently human-focused and cannot be uniformly standardized.The present study has put forth significant findings that enhance the knowledge base for practitioners, managers, and other professionals tasked with providing paediatric general practice services.

Table 1 :
Distribution of socio-demographic characteristics of the parents (N=146)

Table 2 :
Parental ratings on choosing Paediatric Health Care Figure in the parenthesis indicate percentage.

Table - 3
Association between socio-demographic characteristics and deciding factors