Protecting the well-being of parents and children during a pandemic

Student thesis: Doctoral ThesisDoctor of Philosophy


The UK was severely affected by the COVID-19 pandemic. Over the course of three years, the disease claimed the lives of over 220,000 people in the UK. To try to control the spread of COVID-19, the UK Government implemented a range of compulsory and recommended non-pharmaceutical interventions to reduce disease transmission. Between 23 March and 1 June 2020, the guidance that was in place was commonly referred to as “lockdown” or “stay-at-home” guidance, because of the stringent restrictions. For example: non-essential shops were closed, people who could had to work from home, only leave the home to shop as infrequently as possible, and to not meet anyone from another household. If people were to go outside of their home, they were advised to keep two meters away from people from other households. One particularly controversial intervention was the closure of schools. However, schools were not fully closed. They were kept open for children who had a parent that was critical to the COVID-19 response and for children who were vulnerable. Schools closing placed a particular strain on families, as parents were required to home-school their children and there were common concerns about children’s education and about the well-being of children and parents as a result of the restrictions.

Non-pharmaceutical interventions are not only used for pandemic-related interventions. There are also everyday non-pharmaceutical interventions that are used to reduce disease transmission, one of which is a schools’ sickness policy. It is a legal requirement for schools to have a policy that guides parents, children, and school staff about the procedure to follow if a child is too ill to attend school or becomes ill at school. It is important that this guidance is adhered to, as children can be particularly susceptible to many diseases and are often in close contact with many other children. Nonetheless, it is common for children to attend school whilst they are unwell and “presenteeism,” specifically “school-based presenteeism,” has been used to describe this behaviour. Understanding school-based presenteeism is important to prevent the spread of disease and outbreaks within schools. School-based presenteeism is relatively understudied. However, previous research suggests that the reasons and risk factors for presenteeism are related to perceptions about an illness, attitudes about presenteeism, the financial consequences of staying at home when ill and organisational pressures. Exploration of the connection between presenteeism and perceptions about illness may also be important in relation to adherence to COVID-19 guidance. For about two years during the pandemic, the public were required to self-isolate immediately and seek a COVID-19 test via NHS Test and Trace if they identified any of the Government’s listed symptoms of COVID-19.

In this thesis, I investigated the factors that affect (a) the well-being of parents and children during a pandemic and (b) adherence to measures intended to mitigate the spread of disease between families, both in school and during school closures. These aims were investigated under broad objectives, relating to the factors associated with; children attending school whilst unwell; adherence to public health guidance in families; the well-being of children and parents and children’s education during a pandemic; and adherence to NHS Test and Trace guidance in families.

A combination of quantitative and qualitative study designs were used to investigate the thesis’ aims. Study A was a systematic review that was conducted on the 11 July 2022, which included 18 studies concerning factors associated with school-based presenteeism. Study B consisted of one-to-one interviews (n = 5) and two focus groups (n = 5 and n = 7) with a total of 17 parents, that took place between 26 February and 24 March 2020 and asked about parents’ attitudes about presenteeism. Study C was a qualitative study using telephone interviews with parents (n = 30) between 16 and 21 April 2020, which explored families’ experiences of lockdown and about their adherence to the COVID-19 guidance. Study D was a cross-sectional survey (n = 2,010) of a sample of parents in England (8 and 11 June 2020), which assessed the factors associated with children’s school attendance, families’ well-being and children’s non-adherent physical interactions while schools were closed to most children. Study E was a qualitative study with parents (n = 18) interviews were conducted between 30 November and 11 December 2020, which asked about families’ experiences of using and attitudes about NHS Test and Trace. Study F was a cross-sectional survey (n = 941) with UK parents that was conducted between 19 November and 18 December 2021. This final study investigated the risk factors associated with children who continued to socialise and engage in activities when they had signs and symptoms of an infectious disease.

I found that in June 2020, 26% of children and 19% of parents included in my study reported low well-being. Several factors affected the well-being of parents and children. Primarily, responses to the COVID-19 guidance, such as the reduced in-person interactions with non-household members, home-schooling, and concerns about loved ones becoming seriously ill adversely affected family well-being. Moreover, I found that children who had educational difficulties, families with limited resources or a psychological or physical health problems before the pandemic were particularly at risk of low well-being. In contrast, I found that family well-being could be protected by physical exercise, social support, and positive motivations.
I found that 15% of children had non-household family interactions in June 2020, in contravention of Government guidance and that, when schools had re-opened, 33% of children attended school, engaged in other activities, or socialised with others when they had symptoms of an infectious disease that should have led them to remain at home. Across multiple studies, I found several risk factors linked with families’ adherence to public health guidance in general, which included national COVID-19 guidance and schools’ sickness policies. These factors included perceptions about the illness; communications about the guidance; and contextual factors, such as financial resources, organisation pressures, social networks, low well-being in children and parents and having special educational needs.

Overall, I found surprisingly high numbers of families who reported low well-being and who were non-adherent to the guidance that was in place to prevent disease transmission. I found that adherence was associated with themes about the clarity of the guidance, perceptions about COVID-19, a family’s motivation and attitudes about adherence and other environmental factors that may prevent or encourage adherence. These themes are also relevant to adherence to polices that are used to prevent disease outbreaks in schools outside of a pandemic. Notably, children with special educational needs, families that had fewer resources and parents or children with health problems were at an increased risk of (a) having low family well-being and (b) non-adherence to health guidance. Families that engaged in physical activity, stayed connected with family and friends and had positive motivations were better able to cope with the pandemic. Policymakers need to consider these factors when designing and implementing public health guidance to protect families’ well-being and improve adherence to local and national health guidance.

Date of Award1 Dec 2023
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorJames Rubin (Supervisor), Richard Amlot (Supervisor) & Rebecca K Webster (Supervisor)

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