Table 1 Categories with Underlying Concepts, Definitions, and cited examples from the interview transcripts

Focus on the child even when feeling unwell

Focus on the child even when feeling unwell

Taking care of and focusing on the child even when in subjective symptoms

When I get a case of hives, I realize that it must be due to stress or fatigue, so I try to lie down as much as possible, when I can manage. I made an effort to get some rest, but when they’re little, they suddenly start crying because they want to be breastfed. It’s just not possible to have a proper rest. The baby always cries in the middle of the night. So after all that I don’t manage to get any rest, which causes my itching to flare up again. (S2)

Hesitation in visiting a doctor

Reluctance to visit doctor with child

Increased reluctance to visit doctor due to mental and physical burden of visiting with child

When you’re not feeling well, you don’t want to take (your child) with you to the doctor. My children are very active, after all. If it’s just one child, then it probably wouldn’t be so bad. But if it’s all three children, well, it’s a hospital, so it’s not very hygienic. So I’m reluctant to take my children with me to see the doctor. I wouldn’t want them to get sick, so if I can avoid it, I’d rather not take them with me. (W5)

Hesitation to take medication while pregnant/breastfeeding

Hesitation to take medication while pregnant or breastfeeding even when in subjective symptoms due to concern that drug would be transmitted to baby via breastmilk

I used to get migraines, so I would go to the doctor and get some medication, but when you’re nursing, you can’t take medication. If you take medication, it will pass through your breast milk, so you just have to tolerate the pain. (S2)

Innate dislike of medication

Just dislike taking medication, even when in subjective symptoms

When (my headache) was really bad, I would take one tablet. Otherwise, if I think I can put up with the pain, then most of the time I just put up with it. I just refrain from taking medication. I don’t really like taking medication in the first place. I’m not a person who uses medication much. That’s why. (W10)

Reluctance to pay medical costs

Reluctance to pay medical costs for own treatment

When I was sick (with suspected sinusitis), I spent so much money going to the hospital because my family went so often. So I would try to endure because I didn’t have any money, and it would eventually heal on its own. (Omitted) At the time, I was working and I also had kids. But the main reason was because I had already spent my money on past hospital visits. Some months I would go to the hospital very often. My husband also went, so we decided to try and go without. (W8)

Reluctance to spend time visiting doctor

Time required to visit the doctor, including time spent visiting the hospital, waiting to see the doctor, and undergoing medical examinations, mean that mothers are reluctant in terms of physical hardship, considerable time spent looking after their child while at the hospital, and concern for their child while being looked after by others

(Reason for not visiting the doctor despite having migraines) First of all, going to the hospital costs money, and it also takes time. (W10)

Not wanting the hassle of searching for a hospital

Having no family doctor or regular hospital, bothersome to search for a hospital while in subjective symptoms

I still don’t have a primary care physician. Even before I became pregnant, I was generally healthy and didn’t visit the hospital much. Because I didn’t have a primary care physician, it was a hassle to try and find one...I think that’s why. (S4)

Support difficult to use

Hesitation even to ask relatives

Hesitation to ask relatives such as mothers or husbands to look after their child or do housework in order to rest or visit the doctor, not wanting to impose, avoiding the physical effort required to make the trip, having concerns about the child’s reaction to being left with relatives

Even going back home (to my parent’s house) is tiring because we have to take the train, and wouldn’t even think of driving. (W1)

Burden of using temporary childcare

Using temporary childcare when in subjective symptoms brings physical burden of getting ready and traveling to the care facility, concern about the child’s condition and risk of infection while in care, mental burden of a lack of understanding on how to use the service, and financial burden of the cost of care

Even when I see a pamphlet for day care, I’m just not sure, (Omitted) So eventually I just give up on the day of using a day care service. It’s just not that easy to take my child there. (Omitted) Even if I used such a service, I don’t know the people there...so I don’t feel that it’s a type of support that I could use without any concerns. (W3)

Housework even when feeling unwell

Housework even when feeling unwell

Performing housework even when feeling unwell

Yes, I do (housework even when in poor health). It basically makes no difference. Whether I’m sick or not, I still have to do it. (Omitted) When the norovirus was going around, I felt sick and quite nauseated, and I had to do all of the housework and disinfect everything. I was really exhausted. I was working while dry heaving. Then I vomited all over everything. All over the sheets and bedclothes. It took me so long to wash everything. (Omitted) I even made dinner wearing a surgical mask and gloves. (W11)

Working even when feeling unwell

Working even when feeling unwell

Difficulty or inability to take time off work to rest or visit the doctor due to having work that precludes resting, using paid leave for their child, saving paid leave for future occasions, not wanting to worry about what colleagues think of them, not wanting a reduction in salary, not wanting to be rebuked for neglecting own health

(When my skin felt like I had a burn) I still had things to do as well as plenty of work at my workplace, so I honestly didn’t want to upset all that by taking annual leave to visit (the hospital). I don’t do that, and I also knew that it would be an imposition on others. (W6)

No time to spend on myself

No time to spend on myself

Hesitation to devote time outside of work for working mothers to visiting the doctor or resting because hands are full with housework, taking care of children, finding time with the family

As soon as I finish work, I have to leave immediately to make sure that I can pick up my children by 7 p.m. After that, it’s already 7 p.m. and I want them to go to bed by 9 p.m., so once I feed and bathe them, there’s no time left. That’s why I don’t have time to do anything for myself. So I just do what I can to get the children to sleep. (Omitted) Then I do the housework, look after my husband, and prepare for the next day. Then the next morning comes and the battle starts all over again. (W7)

Putting my own needs on hold

Putting my own needs on hold

Prioritizing child care and housework and/or work, putting own needs on hold, despite wanting to rest or visit the doctor

I frequently visit (the hospital) for my child but not for myself. I really haven’t been to the hospital for a personal matter. I’m always down the list in terms of priorities. I’m an adult so I can endure. (S5)

Coping on my own as much as possible

Making an effort to rest

Attempting to rest and relieve symptoms as much as possible while child is sleeping or playing, or while someone is helping with housework or taking care of the child

I just try to get better by sleeping as much as possible. (Omitted) So at times like that when I’m exhausted, I just give my child some bread, and then I would just collapse. My child walks around eating bread and is covered in bread crumbs. She spills her tea as well. And I feel that I should clean it up, but I just can’t move, so on days like that I just leave the place in a mess. Then, if I just do nothing for a day, I usually feel better, then I can get some sleep. (S8)

Coping in my own way

Attempting to deal with symptoms in a variety of unique ways, such as massage or nutrition, not relying on rest or medication

I drink ginger tea every day, so when I’m starting to (catch a cold), I increase the amount of ginger. I put on a surgical mask and lie down. That’s what I do at first. (W9)

Misuse of prescription medication

Using previously-prescribed medication they have at home based on own judgment

I take my child to the hospital when she has a fever, and I would also take some of the cough medicine that was prescribed for my child (laughs). My child’s medicine. I thought if it was ok for children, then it would be fine for me. I heard that it works, so I thought I’d try some before I got sick. The cough syrup (laughs). But it really doesn’t work on adults. Herbal medicine also. Because prescription medication is expensive for adults. So I would use the medication that I received while pregnant. (S1)

Taking over-the-counter medication first

Using over-the-counter medications as a quick solution to alleviate symptoms rather than visiting the doctor and receiving prescription medication

When I think I have caught a cold, I want to go (to the hospital), but then I think about how I don’t want my child to get it, so I take over-the-counter (OTC) medication and try to put up with it. Yes. Going to the hospital (with my child) would be an unnecessary bother if he got a cold as well, so I decided to take OTC medication. (S6)

Discontinuing treatment on my own

Deciding to stop visiting the hospital or taking medication even when ongoing treatment is required

When I was pregnant, I went and saw a dentist. The doctor recommended me to treatment a tooth, but I didn’t do. I didn’t go there. I feel no problem, no problem. I have a carious tooth, but have not had a toothache so much yet. So, I finally decided not to go there. Once I was free from pain after having a tooth hurts a little bit, I felt it was still ok. And then, I had medicine. I didn’t have a toothache so much. (S7)

Visiting the doctor with terrible symptoms

Visiting the doctor with terrible symptoms

Visiting the doctor when illness is so terrible that they cannot cope on their own and feel very ill, such as when symptoms worsen or persist, when feeling anxious, when needing some form of urgent medical treatment, etc.

I only visit the doctor when I’m very ill with a bad fever that just won’t go down and I have trouble breathing from coughing so much that I almost get pneumonia. (W4)

Visiting the doctor early

Visiting the doctor early

Visiting the doctor early when mothers think they would pass on their illness to other family members or that their symptoms would worsen

I thought about visiting the doctor in the morning before my fever got worse. It was influenza season, so I thought that if I got sick, then all of children would get it too, so I suppose I just went to the doctor to get examined. (S8)

Visiting the doctor while accompanying a family member

V Visiting the doctor while accompanying a family member

Consulting the doctor when accompanying child or family member, regardless of the extent of own symptoms

When my kids go to the dentist, I go with them and get a checkup and treatment at the same time. (W1)

Predicting the cause, course, and treatment

Predicting the cause, course, and treatment

Before visiting the doctor, predicting the cause and course of their symptoms, examination results, doctor’s explanation of their condition, and their treatment regimen based on their own knowledge, experience, and information.

My most recent visit to the hospital was when I had influenza. Everyone in the family got sick one after the other and we knew it was the flu, so I went to the doctor to get Tamiflu. (W2)

Searching the Internet for starters

Gathering information on the cause of their symptoms, methods for coping, hospitals, etc., via the Internet

(When I had mastitis) I checked the Internet and it said that some doctors prescribe herbal medication containing arrowroot, so I just decided to take arrowroot. That worked, so I thought that’s all I have to do to fix it. (W11)

Searching for information in books

Gathering information on how to cope with their symptoms from books

When I got a mild case (vaginal candidiasis), I treated it myself once. I had the medication. Because my husband is a dermatologist. There’s that medication. So I read a book that said there was medication you could apply to the mucosa, so I used that and it got better. (S3)

Referring to the opinions of others

Discussing their physical condition with someone, draw on that person’s experiences and opinions

I had this constant pain in my stomach that just persisted for so long, and I was unable to eat because of the pain. Then I happened to bump into a childhood friend who was a nurse. (Omitted) She gave me advice and I had never had (a test), so she recommended that I just undergo the test once to put my mind at ease. So that was recommended by a friend. If it was just me, I probably wouldn’t have gone to get tested, but when a friend recommends it, I feel that I might as well go (to the hospital) once, and that was what motivated me to go. (S9)

Not gathering information when able to make a prediction

Failing to gather any information when capable of making their own decisions on the cause of their symptoms and ways to cope

I don’t particularly look up any information about my own health. When I contracted norovirus, it was obvious that I had the virus. With a cold, I usually get it from my kids, so I know it’s a cold. (S4)

Use of support

Resting or visiting the doctor with help from relatives

Being able to rest and visit the doctor when in subjective symptoms because a family member takes care of their child, accompanies them to the clinic/hospital, or helps with the housework

When I go to the hospital, I usually have a high fever and can’t drive, so (my husband) takes time off work, or on some occasions, it happened to be a holiday, thankfully, all six times that I got sick. (S10)

Resting or visiting the doctor while the child was in day care

Mothers who take their child to day care can rest or visit the doctor while their child is under care

Yes, if I visit the doctor, it will be while my kids are at day care. (W9)

Managing the situation with the help of a friend

Managing to cope by resting, visiting the doctor, doing housework while a friend does the shopping or takes care of their child

(When my body felt heavy) my friend took care of the first child with playing in the pool at her house. I am really thankful for her who told me to lie down. (Omitted) If I didn’t lie down yesterday, I would not have made dinner. (S5)