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Fitzgerald HN, Sevi B, Shook NJ. Fraudulent health claims: Further consideration of the role of emotions. Soc Sci Med 2020; 259:112979. [PMID: 32345448 DOI: 10.1016/j.socscimed.2020.112979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/28/2020] [Accepted: 04/06/2020] [Indexed: 01/25/2023]
Abstract
In order to combat fraudulent health claims, MacFarlane, Hurlstone, and Ecker (2020) have proposed a taxonomy intended to establish factors that increase susceptibility to such messages. We expand upon the work of MacFarlane and colleagues by highlighting the role of emotions in attitude change, and elaborate upon how emotions may increase susceptibility to fraudulent health messaging. We assert that to produce lasting and persistent attitude change, emotion needs to be incorporated into health care fraud interventions, as well as factual information. We concur with MacFarlane and colleagues that fraudulent health claims are a pressing issue with deleterious consequences, and supplement their work by enumerating the importance of emotion in promoting attitude and behavior change.
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252
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Gagneur A. Motivational interviewing: A powerful tool to address vaccine hesitancy. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2020; 46:93-97. [PMID: 32281992 PMCID: PMC7145430 DOI: 10.14745/ccdr.v46i04a06] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
According to the World Health Organization, vaccine hesitancy is among the top threats to global health and few effective strategies address this growing problem. In Canada, approximatively 20% of parents/caregivers are concerned about their children receiving vaccines. Trying to convince them by simply providing the facts about vaccination may backfire and make parents/caregivers even more hesitant. In this context, how can health care providers overcome the challenge of parental decision-making needs regarding vaccination of their children? Motivational interviewing aims to support decision making by eliciting and strengthening a person's motivation to change their behaviour based on their own arguments for change. This approach is based on three main components: the spirit to cultivate a culture of partnership and compassion; the processes to foster engagement in the relationship and focus the discussion on the target of change; and the skills that enable health care providers to understand and address the parent/caregiver's real concerns. With regard to immunization, the motivational interviewing approach aims to inform parents/caregivers about vaccinations, according to their specific needs and their individual level of knowledge, with respectful acceptance of their beliefs. The use of motivational interviewing calls for a respectful and empathetic discussion of vaccination and helps to build a strong relationship. Numerous studies in Canada, including multicentre randomized controlled trials, have proven the effectiveness of the motivational interviewing approach. Since 2018, the PromoVac strategy, an educational intervention based on the motivational interviewing approach, has been implemented as a new practice of care in maternity wards across the province of Quebec through the Entretien Motivationnel en Maternité pour l'Immunisation des Enfants (EMMIE) program.
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Affiliation(s)
- Arnaud Gagneur
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC
- Correspondence:
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253
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Bocquier A, Cortaredona S, Fressard L, Galtier F, Verger P. Seasonal influenza vaccination among people with diabetes: influence of patients' characteristics and healthcare use on behavioral changes. Hum Vaccin Immunother 2020; 16:2565-2572. [PMID: 32209014 PMCID: PMC7644174 DOI: 10.1080/21645515.2020.1729628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Annual seasonal influenza vaccination (SIV) is recommended for people with diabetes, but vaccine coverage remains low. We estimated the probabilities of stopping or starting SIV, their correlates, and the expected time spent in the vaccinated state over 10 seasons for different patient profiles. We set up a retrospective cohort study of patients with diabetes in 2006 (n = 16,026), identified in a representative sample of beneficiaries of the French National Health Insurance Fund. We followed them up over 10 seasons (2005/06–2015/16). We used a Markov model to estimate transition probabilities and a proportional hazards model to study covariates. Between two consecutive seasons, the probabilities of starting (0.17) or stopping (0.09) SIV were lower than those of remaining vaccinated (0.91) or unvaccinated (0.83). Men, older patients, those with type 1 diabetes, treated diabetes or more comorbidities, frequent contacts with doctors, and with any hospital stay for diabetes or influenza during the last year were more likely to start and/or less likely to stop SIV. The mean expected number of seasons with SIV uptake over 10 seasons (range: 2.6–7.9) was lowest for women <65 years with untreated diabetes and highest for men ≥65 years with type 1 diabetes. Contacts with doctors and some clinical events may play a key role in SIV adoption. Healthcare workers have a crucial role in reducing missed opportunities for SIV. The existence of empirical patient profiles with different patterns of SIV uptake should encourage their use of tailored educational approaches about SIV to address patients’ vaccine hesitancy.
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Affiliation(s)
- A Bocquier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME , Marseille, France.,IHU-Méditerranée Infection , Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille, France
| | - S Cortaredona
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME , Marseille, France.,IHU-Méditerranée Infection , Marseille, France
| | - L Fressard
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME , Marseille, France.,IHU-Méditerranée Infection , Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille, France
| | - F Galtier
- INSERM, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu , Paris, France.,CIC 1411, CHU Montpellier, Hôpital Saint Eloi , Montpellier, France
| | - P Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME , Marseille, France.,IHU-Méditerranée Infection , Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille, France.,INSERM, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu , Paris, France
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254
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Siciliani L, Wild C, McKee M, Kringos D, Barry MM, Barros PP, De Maeseneer J, Murauskiene L, Ricciardi W. Strengthening vaccination programmes and health systems in the European Union: A framework for action. Health Policy 2020; 124:511-518. [PMID: 32276852 DOI: 10.1016/j.healthpol.2020.02.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
Vaccination is one of the most cost-effective public health interventions. However, the EU is facing increasing outbreaks of vaccine preventable diseases, with some fatal cases of measles. This paper reviews the main factors influencing vaccination uptake, and assesses measures expected to improve vaccination coverage. Obstacles to vaccination include concerns about vaccine safety and side effects, lack of trust, social norms, exposure to rumours and myths, and access barriers. Responses fall into three broad categories. Regulation, including the introduction of mandatory vaccination, can be justified but it is important to be sure that it is an appropriate solution to the existing problem and does not risk unintended consequences. Facilitation involves ensuring that there is an effective vaccination programme, comprehensive in nature, and reducing the many barriers, in terms of cost, distance, and time, to achieving high levels of uptake, especially for marginalised or vulnerable populations. Information is crucial, but whether in the form of public information campaigns or interactions between health workers and target populations, must be designed very carefully to avoid the risk of backfire. There is no universal solution to achieving high levels of vaccine uptake but rather a range or combinations of options. The choice of which to adopt in each country will depend on a detailed understanding of the problem, including which groups are most affected.
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Affiliation(s)
- Luigi Siciliani
- Department of Economics and Related Studies, University of York, YO10 5DD, York, UK.
| | - Claudia Wild
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090 Vienna, Austria
| | - Martin McKee
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Dionne Kringos
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Margaret M Barry
- WHO Collaborating Centre for Health Promotion Research, National University of Ireland Galway, Galway, Ireland
| | | | - Jan De Maeseneer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Liubove Murauskiene
- Public Health Division, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Walter Ricciardi
- Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
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255
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Habersaat KB, Jackson C. Understanding vaccine acceptance and demand-and ways to increase them. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:32-39. [PMID: 31802154 PMCID: PMC6925076 DOI: 10.1007/s00103-019-03063-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Vaccination saves millions of lives, and the World Health Organization (WHO) European Region celebrated record high coverage in 2018. Still, national or sub-national coverage is insufficient to stop the spread of vaccine-preventable diseases. Health authorities are increasingly aware of the need to prioritize the “demand” side of vaccination. Achieving high and equitable vaccination uptake in all population groups is not a quick-fix; it requires long-term investment in multifaceted interventions, informed by research with the target groups. The WHO focuses on both individual and context determinants of vaccination behaviours. Individual determinants include risk perceptions, (dis)trust and perceived constraints; insights from psychology help us understand these. Context determinants include social norms, socioeconomic status and education level, and the way health systems are designed, operate and are financed. The WHO recommends using a proven theoretical model to understand vaccination behaviours and has adapted the “COM‑B model” for their Tailoring Immunization Programmes (TIP) approach. This adapted model is described in the article. Informed by insights into the factors affecting vaccination behaviours, interventions and policies can be planned to increase vaccination uptake. Some evidence exists on proven methods to do this. At the individual level, some interventions have been seen to increase vaccination uptake, and experimental studies have assessed how certain messages or actions affect vaccination perceptions. At the context level, there is more documentation for effective strategies, including those that focus on making vaccination the easy, convenient and default behaviour and that focus on the interaction between caregivers and health workers.
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Affiliation(s)
- Katrine Bach Habersaat
- World Health Organization Regional Office for Europe, Marmorvej 51, 2100, Copenhagen, Denmark.
| | - Cath Jackson
- World Health Organization Regional Office for Europe, Marmorvej 51, 2100, Copenhagen, Denmark.,Valid Research Limited, Wetherby, UK
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256
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Den Daas C, Adam PCG, Vermey K, Zuilhof W, de Wit JBF. Factors associated with self-reported hepatitis B virus vaccination status among men who have sex with men in the Netherlands. Sex Health 2020; 17:444-452. [PMID: 33176905 DOI: 10.1071/sh20082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/28/2020] [Indexed: 11/23/2022]
Abstract
Background Reducing the number of new acute hepatitis B virus (HBV) infections to zero by 2022 is an important goal in the Netherlands. Free HBV vaccination is available for population groups at higher risk of infection, including men who have sex with men (MSM). Identifying correlates of HBV vaccination among MSM can guide the development of health promotion interventions to increase coverage of HBV vaccination. METHODS We assessed factors associated with the HBV vaccination status of 4270 MSM in the Netherlands. Data were collected through the 2018 online Men & Sexuality survey. RESULTS Multinomial regression analysis showed that lower education level, having never tested for HIV, not recently diagnosed with a sexually transmissible infection, recently having had sex abroad and unknown HBV testing status were associated with higher odds of being unvaccinated as opposed to fully vaccinated. Living in Amsterdam and testing HBV negative were associated with lower odds of being unvaccinated as opposed to fully vaccinated. Age (25-39 years vs younger ages), living in Amsterdam and using pre-exposure prophylaxis decreased the odds to be partly vaccinated as opposed to fully vaccinated; having a migration background increased these odds. CONCLUSIONS HBV vaccination rates among MSM will not reduce HBV transmission to zero. HBV promotion should focus on MSM outside of Amsterdam who are likely less connected with sexual health services and may be at lower (perceived) risk. The factors identified related to HBV vaccination status provide guidance for health promotion interventions to increase uptake and vaccination completion among MSM.
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Affiliation(s)
- C Den Daas
- Health Psychology Group, University of Aberdeen Institute of Applied Health Sciences, Foresterhill, Aberdeen, AB25 2ZD, Scotland; and Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands; and Interdisciplinary Social Science, Utrecht University, PO Box 80140, 3508 TC, Utrecht, the Netherlands; and Corresponding author.
| | - P C G Adam
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW 2052, Australia; and Institute for Prevention and Social Research (IPSR), Minrebroederstraat 7a, 3512 GS, Utrecht, the Netherlands
| | - K Vermey
- STI Aids Netherlands, Condensatorweg 54, 1014 AX, Amsterdam, the Netherlands
| | - W Zuilhof
- STI Aids Netherlands, Condensatorweg 54, 1014 AX, Amsterdam, the Netherlands
| | - J B F de Wit
- Interdisciplinary Social Science, Utrecht University, PO Box 80140, 3508 TC, Utrecht, the Netherlands; and Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW 2052, Australia; and Institute for Prevention and Social Research (IPSR), Minrebroederstraat 7a, 3512 GS, Utrecht, the Netherlands
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257
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Getting Involved with Vaccination. Swiss Student Teachers’ Reactions to a Public Vaccination Debate. SUSTAINABILITY 2019. [DOI: 10.3390/su11236644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vaccination is an explicit topic of the United Nations’ 2030 Agenda for Sustainable Development. The present article explores a new way of involving student teachers into the vaccination debate. To this aim, 273 students at a Swiss university for teacher education were invited to read a debate between a vaccination proponent and a vaccination opponent that had been published in a free local newspaper. Then, they were asked to judge five of the main arguments of each discussant and to take a (hypothetical) general decision in favor or against vaccination. This decision, the judgements, and students’ comments were investigated with a mixed method approach in order to better understand the students’ needs and to refine the new approach. It was found that the students eagerly took part in the intervention, but that they were very ambivalent concerning the arguments. They could be classified into three groups. Two groups, called the acceptors and the rejectors, supported the proponent and the opponent, respectively, and decided accordingly in favor or against vaccination. However, there remained a considerably large group that was called the hesitators. They were particularly ambivalent towards both types of argumentation, but, as structural equation modelling revealed, they eventually were more influenced by the arguments in favor than by those against vaccination. In their comments, these students wanted to know more about the prevented diseases, and they often referred to their personal experience but not to the experts’ arguments. It was concluded that this group would benefit most from the new type of intervention. A shared-decision approach, as is today prominently discussed in medicine, could improve its impact, and ways should be found to more seriously and consistently include empathetic understanding in pedagogical settings—for example, by adapting the three-step model from medicine or the reflective equilibrium approach from applied ethics.
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258
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Effects of California Assembly Bill 2109 in Low Vaccination Rate Counties: Are We Looking at the Right Variables? JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 24:e25-e32. [PMID: 28383344 DOI: 10.1097/phh.0000000000000560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES California Assembly Bill 2109 (AB2109) was passed in 2012 and restricted the obtainment of personal belief exemptions (PBEs) for vaccination requirements for school-aged children. This study examined changes in up-to-date (UTD) vaccination rates, PBEs, and conditionally accepted students (CASs) at 3 time points. The study also examined the association of PBEs and CASs on county and school immunization rates. DESIGN This study utilized 6 academic years of immunization data from all kindergartens in California from 2010-2011 to 2015-2016. The years were selected to include data 2 years prior to the introduction of the bill, 2 years prior to implementation, and 2 years after the new legislation went into effect in 2014. Data were analyzed for changes in variables over time at the state, county, and school levels. A Pearson correlation was performed to assess the association between CAS, PBE, and not-UTD rates in low- and high-UTD counties. RESULTS Counties with the highest percentage of unimmunized students have significantly higher mean CAS rates than PBE rates (P < .01 for all years). CASs were found to be more highly correlated with students not-UTD with immunizations than PBEs in all years studied (P < .01 for all years) and with far greater effect size in low-UTD counties (<90% UTD rate). There was a small rise in PBEs and a small reduction in UTD rates after AB2109 was signed but a fall in PBE and CAS rates and a rise in UTD rates postimplementation. CONCLUSION Many California counties have high levels of CASs at the time of kindergarten entry. The extent to which schools require CASs to complete required vaccinations is not known, which could contribute to the pool of undervaccinated students in California. Public health officials should be vigilant to ensure that schools follow up and enforce the completion of vaccines for conditionally admitted students. This study has policy implications due to the fact that it has been revealed that there is a large undervaccinated population remaining relatively unaccounted for in California despite recent efforts.
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259
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Verger P, Fressard L, Cortaredona S, Lévy-Bruhl D, Loulergue P, Galtier F, Bocquier A. Trends in seasonal influenza vaccine coverage of target groups in France, 2006/07 to 2015/16: Impact of recommendations and 2009 influenza A(H1N1) pandemic. ACTA ACUST UNITED AC 2019; 23. [PMID: 30514414 PMCID: PMC6280418 DOI: 10.2807/1560-7917.es.2018.23.48.1700801] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background and aimsSeasonal influenza vaccination (SIV) uptake (SIVU) rates in France are below target. We (i) describe trends in French SIVU over 10 consecutive seasons among different target groups and (ii) examine the effects of the 2009 influenza A(H1N1) pandemic and the publication of new SIV recommendations in 2011 and 2013.MethodsOur study was based on records of vaccines delivered in community pharmacies for a permanent, representative sample of 805,000 beneficiaries of the French National Health Insurance Fund. For the first objective, we analysed SIVU rate trends among ≥ 65 year olds as well as among < 65 year olds with each of the following conditions: diabetes, respiratory, cardiovascular, neuromuscular, or chronic liver disease. For the second goal, we computed segmented log-binomial regression analyses.ResultsAfter the 2009 pandemic, except for the target group with liver diseases, where the difference was not statistically significant, SIVU fell significantly in all groups during the 2010/11 season, remaining relatively stable until 2015/16 in groups not targeted by new recommendations. Crude SIVU rates in 2015/16 were 48% (43,950/91,794) for ≥ 65 year olds and between 16% (407/2,565) and 29% (873/3,056) for < 65 year olds depending on their condition. SIVU increased modestly after new recommendations were published, but only in patients newly eligible for a free vaccine voucher.ConclusionsOur results suggest: (i) a prolonged confidence crisis in SIV, initially impelled by the 2009 pandemic vaccination campaign; (ii) that new recommendations are ineffective without additional measures. Interventional research in this field is a priority.
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Affiliation(s)
- Pierre Verger
- INSERM, F-CRIN, Innovative Clinical research Network in vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu, Paris, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Lisa Fressard
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Sébastien Cortaredona
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Daniel Lévy-Bruhl
- Santé publique France, Direction des maladies infectieuses, Saint-Maurice, France
| | - Pierre Loulergue
- Assistance Publique Hôpitaux de Paris, CIC Cochin-Pasteur, Paris, France.,Inserm CIC 1417, Paris, France.,Université Paris Descartes, Sorbonne Paris cité, Paris, France.,INSERM, F-CRIN, Innovative Clinical research Network in vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu, Paris, France
| | - Florence Galtier
- CIC 1411, CHU Montpellier, Hôpital Saint Eloi, Montpellier, France.,INSERM, F-CRIN, Innovative Clinical research Network in vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu, Paris, France
| | - Aurélie Bocquier
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
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260
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Violette R, Pullagura GR. Vaccine hesitancy: Moving practice beyond binary vaccination outcomes in community pharmacy. Can Pharm J (Ott) 2019; 152:391-394. [PMID: 31762851 DOI: 10.1177/1715163519878745] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Richard Violette
- Ontario Pharmacy Evidence Network (Violette), University of Waterloo, Kitchener, Ontario.,School of Pharmacy (Violette, Pullagura), University of Waterloo, Kitchener, Ontario
| | - Gokul Raj Pullagura
- Ontario Pharmacy Evidence Network (Violette), University of Waterloo, Kitchener, Ontario.,School of Pharmacy (Violette, Pullagura), University of Waterloo, Kitchener, Ontario
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261
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A scoping review examining the availability of dialogue-based resources to support healthcare providers engagement with vaccine hesitant individuals. Vaccine 2019; 37:6594-6600. [PMID: 31540811 DOI: 10.1016/j.vaccine.2019.09.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/19/2019] [Accepted: 09/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is growing attention around the need to improve the confidence and skills of healthcare providers to assist them in completing the complex task of communicating to vaccine hesitant parents and other individuals. While interventions have been developed and evaluated in a research setting, there is uncertainty regarding the public availability. This study aimed to examine the current landscape regarding the availability of online dialogue- based interventions which aim to support vaccination conversations. METHODS A scoping review was undertaken to identify and appraise the availability and accessibility of dialogue-based interventions. A dialogue-based intervention was defined as a strategy aiming to improve an individual's confidence and communication skills to engage with and respond to vaccine hesitant individuals. Two approaches were utilised to identify relevant interventions and resources. Firstly, the European Centre for Disease Prevention and Control Catalogue of Interventions was assessed to identify interventions that met the definition. Secondarily, a Google search (in English only) was conducted using key words, that reflected the strategy that healthcare providers may use to identify resources. RESULTS We identified a total of 31 dialogue-based interventions, of which 29 were reviewed. The interventions were all text based and instructional in nature. Twenty-two were suitable for healthcare providers, as well as non-clinical immunisation spokespersons to use. Of issue, was that in many instances it was common to find the resource located on the fifth to tenth page of search entries, and usually disguised under seemingly non-descript and nonspecific titles. Lastly, not all resources were available for free and not all could be accessed directly from the site. CONCLUSIONS Findings suggest that while there have been numerous interventions developed to support healthcare providers to communicate with vaccine hesitant parents/individuals, there are fundamental issues with accessing the materials in a timely and convenient way. Having a central repository or website (which links to the interventions) would not only assistant healthcare providers to have an improved comprehension of the different interventions available but also would theoretically increase the utilisation by providers.
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262
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Gaillat J. [Vaccine hesitancy: How to lift the brake?]. Rev Mal Respir 2019; 36:962-970. [PMID: 31522949 DOI: 10.1016/j.rmr.2018.10.620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/24/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We are at a "post-trust" period, characterised by vaccine hesitancy which is being widely diffused by the media and social networks. The consequences of this include: measles, whooping cough epidemics, vaccine coverage decreasing for the youngest, and remaining at low levels in adults. Mandatory vaccination has been extended for children less than two years in France, with the objective to increase vaccination rates during this period. STATE OF THE ART The medical literature on this topic is increasing, mainly regarding descriptions of reasons for vaccine hesitancy. These include doubt about vaccine efficacy, safety, and real need as well as with regard to social aspects, cultural, religious beliefs. The literature that explores the best way to address vaccine hesitancy is still scarce. Healthcare workers are a key in promoting vaccine acceptance. There is a need to address the issue of vaccine hesitancy in a multicompartmental way. Health authorities must communicate in a clear and concise style that is trust-based and science-informed, being transparent both on vaccine benefits and on issues around vaccine safety. For caregivers, motivational interviewing can help patients change behaviour. CONCLUSION Anti-vaccine ideas were born with vaccines; they are abundantly spread through the Internet and social networks and can give a false impression of their basis in reality. It is time for positive action not merely a defensive approach.
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Affiliation(s)
- J Gaillat
- Centre de recherche clinique, service des maladies infectieuses CHANGE, centre hospitalier Annecy-Genevois, 1, avenue de l'hôpital, 74374 Pringy cedex, France.
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263
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Salmon DA, Limaye RJ, Dudley MZ, Oloko OK, Church-Balin C, Ellingson MK, Spina CI, Brewer SE, Orenstein WA, Halsey NA, Chamberlain AT, Bednarczyk RA, Malik FA, Frew PM, O'Leary ST, Omer SB. MomsTalkShots: An individually tailored educational application for maternal and infant vaccines. Vaccine 2019; 37:6478-6485. [PMID: 31506192 DOI: 10.1016/j.vaccine.2019.08.080] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/23/2019] [Accepted: 08/29/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The development and initial assessment in a clinical setting of a theory-driven, individually tailored educational application (app), MomsTalkShots, focused on increasing uptake of maternal and infant vaccines is described. METHODS MomsTalkShots algorithmically tailored videos based on parent needs to deliver an intervention that was specifically responsive to individual vaccine attitudes, beliefs and intentions, demographics, and source credibility. MomsTalkShots was evaluated among 1103 pregnant women recruited from 23 geographically and socio-demographically diverse obstetrician-gynecologist offices in Georgia and Colorado in 2017. Self-reported information needs were assessed pre-and post-videos and participants self-reported factors related to usability and analyzed in 2018. RESULTS The vast majority of women reported MomsTalkShots was helpful (95%), trustworthy (94%), interesting (97%) and clear to understand (99%), none of which varied by demographics or parity. Reported usability was slightly lower among vaccine hesitant women, yet the majority reported MomsTalkShots was helpful (91%), trustworthy (85%), interesting (97%) and clear (99%). The majority of women (72%) who did not have enough vaccine information pre-videos reported enough information post-videos. CONCLUSIONS MomsTalkShots was designed to provide individually tailored vaccine information to pregnant women from a population with varied vaccine intentions, confidence and vaccine concerns. MomsTalkShots was extremely well-received among pregnant women, even among women who were initially vaccine hesitant and did not intend to vaccinate themselves and their infants according to the recommended immunization schedule. Next steps include evaluation to assess impact on vaccine uptake and expansion to adolescent and adult vaccines.
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Affiliation(s)
- Daniel A Salmon
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States.
| | - Rupali J Limaye
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - Matthew Z Dudley
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - Oladeji K Oloko
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - Cathy Church-Balin
- Johns Hopkins University Center for Communications Programs, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - Mallory K Ellingson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA 30322, United States
| | - Christine I Spina
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital, 13199 E Montview Blvd, Suite 300, Mail Stop F443, Aurora, CO 80045, United States
| | - Sarah E Brewer
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital, 13199 E Montview Blvd, Suite 300, Mail Stop F443, Aurora, CO 80045, United States; Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 East 17th Ave. AO1, 3rd Floor, Room 3601, Aurora, CO 80045, United States
| | - Walter A Orenstein
- Department of Medicine, School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA, United States
| | - Neal A Halsey
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - Allison T Chamberlain
- Department of Medicine, School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, United States
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA 30322, United States; Department of Medicine, School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA, United States
| | - Fauzia A Malik
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA 30322, United States
| | - Paula M Frew
- School of Community Health Sciences and Office of Research and Economic Development, University of Nevada, Las Vegas, 4505 S Maryland Pkwy, Las Vegas, NV 89154, United States; Population Health & Health Equity Initiative, University of Nevada, Las Vegas, 4505 S Maryland Pkwy, Las Vegas NV 89154, United States
| | - Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital, 13199 E Montview Blvd, Suite 300, Mail Stop F443, Aurora, CO 80045, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave., B065, Aurora, CO, United States
| | - Saad B Omer
- Department of Medicine, School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA, United States; Emory Vaccine Center, Emory University, 201 Dowman Drive, Atlanta, GA 30322, United States
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264
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Gagneur A, Battista MC, Boucher FD, Tapiero B, Quach C, De Wals P, Lemaitre T, Farrands A, Boulianne N, Sauvageau C, Ouakki M, Gosselin V, Petit G, Jacques MC, Dubé È. Promoting vaccination in maternity wards ─ motivational interview technique reduces hesitancy and enhances intention to vaccinate, results from a multicentre non-controlled pre- and post-intervention RCT-nested study, Quebec, March 2014 to February 2015. Euro Surveill 2019; 24:1800641. [PMID: 31507265 PMCID: PMC6737828 DOI: 10.2807/1560-7917.es.2019.24.36.1800641] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/02/2019] [Indexed: 01/30/2023] Open
Abstract
BackgroundMany countries are grappling with growing numbers of parents who delay or refuse recommended vaccinations for their children. This has created a need for strategies to address vaccine hesitancy (VH) and better support parental decision-making regarding vaccination.AimTo assess vaccination intention (VI) and VH among parents who received an individual motivational-interview (MI) based intervention on infant immunisation during post-partum stay at a maternity ward between March 2014 and February 2015.MethodsThis non-controlled pre-/post-intervention study was conducted using the results from parents enrolled in the intervention arm of the PromoVaQ randomised control trial (RCT), which was conducted in four maternity wards across the Province of Quebec. Participants (n = 1,223) completed pre- and post-intervention questionnaires on VI and VH using Opel's score. Pre-/post-intervention measures were compared using McNemar's test for categorical variables and Wilcoxon signed-rank test for continuous variables.ResultsPre-intervention: overall VI was 78% and significantly differed across maternity wards (74%, 77%, 84%, 79%, p = 0.02). Post-intervention: VI rose significantly across maternity wards (89%, 85%, 95%, 93%) and the overall increase in VI was 12% (78% vs 90%, p < 0.0001). VH corroborated these observations, pre- vs post-intervention, for each maternity ward (28% vs 16%, 29% vs 21%, 27% vs 17%, 24% vs 13%). Overall, VH was curbed post-intervention by 40% (27% vs 16%; p < 0.0001).ConclusionsCompared with pre-intervention status, participants who received the MI-based intervention on immunisation displayed lower hesitancy and greater intention to vaccinate their infant at 2 months of age.
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Affiliation(s)
- Arnaud Gagneur
- Centre de recherche du CHUS, Sherbrooke, Québec, Canada
- Centre hospitalier universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Marie-Claude Battista
- Centre de recherche du CHUS, Sherbrooke, Québec, Canada
- Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - François D Boucher
- Centre de recherche du Centre Hospitalier Universitaire de Québec, Québec, Québec, Canada
| | - Bruce Tapiero
- CHU Sainte Justine, Université de Montréal, Montréal, Québec, Canada
| | - Caroline Quach
- CHU Sainte Justine, Université de Montréal, Montréal, Québec, Canada
- McGill University Health Centre Research Institute - Vaccine Study Centre, Montréal, Québec, Canada
| | - Philippe De Wals
- Department of Social and Preventive Medicine, Laval University, Québec, Québec, Canada
| | | | - Anne Farrands
- Centre de recherche du CHUS, Sherbrooke, Québec, Canada
| | - Nicole Boulianne
- Centre de recherche du Centre Hospitalier Universitaire de Québec, Québec, Québec, Canada
- Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Chantal Sauvageau
- Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Department of Social and Preventive Medicine, Laval University, Québec, Québec, Canada
- Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Manale Ouakki
- Institut national de santé publique du Québec, Québec, Québec, Canada
| | | | - Geneviève Petit
- Direction de santé publique du CIUSSS de l'Estrie - CHUS, Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Marie-Claude Jacques
- Institut universitaire de première ligne en santé et services sociaux du CIUSSS de l'Estrie - CHUS, Québec, Canada
| | - Ève Dubé
- Institut national de santé publique du Québec, Québec, Québec, Canada
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265
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Evans DR, Yemeke TT, Kiracho EE, Mutebi A, Apolot RR, Ssebagereka A, Ozawa S. Trust in vaccines and medicines in Uganda. Vaccine 2019; 37:6008-6015. [PMID: 31447127 DOI: 10.1016/j.vaccine.2019.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 07/03/2019] [Accepted: 07/06/2019] [Indexed: 01/10/2023]
Abstract
Trust underlies numerous decisions in health care, affecting vaccine uptake as well as care seeking rates, treatment adherence, and health outcomes. Although trust in the doctor-patient relationship has garnered much attention, trust in health care commodities such as vaccines and medicines has rarely been examined. We report findings from a cross-sectional survey to assess trust in vaccines vis-à-vis their trust in conventional medicines and traditional medicines in Uganda. Trust in vaccines, conventional and traditional medicines were assessed by adapting the vaccine hesitancy scale developed by the SAGE Working Group on Vaccine Hesitancy. Reported trust in vaccines and conventional medicines was much higher than trust in traditional medicines. Significant associations were observed between trust in vaccines and trust in conventional medicines. Of the trust components explored, respondents were most concerned about access to and safety of vaccines and medicines. Further, respondents' previous health care experiences, primary source of health information, and trust in providers' skills were significantly associated with reported trust in vaccines and medicines. Although strong levels of trust in vaccines and conventional medicines were observed overall, the findings identify areas where policies and communication efforts can focus to strengthen trust.
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Affiliation(s)
| | - Tatenda T Yemeke
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth E Kiracho
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Aloysius Mutebi
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Rebecca R Apolot
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Anthony Ssebagereka
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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266
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Cataldi JR, Sevick C, Pyrzanowski J, Wagner N, Brewer SE, Narwaney KJ, Shoup JA, Resnicow K, Glanz J, Dempsey A, Kwan BM. Addressing personal parental values in decisions about childhood vaccination: Measure development. Vaccine 2019; 37:5688-5697. [PMID: 31421930 DOI: 10.1016/j.vaccine.2019.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 08/04/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Evidence-based strategies to address vaccine hesitancy are lacking. Personal values are a measurable psychological construct that could be used to deliver personalized messages to influence vaccine hesitancy and behavior. Our objectives were to develop a valid, reliable self-report survey instrument to measure vaccine values based on the Schwartz theory of basic human values, and to test the hypothesis that vaccine values are distinct from vaccine attitudes and are related to vaccine hesitancy and behavior. METHODS Parental Vaccine Values (PVV) scale items were generated using formative qualitative research and expert input, yielding 24 items for testing. 295 parents of children aged 14-30 months completed a self-report survey with measures of Schwartz's global values, the PVV, vaccine attitudes, and vaccine hesitancy. Factor analysis was used to determine vaccine values factor structure. Associations between vaccine values, vaccine attitudes, vaccine hesitancy, and vaccination behavior were assessed using linear and logistic regression models. Late vaccination was assessed from electronic medical records. RESULTS A six-factor structure for vaccine values was determined with good fit (RMSEA = 0.07, Bentler's CFI = 0.91) with subscales for Conformity, Universalism, Tradition, Self-Direction, Security- Disease Prevention, and Security- Vaccine Risk. Vaccine values were moderately associated with Schwartz global values and vaccine attitudes, indicating discriminant validity from these constructs. Multivariable linear regression showed vaccine hesitancy was associated with vaccine values Conformity (partial R2 = 0.10) and Universalism (0.04) and vaccine attitudes Vaccine Safety (0.52) and Vaccine Benefit (0.16). Multivariable logistic regression showed that late vaccination was associated with vaccine value Self-direction (OR = 1.80, 95% CI: 1.26-2.65) and vaccine attitude of Vaccine Benefit (OR = 0.44, 95% CI: 0.32-0.60). CONCLUSIONS The PVV scale had good psychometric properties and appears related to but distinct from Schwartz global values and vaccine attitudes. Vaccine values are associated with vaccine hesitancy and late vaccination and may be useful in tailoring future interventions.
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Affiliation(s)
- Jessica R Cataldi
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO, United States; University of Colorado, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, CO, United States.
| | - Carter Sevick
- University of Colorado, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, CO, United States
| | - Jennifer Pyrzanowski
- University of Colorado, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, CO, United States
| | - Nicole Wagner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States
| | - Sarah E Brewer
- University of Colorado, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, CO, United States
| | - Komal J Narwaney
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States
| | - Ken Resnicow
- University of Michigan, School of Public Health, Ann Arbor, MI, United States
| | - Jason Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States; Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States
| | - Amanda Dempsey
- University of Colorado, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, CO, United States
| | - Bethany M Kwan
- University of Colorado, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, CO, United States; University of Colorado School of Medicine, Department of Family Medicine, United States
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267
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Fleming JA, Munthali A, Ngwira B, Kadzandira J, Jamili-Phiri M, Ortiz JR, Lambach P, Hombach J, Neuzil KM, Stepanchak M, Bhat N. Maternal immunization in Malawi: A mixed methods study of community perceptions, programmatic considerations, and recommendations for future planning. Vaccine 2019; 37:4568-4575. [PMID: 31319932 PMCID: PMC6642336 DOI: 10.1016/j.vaccine.2019.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Safe, effective vaccines are given to pregnant women to protect their infants and/or themselves against certain infectious agents; however, apart from tetanus vaccination, maternal immunization in low- and middle-income countries (LMICs) remains low. Tetanus toxoid vaccine is integrated into antenatal care services in Malawi with high coverage and provides an opportunity to identify factors that facilitate successful immunization delivery to pregnant women in LMICs. METHODS PATH and the University of Malawi's Centre for Social Research conducted a mixed-methods study in 2015 to document community perceptions of maternal immunization, using tetanus vaccine as an example, and to identify factors perceived to be important to successfully introducing other maternal vaccines, such as influenza vaccine, in Malawi. We conducted 18 focus group discussions with pregnant and recently pregnant women and their family members and 76 semi-structured interviews with pregnant and recently pregnant women, community leaders, health workers, public health program managers, non-governmental partners, and policy makers. RESULTS We identified factors perceived to support the introduction of new maternal vaccines, including strong maternal vaccine acceptance in the community, an existing strategy for maternal tetanus vaccine delivery, and positive health workers' views about the introduction of additional maternal vaccines. Potential challenges to adoption and acceptance included identifying and tracking the target population and monitoring adverse events, and the need to ensure operational capacity of the health system to support the introduction and wide-scale use of an additional vaccine. For influenza vaccine specifically, additional challenges included limited awareness of influenza disease and its low prioritization among health needs. CONCLUSIONS Lessons from the successful delivery of maternal tetanus immunization in Malawi may be informative for similar countries considering new vaccines for pregnant women or striving to optimize the delivery of those currently provided.
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Affiliation(s)
- Jessica A Fleming
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA.
| | - Alister Munthali
- The Centre for Social Research, University of Malawi, PO Box 280, Zomba, Malawi.
| | - Bagrey Ngwira
- Malawi Polytechnic, Private Bag 303, Chichiri, Blantyre 3, Malawi
| | - John Kadzandira
- The Centre for Social Research, University of Malawi, PO Box 280, Zomba, Malawi
| | - Monica Jamili-Phiri
- The Centre for Social Research, University of Malawi, PO Box 280, Zomba, Malawi.
| | - Justin R Ortiz
- Initiative for Vaccine Research, World Health Organization, Appia 20, 1211, Geneva 27, Switzerland.
| | - Philipp Lambach
- Initiative for Vaccine Research, World Health Organization, Appia 20, 1211, Geneva 27, Switzerland.
| | - Joachim Hombach
- Initiative for Vaccine Research, World Health Organization, Appia 20, 1211, Geneva 27, Switzerland.
| | - Kathleen M Neuzil
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA.
| | - Maria Stepanchak
- Global Alliance to Prevent Prematurity and Stillbirth, 19009 33rd Ave W #200, Lynnwood, WA 98036, USA.
| | - Niranjan Bhat
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA.
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268
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Perceptions of influenza and pneumococcal vaccine uptake by older persons in Australia. Vaccine 2019; 37:4454-4459. [DOI: 10.1016/j.vaccine.2019.06.079] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 01/21/2023]
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269
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Miko D, Costache C, Colosi HA, Neculicioiu V, Colosi IA. Qualitative Assessment of Vaccine Hesitancy in Romania. ACTA ACUST UNITED AC 2019; 55:medicina55060282. [PMID: 31213037 PMCID: PMC6631779 DOI: 10.3390/medicina55060282] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 11/16/2022]
Abstract
Background and objectives: Health systems all over the world are confronted with an alarming rise of cases in which individuals hesitate, delay, and even refuse vaccination, despite availability of quality vaccine services. In order to mitigate and combat this phenomenon, which are now defined by the World Health Organization (WHO) as vaccine hesitancy (VH), we must first understand the factors that lead to its occurrence in an era characterized by wide access to safe and effective vaccines. To achieve this, we conducted field testing of the Vaccine Hesitancy Scale (VHS), as it was developed by the Strategic Advisory Group of Experts Working Group (SAGE WG), in Cluj-Napoca city, Cluj County, Romania. The scale is designed to quantify VH prevalence in a population, establish which vaccines generate the highest percentage of hesitancy, and allow a qualitative assessment of the individual’s reasons for hesitance. Materials and Methods: We conducted an observational cross-sectional survey, which was comprised of descriptive, analytical, and qualitative elements regarding VH. The necessary sample size was 452 individuals. The VHS and Matrix of Determinants (recommended by SAGE WG) for reasons people gave to justify their hesitance, was interpreted by qualitative thematic analysis (QTA) to ensure the validity and reliability in detecting hesitancy across various cultural settings and permit global comparisons. Results: We found a VH of 30.3% and 11.7% of parents reported refusing to vaccinate their child. Among the VH responders, the varicella vaccine generated 35% hesitancy, measles vaccine 27.7%, Human Papillomavirus (HPV) 24.1%, and mumps vaccine 23.4%, respectively. The QTA values for percent agreement ranged from 91% to 100%. Cohen’s Kappa values ranged from 0.45 to 0.95. Contextual influences identified for VH were “media,” “leaders and lobbies,” and “perception of the pharmaceutical industry.” Individual and group influences for VH were “beliefs,” “knowledge,” and “risk/benefits (perceived).” Vaccine and vaccination specific issues for VH were “risk/benefit (rational)” and “health care practitioners (trustworthiness, competence).” Conclusions: One-third of the investigated population had expressed VH, and a further one-third of these had refused a vaccine for their child. Chicken Pox, Measles, Mumps, Rubella (MMR), and HPV vaccines generated the most hesitation. Negative information from the media was the most frequently evoked reason for VH.
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Affiliation(s)
- David Miko
- Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania.
| | - Carmen Costache
- Department of Microbiology, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania.
| | - Horațiu Alexandru Colosi
- Department of Medical Education, Division of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania.
| | - Vlad Neculicioiu
- Department of Microbiology, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania.
| | - Ioana Alina Colosi
- Department of Microbiology, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania.
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270
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Gagneur A, Gosselin V, Bergeron J, Farrands A, Baron G. Development of motivational interviewing skills in immunization (MISI): a questionnaire to assess MI learning, knowledge and skills for vaccination promotion. Hum Vaccin Immunother 2019; 15:2446-2452. [PMID: 30829114 DOI: 10.1080/21645515.2019.1586030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective: Vaccine hesitancy is a complex problem. We previously demonstrated that motivational interviewing (MI) could be helpful to enhance parents' motivation to vaccinate their child. The aim of this study is to develop a new, simple and robust evaluation tool that is suitable for evaluating MI learning of vaccination health professionals. Methods: We designed the Motivational Interviewing Skills in Immunization (MISI), a short written questionnaire to evaluate the MI knowledge and skills of participants in an immunization context. It covers three key areas: knowledge of MI, ability to apply MI-related skills, participant self-confidence in using MI. Questionnaire content and face validity were assessed by MI experts and internal consistency, reliability and effect size were analyzed using a multiple pretest-posttest design. Results: Psychometric measures showed good to excellent internal consistency of the questionnaire for all three areas (Cronbach's and KR coefficient: 0.70 to 0.88). Test-retest reliability showed good measurement stability (ICC: 0.53). Good sensitivity to change was also obtained (Cohen's d: 0.80 to 1.66). Conclusion: The MISI questionnaire is the first paper/pencil evaluation method to assess MI training specific to immunization. Psychometric measures showed high reliability. Practice implications: This questionnaire could provide a convenient and inexpensive method to evaluate knowledge and competencies following immunization-specific MI training.
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Affiliation(s)
- Arnaud Gagneur
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke , Sherbrooke , Quebec , Canada.,Centre de Recherche du Centre hospitalier universitaire de Sherbrooke , Sherbrooke , Quebec , Canada
| | - Virginie Gosselin
- Centre de Recherche du Centre hospitalier universitaire de Sherbrooke , Sherbrooke , Quebec , Canada
| | - Julie Bergeron
- Centre de Recherche du Centre hospitalier universitaire de Sherbrooke , Sherbrooke , Quebec , Canada.,Department of Research in Health Sciences, Université de Sherbrooke , Sherbrooke , Quebec , Canada
| | - Anne Farrands
- Centre de Recherche du Centre hospitalier universitaire de Sherbrooke , Sherbrooke , Quebec , Canada
| | - Geneviève Baron
- Eastern Townships Public Health Department , Sherbrooke , Quebec , Canada.,Department of Community Health Sciences, Faculty of Medecine and Health Sciences, Université de Sherbrooke , Sherbrooke , Quebec , Canada.,Centre de Recherche de l'Institut universitaire de première ligne en santé et services sociaux , Sherbrooke , Québec , Canada
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271
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Eller NM, Henrikson NB, Opel DJ. Vaccine Information Sources and Parental Trust in Their Child's Health Care Provider. HEALTH EDUCATION & BEHAVIOR 2019; 46:445-453. [PMID: 30616381 PMCID: PMC7872219 DOI: 10.1177/1090198118819716] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Parental trust in their child's health care provider and the number and type of vaccine information sources are important dimensions of vaccine hesitancy and may suggest intervention components for future research. METHOD We conducted secondary analysis of survey data from mothers of healthy newborns in Washington State, and examined the association between parental trust in their child's health care provider and vaccine information sources. RESULTS We found that mothers with less trust in their child's health care provider used more sources, more informal sources, and were less likely to consider their child's pediatrician their main source of vaccine information compared with more trusting mothers. However, less trusting mothers did not report more effort to read or watch stories about vaccines than more trusting mothers, nor were they more likely to report the internet as their main vaccine information source. CONCLUSIONS Future interventions seeking to reduce parental vaccine hesitancy should consider intervention components focused on building or improving parent trust in their child's health care provider.
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Affiliation(s)
| | - Nora B. Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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272
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Exploring childhood immunization among undocumented migrants in Sweden - following qualitative study and the World Health Organizations Guide to Tailoring Immunization Programmes (TIP). Public Health 2019; 171:97-105. [DOI: 10.1016/j.puhe.2019.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/11/2019] [Accepted: 04/09/2019] [Indexed: 11/19/2022]
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273
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Guay M, Gosselin V, Petit G, Baron G, Gagneur A. Determinants of vaccine hesitancy in Quebec: a large population-based survey. Hum Vaccin Immunother 2019; 15:2527-2533. [PMID: 31050594 PMCID: PMC6930046 DOI: 10.1080/21645515.2019.1603563] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/18/2019] [Accepted: 03/29/2019] [Indexed: 10/22/2022] Open
Abstract
Objectives: Vaccine hesitancy is a global phenomenon that needs to be measured and addressed. This study aimed to identify the determinants of vaccine hesitancy among a large regional population.Methods: A structured telephone survey was administered to a random digit sample in Quebec's Eastern Townships region. In addition to socioeconomic information, respondents were asked questions on several health topics such as knowledge and beliefs about immunization, medical consultations, health status, and life habits. Data were weighted according to age, sex, and territories. Statistically significant variables in the univariate analysis were introduced into a multivariate logistic regression model to determine independent factors for vaccine hesitancy (adjusted odds ratios [aOR] and 95% confidence intervals).Results: A total of 8,737 interviews were conducted (participation rate 48.3%). Among all respondents, 32.2% were vaccine-hesitant. Several beliefs were significantly associated with vaccine hesitancy: belief that children receive too many vaccines (aOR = 2.72; 2.32-3.18), belief that a healthy lifestyle can eliminate the need for vaccination (aOR = 2.48; 2.09-2.93), and belief that the use of alternative medicine practices can eliminate the need for vaccination (aOR = 1.39; 1.16-1.68). Other determinants associated with vaccine hesitancy were having consulted a massage therapist (aOR = 2.34; 1.46-3.75), not being vaccinated against influenza (aOR = 1.80; 1.49-2.16), having a low (<$30,000) (aOR = 1.58; 1.24-2.02) or moderate ($30,000-$79,000) (aOR = 1.37; 1.12-1.67) household income, distrust in public health authorities (aOR = 1.40; 1.21-1.63), perceived insufficient knowledge about immunization (aOR = 1.26; 1.04-1.51), and smoking (aOR = 1.22; 1.01-1.47).Conclusions: Many determinants are related to vaccine hesitancy. These determinants should be taken into account when health professionals engage with vaccine-hesitant individuals.
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Affiliation(s)
- Maryse Guay
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Institut national de santé publique du Québec, Québec, Québec, Canada
- Centre de recherche, Hôpital Charles-Le Moyne, Longueuil, Québec, Canada
| | | | - Geneviève Petit
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Direction de santé publique du CIUSSS de l’Estrie – CHUS, Sherbrooke, Québec, Canada
| | - Geneviève Baron
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Direction de santé publique du CIUSSS de l’Estrie – CHUS, Sherbrooke, Québec, Canada
- Institut universitaire en première ligne en santé et services sociaux, Sherbrooke, Québec, Canada
| | - Arnaud Gagneur
- Centre de recherche du CHUS, Sherbrooke, Québec, Canada
- Département de pédiatrie, Université de Sherbrooke, Sherbrooke, Québec, Canada
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274
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Parents' beliefs in misinformation about vaccines are strengthened by pro-vaccine campaigns. Cogn Process 2019; 20:325-331. [PMID: 30963330 DOI: 10.1007/s10339-019-00919-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 04/04/2019] [Indexed: 11/27/2022]
Abstract
The main objective of this study was to determine whether one of the most commonly employed pro-vaccination strategies based on the "myths vs. facts" format can be considered an effective tool to counter vaccines misinformation. Sixty parents were randomly presented with either a control message or a booklet confronting some common myths about vaccines with a number of facts. Beliefs in the autism/vaccines link and in vaccines side effects, along with intention to vaccinate one's child, were evaluated both immediately after the intervention and after a 7-day delay to reveal possible backfire effects. Data provided support for the existence of backfire effects associated with the use of the myths vs. facts format, with parents in this condition having stronger vaccine misconceptions over time compared with participants in the control condition. The myths vs. facts strategy proved to be ineffective. Efforts to counter vaccine misinformation should take into account the many variables that affect the parents' decision-making.
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275
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Fuchs EL, Starkey JM, Rupp RE, Berenson AB. Prenatal vaccination of mothers and hepatitis B vaccination of their infants. Prev Med 2019; 121:68-73. [PMID: 30763628 PMCID: PMC6399050 DOI: 10.1016/j.ypmed.2019.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/02/2019] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination and influenza vaccination are recommended during pregnancy primarily to prevent influenza and pertussis in mothers and their infants. This study examines associations between prenatal Tdap vaccination and influenza vaccination of mothers and hepatitis B vaccination of their infants. A retrospective cohort study was conducted using data from electronic medical records from 15,468 deliveries to 14,925 mothers occurring April 2, 2014-December 3, 2016 at a university hospital in Texas. Hepatitis B vaccine receipt in the first 3 days of life was dichotomized. Margins post-estimation commands in Stata SE 15.1 were used to obtain predicted probabilities and risk differences after estimating odds ratios in logistic regression with robust variance estimates. Adjusted models included maternal age, race/ethnicity, Medicaid use, year of delivery, parity, and gravidity. Infants of mothers who received prenatal influenza vaccination in the 2014-2015 and 2015-2016 influenza seasons were more likely than those of mothers who did not to receive a hepatitis B vaccine in their first 3 days of life (adjusted risk difference (RD) 2.8%, 95% confidence interval (CI) 1.5-4.1% and RD 2.2%, 95% CI 0.9-3.5%, respectively). Hepatitis B vaccination was also higher among infants of Tdap-eligible mothers who received prenatal Tdap vaccination during pregnancy compared to those of mothers who did not (adjusted RD 9.1%, 95% CI 7.6-10.5%). Overall, prenatal vaccination was significantly associated with uptake of infant hepatitis B vaccine.
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Affiliation(s)
- Erika L Fuchs
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0587, USA.
| | - Jonathan M Starkey
- Institute for Translational Sciences & Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0587, USA.
| | - Richard E Rupp
- Sealy Institute for Vaccine Sciences, Department of Pediatrics, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0587, USA.
| | - Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0587, USA.
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276
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Zhang EJ, Chughtai AA, Heywood A, MacIntyre CR. Influence of political and medical leaders on parental perception of vaccination: a cross-sectional survey in Australia. BMJ Open 2019; 9:e025866. [PMID: 30914408 PMCID: PMC6475250 DOI: 10.1136/bmjopen-2018-025866] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this survey was to investigate parental vaccination attitudes and responses to vaccine-related media messages from political and medical leaders. DESIGN This was a cross-sectional study using a semiquantitative questionnaire. Data were analysed using descriptive statistics, X2 tests and logistic regression. SETTING Data were collected from a web-based questionnaire distributed in Australia by a market research company in May of 2017. PARTICIPANTS 411 participants with at least one child under 5 were included in this study. The sample was designed to be representative of Australia in terms of gender and state of residence. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measures were parental attitudes towards childhood immunisation before and after viewing vaccine-related messages from political and medical leaders, including Donald Trump (USA), Pauline Hanson (Australia) and Michael Gannon (Australia). Parents were classified as having 'susceptible' (not fixed) or 'fixed' (positive or negative) views towards vaccination based on a series of questions. RESULTS Parents with fixed vaccination views constituted 23.8% (n=98) of the total sample; 21.7% (n=89) were pro-vaccination and 2.2% (n=9) were anti-vaccination. The remaining 76.2% of participants were classified as having susceptible views towards vaccination. Susceptible parents were more likely to report a change in their willingness to vaccinate after watching vaccine-related messages compared with fixed-view parents, regardless of whether the messaging was positive or negative (Trump OR 2.54, 95% CI (1.29 to 5.00); Hanson OR 2.64, 95% CI (1.26 to 5.52); Gannon OR 2.64, 95% CI (1.26 to 5.52)). Susceptible parents were more likely than fixed-view parents to report increased vaccine hesitancy after viewing negative vaccine messages (Trump OR 2.14, 95% CI (1.11 to 4.14), Hanson OR 2.34, 95% CI (1.21 to 4.50)). CONCLUSIONS The findings suggest that most parents including the vaccinating majorty are susceptible to vaccine messaging from political and medical leaders. Categorising parents as 'fixed-view' or 'susceptible' can be a useful strategy for designing and implementing future vaccine promotion interventions.
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Affiliation(s)
- Elissa J Zhang
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Anita Heywood
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Chandini Raina MacIntyre
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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277
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Navin MC, Wasserman JA, Ahmad M, Bies S. Vaccine Education, Reasons for Refusal, and Vaccination Behavior. Am J Prev Med 2019; 56:359-367. [PMID: 30777155 DOI: 10.1016/j.amepre.2018.10.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Little is known about associations between the reasons parents refuse or delay vaccines for their children, their responsiveness to vaccine counseling, and their children's vaccination status at various ages. Since 2015, Michigan has required parents to attend education sessions at local health departments to receive nonmedical exemptions. This requirement provides an opportunity to study otherwise opaque aspects of vaccine refusal. METHODS In 2017 and 2018, researchers analyzed a combined data set that included electronic medical records (n=4,098) generated by one Michigan health department during 2015 immunization education sessions, and immunization records from an August 2016 report of the Michigan Care Improvement Registry immunization registry. Analyses employed difference of proportions and ANOVAs to explore group differences in vaccination behaviors after education sessions and on-time vaccination status at various ages. RESULTS Children whose parents stated a commitment to an alternative schedule at the education session subsequently received a vaccine their parents had refused at a much higher rate (39.2%) than did children whose parents refused for reasons of religion (4.4%), concerns about the risks of vaccines (8.1%), or beliefs that vaccines provide little benefit (10.5%). CONCLUSIONS Different reasons for refusal are associated with different patterns of vaccination behavior. Furthermore, results suggest that education sessions may overcome vaccine refusal in some cases, and that distinct refusal reasons mark real differences in parental motivations regarding vaccination choices. These differences in parental motivations may indicate the existence of different sites for potential pro-vaccination interventions.
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Affiliation(s)
- Mark C Navin
- Department of Philosophy, Oakland University, Rochester, Michigan.
| | - Jason Adam Wasserman
- Department of Foundational Medical Studies and Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Miriam Ahmad
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Shane Bies
- Oakland County Health Division, Pontiac, Michigan
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278
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Rosso A, Massimi A, De Vito C, Adamo G, Baccolini V, Marzuillo C, Vacchio MR, Villari P. Knowledge and attitudes on pediatric vaccinations and intention to vaccinate in a sample of pregnant women from the City of Rome. Vaccine 2019; 37:1954-1963. [PMID: 30827733 DOI: 10.1016/j.vaccine.2019.02.049] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND In recent years, pediatric immunization rates in Italy have decreased well below the recommended thresholds, largely due to an increase in scepticism about the efficacy and safety of vaccines. We aimed to identify the degree of such scepticism, and the factors driving it, among a sample of pregnant women in the City of Rome. METHODS We conducted a cross-sectional survey on a sample of pregnant women attending antenatal classes (CANs) in Rome through distribution of a self-administered questionnaire. Multiple logistic regression models were built to analyze the determinants of knowledge, attitudes and intention to vaccinate in this population. RESULTS A total of 458 pregnant women attending CANs in 36 family health centers and two hospitals in Rome answered the survey. Mean age was 32.9 (±5.0) years, and over 90% of women were in their first pregnancy. More than 26% of respondents showed a good level of knowledge of the safety and efficacy of vaccines, but there were high rates of uncertainty or agreement with some of the most common anti-vaccination sentiments. Only 75% of women were sure about vaccinating their children with the hexavalent vaccine, and 64.3% with MMR. A good level of knowledge was the strongest predictor of positive attitudes towards vaccination (OR 11.61, 95% CI 6.43-20.96), which, in turn, influenced the intention to vaccinate for most vaccines with the perception of the benefit of immunization for protection against disease. CONCLUSIONS Scepticism about the safety, efficacy and importance of vaccines is associated to pregnant women's hesitancy to vaccinate their children, suggesting the need to develop strategies to increase vaccine acceptance in the antenatal period. The capacity of health care professionals, particularly midwives, to correctly deliver information to future parents should be strengthened in order to reduce the spread of misinformation and fear of vaccine safety.
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Affiliation(s)
- Annalisa Rosso
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy.
| | - Azzurra Massimi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy.
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy.
| | - Giovanna Adamo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy.
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy.
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy.
| | - Maria Rosaria Vacchio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy.
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy.
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279
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Porth JM, Wagner AL, Teklie H, Abeje Y, Moges B, Boulton ML. Vaccine non-receipt and refusal in Ethiopia: The expanded program on immunization coverage survey, 2012. Vaccine 2019; 37:2106-2121. [PMID: 30826143 DOI: 10.1016/j.vaccine.2019.02.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/16/2019] [Accepted: 02/20/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Rates of full childhood immunization in Ethiopia are well below the WHO global goal of 90% coverage by 2020. This study explores associations between sociodemographic characteristics and healthcare services utilization with experiences of not receiving a vaccine in Ethiopia. METHODS This analysis uses data from Ethiopia's 2012 Expanded Program on Immunization Coverage Survey. The relationships between explanatory variables, including sociodemographic and healthcare utilization factors, and various reasons a child was not vaccinated were assessed with Rao-Scott chi-square tests. Multivariable logistic regression analyses examined significant predictors of these experiences. RESULTS The sample includes the caregivers of 2,722 children. Experiences of not receiving a vaccine were characterized overall and by type of experience: whether a caregiver ever refused vaccination for their child (2.9%), ever decided to not take their child to a health center for vaccination (3.6%), and ever went to a health facility for vaccination but child was not vaccinated (12.0%). Region of residence, possession of a vaccination card, and the setting of the child's last routine vaccination were predictors of not receiving a vaccine. Caregivers reported negative perceptions of vaccines were among their reasons for refusing a vaccine or declining to take their child to a health facility for vaccination. CONCLUSION Prior experiences with health facilities, such as where a child received their last routine vaccine, play a key role in future vaccination. Vaccine receipt at an outreach event is associated with not bringing a child to a health facility for vaccination, which may indicate an unwillingness to visit or difficulty accessing health centers. Further, negative perceptions of vaccines may result in vaccine refusal or delay. Findings of this study provide public health officials with a better understanding of factors related to vaccination experiences and can inform development of interventions that will improve childhood vaccination rates in Ethiopia.
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Affiliation(s)
- Julia M Porth
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Habtamu Teklie
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yemesrach Abeje
- Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Beyene Moges
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, MI, USA
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280
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Karafillakis E, Simas C, Jarrett C, Verger P, Peretti-Watel P, Dib F, De Angelis S, Takacs J, Ali KA, Pastore Celentano L, Larson H. HPV vaccination in a context of public mistrust and uncertainty: a systematic literature review of determinants of HPV vaccine hesitancy in Europe. Hum Vaccin Immunother 2019; 15:1615-1627. [PMID: 30633623 PMCID: PMC6783136 DOI: 10.1080/21645515.2018.1564436] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/03/2018] [Accepted: 12/18/2018] [Indexed: 11/15/2022] Open
Abstract
Europe is increasingly described as the region in the world with the least confidence in vaccination, and particularly in the safety of vaccines. The aim of this systematic literature review was to gather and summarise all peer-reviewed and grey literature published about determinants of Human Papillomavirus (HPV) vaccine hesitancy in Europe. Ten thematic categories were identified across the 103 articles which were included in the review. Participants from European studies most commonly reported issues with the quantity and quality of information available about HPV vaccination; followed by concerns about potential side effects of the vaccine; and mistrust of health authorities, healthcare workers, and new vaccines. Comparative analyses indicated that confidence determinants differed by country and population groups. This evidence supports the need to develop context-specific interventions to improve confidence in HPV vaccination and design community engagement strategies aiming to build public trust.
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Affiliation(s)
- Emilie Karafillakis
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Clarissa Simas
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Caitlin Jarrett
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Universität Basel, Basel, Switzerland
| | - Pierre Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- Aix Marseille Université, UMR_S 912, IRD, Marseille, France
- INSERM, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu, Paris, France
| | - Patrick Peretti-Watel
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- Aix Marseille Université, UMR_S 912, IRD, Marseille, France
- INSERM, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu, Paris, France
| | - Fadia Dib
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Department of Social Epidemiology, Paris, France
- INSERM CIC 1417, F-CRIN, I-REIVAC, Paris, France
- Assistance Publique Hopitaux de Paris (AP-HP), Hôpital Cochin, CIC Cochin, Pasteur, Paris, France
| | - Stefania De Angelis
- Vaccine Preventable Disease Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Judit Takacs
- Centre for Social Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Karam Adel Ali
- Vaccine Preventable Disease Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Lucia Pastore Celentano
- Vaccine Preventable Disease Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Heidi Larson
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
- Department of Global Health, Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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281
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Kieslich K. Addressing vaccination hesitancy in Europe: a case study in state-society relations. Eur J Public Health 2019; 28:30-33. [PMID: 30383256 PMCID: PMC6209815 DOI: 10.1093/eurpub/cky155] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In light of recent outbreaks of diseases such as measles in Europe, policymakers and public health practitioners are seeking strategies to address anti-vaccination attitudes and to increase immunization rates. Identifying effective strategies that will not further alienate vaccination sceptics raises challenges that go to the heart of relations between the state and society. Drawing on accounts of state–society relations, this article discusses how the problem of vaccination hesitancy might be explained from a political science perspective. Discourse-analytical approaches emphasize the importance of storylines, politics and social context in explaining a range of phenomena. Given the number and strength of prevailing discourses in groups with anti-vaccination sentiments, the literature on discourse coalitions can offer perspectives on the challenges that arise in designing strategies to address vaccine hesitancy. Paying closer attention to individual reasons why parents are vaccine hesitant might allow for designing strategies that are more suited to address concerns. However, given the pervasiveness of the discourses of anti-vaccination movements, challenges in reaching citizens who are sceptical of vaccines will remain.
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282
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Jalloh MF, Bennett SD, Alam D, Kouta P, Lourenço D, Alamgir M, Feldstein LR, Ehlman DC, Abad N, Kapil N, Vandenent M, Conklin L, Wolff B. Rapid behavioral assessment of barriers and opportunities to improve vaccination coverage among displaced Rohingyas in Bangladesh, January 2018. Vaccine 2019; 37:833-838. [PMID: 30642728 PMCID: PMC10472973 DOI: 10.1016/j.vaccine.2018.12.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND In November 2017, the World Health Organization received initial reports of suspected diphtheria cases in camps established for displaced Rohingyas in Cox's Bazar district, Bangladesh. By January 11, 2018, over 4,000 suspected cases of diphtheria and 30 deaths were reported. The Bangladesh government and partners implemented a diphtheria vaccination campaign in December 2017. Outbreak response staff reported anecdotal evidence of vaccine hesitancy. Our assessment aimed to understand vaccination barriers and opportunities to enhance vaccine demand among displaced Rohingyas in Bangladesh. METHODS In January 2018, we conducted a qualitative assessment consisting of nine focus group discussions and 15 key informant interviews with displaced Rohingyas in three camps. Participants included mothers and fathers with under five-year-old children, community volunteers, majhis (camp leaders), Islamic religious leaders, traditional and spiritual healers, and teachers. We recruited participants using purposive sampling, and analyzed the data thematically. RESULTS Across focus groups and in-depth interviews, trusted information sources cited by participants included religious leaders, elders, village doctors, pharmacists, majhis, and mothers trained by non-governmental organizations to educate caregivers. Treatment of diphtheria and measles was usually sought from multiple sources including traditional and spiritual healers, village doctors, pharmacies, and health clinics. Major barriers to vaccination included: various beliefs about vaccination causing people to become Christian; concerns about multiple vaccines being received on the same day; worries about vaccination side effects; and, lack of sensitivity to cultural gender norms at the vaccination sites. CONCLUSION Although vaccination was understood as an important intervention to prevent childhood diseases, participants reported numerous barriers to vaccination. Strengthening vaccine demand and acceptance among displaced Rohingyas can be enhanced by improving vaccination delivery practices and engaging trusted leaders to address religious and cultural barriers using community-based channels.
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Affiliation(s)
- Mohamed F Jalloh
- Immunization Systems Branch, Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - Sarah D Bennett
- Immunization Systems Branch, Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | | | - Paryss Kouta
- UNICEF Field Office, Cox's Bazar, Bangladesh; Communicating with Communities, Cox's Bazar, Bangladesh
| | - Dalia Lourenço
- World Health Organization Field Office, Cox's Bazar, Bangladesh
| | | | - Leora R Feldstein
- Immunization Systems Branch, Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Daniel C Ehlman
- Immunization Systems Branch, Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Neetu Abad
- Immunization Systems Branch, Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Neha Kapil
- UNICEF Country Office, Dhaka, Bangladesh
| | | | - Laura Conklin
- Immunization Systems Branch, Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Brent Wolff
- Immunization Systems Branch, Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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283
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Lemaitre T, Carrier N, Farrands A, Gosselin V, Petit G, Gagneur A. Impact of a vaccination promotion intervention using motivational interview techniques on long-term vaccine coverage: the PromoVac strategy. Hum Vaccin Immunother 2019; 15:732-739. [PMID: 30457421 DOI: 10.1080/21645515.2018.1549451] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Delayed vaccinations at 2, 4, and 6 months are associated with a higher probability of delayed age-appropriate vaccination during childhood. This study aimed to assess the effectiveness of an information session on immunization during infancy. METHODS An individual educational information session with motivational interview techniques for immunization of infants was conducted (experimental group) or not conducted (control group) during postpartum stay in a quasi-experimental cohort study. Immunization data were collected from the Eastern Townships Public Health registry at 3, 5, 7, 13, 19, and 24 months of age. Logistic regressions with repeated measures were performed to assess the intervention's impact. Relative risks (RR) were estimated. A multivariate model was obtained adjusted for confounding factors. RESULTS The experimental and control groups included 1140 and 1249 families, respectively. In per protocol analysis, a significant increase in VC of 3.2, 4.9, 7.3, 6.7, 10.6, and 5.1% was observed at 3, 5, 7, 13, 19, and 24 months. Children from experimental group had 9% more chance at a complete vaccination status between 3 and 24 months compared to children from control group (RR (95% CI): 1.09 (1.05-1.13), p < .001). Children with complete vaccination status at 3 months were more likely to have a complete vaccination status at 24 months (82.3 vs. 48.1%, RR (95% CI): 2.72 (2.28-3.24), p < .001). After adjustment, the estimated RR of the intervention's impact was 1.05 (1.02-1.07), p < .001. CONCLUSIONS An educational information session about immunization based on motivational interview techniques conducted during postpartum hospitalization could improve immunization during infancy.
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Affiliation(s)
- Thomas Lemaitre
- a Centre de Recherche du Centre hospitalier universitaire de Sherbrooke , Sherbrooke , Quebec , Canada
| | - Nathalie Carrier
- a Centre de Recherche du Centre hospitalier universitaire de Sherbrooke , Sherbrooke , Quebec , Canada
| | - Anne Farrands
- a Centre de Recherche du Centre hospitalier universitaire de Sherbrooke , Sherbrooke , Quebec , Canada
| | - Virginie Gosselin
- a Centre de Recherche du Centre hospitalier universitaire de Sherbrooke , Sherbrooke , Quebec , Canada
| | - Geneviève Petit
- b Eastern Townships Public Health Department , Sherbrooke , Quebec , Canada
| | - Arnaud Gagneur
- a Centre de Recherche du Centre hospitalier universitaire de Sherbrooke , Sherbrooke , Quebec , Canada.,c Department of Pediatrics, Faculty of Medicine and Health Sciences , Université de Sherbrooke , Sherbrooke , Quebec , Canada
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284
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Arora G, Lehman D, Charlu S, Ross N, Ardy A, Gordon B, Pannaraj PS. Vaccine health beliefs and educational influences among pediatric residents. Vaccine 2019; 37:857-862. [PMID: 30611603 DOI: 10.1016/j.vaccine.2018.12.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/15/2018] [Accepted: 12/18/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE A pilot study of pediatric residents to describe perceived benefits and effects of vaccines and educational influences on vaccine practice among pediatric residents. STUDY DESIGN Eighty-seven residents, from two institutions in a region with relatively high vaccine hesitancy, responded to a survey conducted in 2014-2015. RESULTS Residents identified professional experiences with vaccine preventable diseases (VPDs) and observing pediatricians as most impactful to their vaccine beliefs. Residents who had observed pediatric faculty agreeing to alternative or delayed vaccinations were more likely to believe this to be acceptable vaccine practice (70.1% vs. 21.1%, χ2 = 17.778, p < 0.001). Most residents (68 [79.1%]) reported feeling confident in their ability to discuss vaccines. CONCLUSIONS Pediatricians must be equipped with accurate vaccine health beliefs to impact parental vaccine hesitancy. This study identifies important gaps in medical education, with pediatric residents reporting limitations in their professional experience with VPDs and high rates of observing alternative vaccination practice.
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Affiliation(s)
- Gitanjli Arora
- Department of Pediatrics, Children's Hospital Los Angeles, United States.
| | - Deborah Lehman
- Department of Pediatrics, University of California Los Angeles, United States
| | - Sandhya Charlu
- Department of Pediatrics, Children's Hospital Los Angeles, United States
| | - Nicole Ross
- Department of Pediatrics, Children's Hospital Los Angeles, United States
| | - Adriana Ardy
- Department of Pediatrics, Children's Hospital Los Angeles, United States
| | - Bahareh Gordon
- Department of Pediatrics, University of California Los Angeles, United States
| | - Pia S Pannaraj
- Department of Pediatrics, Children's Hospital Los Angeles, United States; Department of Molecular Microbiology and Immunology, University of Southern California, United States
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285
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Rozbroj T, Lyons A, Lucke J. Psychosocial and demographic characteristics relating to vaccine attitudes in Australia. PATIENT EDUCATION AND COUNSELING 2019; 102:172-179. [PMID: 30166057 DOI: 10.1016/j.pec.2018.08.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/13/2018] [Accepted: 08/21/2018] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Distrust in vaccination is a public health concern. In responding to vaccination distrust, the psychosocial context it occurs in needs to be accounted for. But this psychosocial context is insufficiently understood. We examined how Australians' attitudes to childhood vaccination relate to broader psychosocial characteristics pertaining to two key areas: health and government. DESIGN 4370 Australians were surveyed and divided into five vaccine attitude groups. Logistic univariable and multivariable regression analyses were used to compare differences in psychosocial characteristics between these groups. RESULTS Multivariate analysis showed that, compared to groups with positive vaccine attitudes, groups with negative attitudes were more informed, engaged and independent health consumers, with greater adherence to complementary medicine, but lower belief in holistic health. They had higher distrust in the mainstream healthcare system, higher conspiracist ideation, and were more likely to vote for minor political parties. They were more likely to be male, religious, have children, and self-report better health. CONCLUSIONS This research revealed HOW profiles of psychosocial characteristics differed between each of the five attitudes to childhood vaccines. PRACTICE IMPLICATIONS These findings are useful for tailoring communications about vaccination-related concerns. They also show that more granular classification and measurement of vaccine attitudes may be useful.
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Affiliation(s)
- Tomas Rozbroj
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia.
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
| | - Jayne Lucke
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; School of Public Health, The University of Queensland, Australia
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286
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Hakim H, Provencher T, Chambers CT, Driedger SM, Dube E, Gavaruzzi T, Giguere AMC, Ivers NM, MacDonald S, Paquette JS, Wilson K, Reinharz D, Witteman HO. Interventions to help people understand community immunity: A systematic review. Vaccine 2018; 37:235-247. [PMID: 30528593 DOI: 10.1016/j.vaccine.2018.11.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/05/2018] [Accepted: 11/01/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Herd immunity, or community immunity, occurs when susceptible people in a population are indirectly protected from infection thanks to the pervasiveness of immunity within the population. In this study, we aimed to systematically review interventions designed to communicate what community immunity is and how community immunity works to members of the general public. METHODS We searched PubMed, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials and Web of Science for peer-reviewed articles describing interventions with or without evaluations. We then conducted web searches with Google to identify interventions lacking associated publications. We extracted data about the target population of the interventions, the interventions themselves (e.g., did they describe what community immunity is, and how it works), any effects of evaluated interventions, and synthesized data narratively. RESULTS We identified 32 interventions: 11 interventions described in peer-reviewed articles and 21 interventions without associated articles. Of the 32 interventions, 5 described what community immunity is, 6 described the mechanisms of how community immunity occurs and 21 described both. Fourteen of the 32 addressed infectious diseases in general while the other 13 addressed one or more specific diseases. Twelve of the 32 interventions used videos, 7 used interactive simulations and 6 used questionnaires. Ten of the 11 peer-reviewed articles described studies evaluating at least one effect of the interventions. Within these 10, 4/4 reported increased knowledge, 3/5 reported shifts of attitudes in favour of vaccination, 2/5 reported increased intentions to vaccinate. Of 3 studies evaluating interventions specifically about community immunity, 2 reported increased intentions to vaccinate. CONCLUSIONS A compelling benefit of vaccination exists at the population level in the form of community immunity. Identifying ways to optimally communicate about this benefit may be important, because some evidence suggests that effective communication about community immunity can increase vaccination intentions.
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Affiliation(s)
- Hina Hakim
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
| | | | - Christine T Chambers
- Department of Pediatrics and Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Eve Dube
- Institut national de santé publique du Québec, Quebec City, QC, Canada.
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padova, Italy.
| | - Anik M C Giguere
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
| | - Noah M Ivers
- Department of Family and Community Medicine, Women's College Hospital - University of Toronto, Toronto, ON, Canada.
| | | | - Jean-Sebastien Paquette
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Daniel Reinharz
- Department of Social and Preventive Medicine, Laval University, Quebec City, QC, Canada.
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
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287
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Wiyeh AB, Cooper S, Nnaji CA, Wiysonge CS. Vaccine hesitancy ‘outbreaks’: using epidemiological modeling of the spread of ideas to understand the effects of vaccine related events on vaccine hesitancy. Expert Rev Vaccines 2018; 17:1063-1070. [DOI: 10.1080/14760584.2018.1549994] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Alison B. Wiyeh
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Chukwudi A. Nnaji
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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288
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Maurici M, Arigliani M, Dugo V, Leo C, Pettinicchio V, Arigliani R, Franco E. Empathy in vaccination counselling: a survey on the impact of a three-day residential course. Hum Vaccin Immunother 2018; 15:631-636. [PMID: 30325260 PMCID: PMC6605730 DOI: 10.1080/21645515.2018.1536587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND In an era of hesitance to use vaccines, the importance of effective communication for increasing vaccine acceptance is well known. This study aimed to assess the impact of a three-day residential course concerning empathy and counselling abilities on patients' ratings of the level of empathy of physicians and nurses working in vaccination centers. METHODS The empathy of healthcare providers was evaluated using the Adapted Consultation and Relational Empathy (CARE) Measure. The survey involved 20 healthcare workers, doctors, and nurses in three immunization services of a Local Health Unit in South Italy. Before and after attending the course, all of them administered the questionnaire to 50 consecutive parents of vaccinated children. Statistical tests were used to assess the homogeneity of pre- and post -course samples, to measure the level of empathy perceived by parents in doctors and nurses in pre- and post-course evaluations, and to compare the average CARE Measure scores among groups. RESULTS Analysis of the questionnaires showed an increase of "excellent" scores and statistically significant differences between the pre- and post -course median values. Statistically significant differences between doctors and nurses were shown in almost all questions pre-course and in only four questions post-course. CONCLUSIONS This study demonstrated that a residential course is effective at improving patient-rated empathy of doctors and nurses working in vaccination centers and could result in an increase of parents' adherence to vaccination programs.
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Affiliation(s)
- Massimo Maurici
- a Department of Biomedicine and Prevention , University of Rome Tor Vergata , Italy
| | - Michele Arigliani
- b Department of Clinical and Experimental Medical Sciences , University Hospital of Udine , Italy
| | - Valentina Dugo
- c Department of Biomedicine and Prevention, Specialization School for Hygiene and Preventive Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Carlo Leo
- d Department of Clinical and Experimental Medical Sciences , University Hospital of Udine, Italy TO Department of Medicine , Udine , Italy
| | - Valentina Pettinicchio
- c Department of Biomedicine and Prevention, Specialization School for Hygiene and Preventive Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Raffaele Arigliani
- e Department of Biomedicine and Prevention , Specialization School for Hygiene and Preventive Medicine, University of Rome Tor Vergata , Rome , Italy
| | - Elisabetta Franco
- a Department of Biomedicine and Prevention , University of Rome Tor Vergata , Italy
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289
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Dubé E, Gagnon D, MacDonald N, Bocquier A, Peretti-Watel P, Verger P. Underlying factors impacting vaccine hesitancy in high income countries: a review of qualitative studies. Expert Rev Vaccines 2018; 17:989-1004. [DOI: 10.1080/14760584.2018.1541406] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Eve Dubé
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
- Axe maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Dominique Gagnon
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Aurélie Bocquier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Patrick Peretti-Watel
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Pierre Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
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290
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Dubé È, Farrands A, Lemaitre T, Boulianne N, Sauvageau C, Boucher FD, Tapiero B, Quach C, Ouakki M, Gosselin V, Gagnon D, De Wals P, Petit G, Jacques MC, Gagneur A. Overview of knowledge, attitudes, beliefs, vaccine hesitancy and vaccine acceptance among mothers of infants in Quebec, Canada. Hum Vaccin Immunother 2018; 15:113-120. [PMID: 30095325 DOI: 10.1080/21645515.2018.1509647] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Vaccine hesitancy (VH) is a growing problem. The first step in addressing VH is to have an understanding of who are the hesitant individuals and what are their specific concerns. The aim of this survey was to assess mothers' level of vaccine hesitancy and vaccination knowledge, attitudes, and beliefs. METHODS Mothers of newly-born infants in four maternity wards in Quebec (Canada) completed a self-administered questionnaire. The questionnaire included items to assess VH and intention to vaccinate. VH scores were calculated using the Parents Attitudes about Childhood Vaccines (PACV) survey. Multivariate logistic regression was performed to determine variables associated with intention to vaccinate (OR; 95% CI). RESULTS Overall, 2645 questionnaires were included in this analysis and 77.5% of respondents certainly intended to vaccinate their infant at 2 months of age. Based on the PACV 100-point scale, 56.4% of mothers had a 0 to ˂30 score (low level of VH); 28.6% had a 30 to ˂50 and 15.0% had a score of 50 and higher (high level of VH).The main determinants of mothers' intention to vaccinate were the perceived importance of vaccinating infants at 2 months of age (OR = 9.2; 5.9-14.5) and a low score of VH (OR = 7.4; 5.3-10.3). DISCUSSION Although the majority of mothers held positive attitudes toward vaccination, a large proportion were moderately or highly vaccine hesitant. Mothers' level of VH was strongly associated with their intention to vaccinate their infants, showing the potential detrimental impact of VH on vaccine uptake rates and the importance of addressing this phenomenon.
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Affiliation(s)
- Ève Dubé
- a Institut national de santé publique du Québec , Québec , Québec , Canada
| | - Anne Farrands
- b Centre de recherche du CHUS , Sherbrooke , Québec , Canada
| | - Thomas Lemaitre
- b Centre de recherche du CHUS , Sherbrooke , Québec , Canada
| | - Nicole Boulianne
- a Institut national de santé publique du Québec , Québec , Québec , Canada
| | - Chantal Sauvageau
- a Institut national de santé publique du Québec , Québec , Québec , Canada
| | - François D Boucher
- c Centre de recherche du Centre Hospitalier Universitaire de Québec , Québec , Québec , Canada
| | - Bruce Tapiero
- d Department of Pediatrics, CHU Sainte Justine , Université de Montréal , Montréal , Québec , Canada
| | - Caroline Quach
- e Vaccine Study Centre , McGill University Health Centre Research Institute , Montréal , Québec , Canada
| | - Manale Ouakki
- a Institut national de santé publique du Québec , Québec , Québec , Canada
| | | | - Dominique Gagnon
- a Institut national de santé publique du Québec , Québec , Québec , Canada
| | - Philippe De Wals
- f Department of Social and Preventive Medicine , Laval University , Québec , Canada
| | - Geneviève Petit
- g Direction de santé publique du CIUSSS de l'Estrie, CHUS, Département des sciences de la santé communautaire , Université de Sherbrooke , Sherbrooke, Québec , Canada
| | - Marie-Claude Jacques
- h Institut universitaire de première ligne en santé et services sociaux du CIUSSS de l'Estrie - CHUS , Sherbrooke, Québec , Canada
| | - Arnaud Gagneur
- b Centre de recherche du CHUS , Sherbrooke , Québec , Canada.,i Department of Pediatrics, Centre hospitalier universitaire de Sherbrooke , Université de Sherbrooke , Sherbrooke , Québec , Canada
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291
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Domek GJ, O'Leary ST, Bull S, Bronsert M, Contreras-Roldan IL, Bolaños Ventura GA, Kempe A, Asturias EJ. Measuring vaccine hesitancy: Field testing the WHO SAGE Working Group on Vaccine Hesitancy survey tool in Guatemala. Vaccine 2018; 36:5273-5281. [PMID: 30061026 DOI: 10.1016/j.vaccine.2018.07.046] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/14/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Despite safe and effective childhood immunizations, decreased acceptance of vaccines has become an emerging global problem. The WHO SAGE Working Group on Vaccine Hesitancy developed a common diagnostic tool, the Vaccine Hesitancy Scale (VHS), to identify and compare hesitancy in different global settings. We field tested the VHS in rural and urban Guatemala. METHODS We analyzed data from the enrollment visit of a study conducted at four public health clinics in Guatemala. Infants ages 6 weeks-6 months presenting for their first wellness visit were enrolled March-November 2016. Parents completed a demographic survey that included the 10 dichotomous and 10 Likert scale VHS questions. Chi-square or Fisher's exact for categorical and ANOVA test for continuous variables were used to assess significance levels in survey differences. We conducted a factor analysis to assess the Likert scale questions. RESULTS Of 1088 families screened, 871 were eligible and 720 (82.7%) participated. No parent had ever refused a vaccination, and only eight parents (1.1%) had been reluctant or hesitated to get a vaccination for their children. However, only 40.8% (n = 294) of parents said that they think most parents like them have their children vaccinated with all the recommended vaccines. Factor analysis identified two underlying constructs that had eigenvalues of 1.0 or greater and a substantive lack of variability in response across the Likert scale. There were consistent differences between how study clinics responded to the ordinal scaling. CONCLUSION Our results suggest problems with interpretation of the VHS, especially in the presence of vaccine shortages and using a Likert scale that does not resonate across diverse cultural settings. Our factor analysis suggests that the Likert scale items are more one-dimensional and do not represent the multiple constructs of vaccine hesitancy. We suggest more work is needed to refine this survey for improved reliability and validity. Clinical Trial Registry: NCT02567006.
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Affiliation(s)
- Gretchen J Domek
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, B065, 13123 E 16th Ave, Aurora, CO 80045, USA; Center for Global Health, Colorado School of Public Health, A090, 13199 E Montview Blvd, Suite 310, Aurora, CO 80045, USA.
| | - Sean T O'Leary
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, B065, 13123 E 16th Ave, Aurora, CO 80045, USA; Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, F443, 13199 E Montview Blvd, Suite 300, Aurora, CO 80045, USA.
| | - Sheana Bull
- Center for Global Health, Colorado School of Public Health, A090, 13199 E Montview Blvd, Suite 310, Aurora, CO 80045, USA; Department of Community and Behavioral Health, Colorado School of Public Health, B119, 13001 E 17th Place, Aurora, CO 80045, USA.
| | - Michael Bronsert
- Center for Global Health, Colorado School of Public Health, A090, 13199 E Montview Blvd, Suite 310, Aurora, CO 80045, USA; Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, F443, 13199 E Montview Blvd, Suite 300, Aurora, CO 80045, USA.
| | - Ingrid L Contreras-Roldan
- Center for Health Studies, Universidad del Valle de Guatemala, 18 Av. 11-95, Zona 15, Vista Hermosa III, Guatemala City, Guatemala.
| | - Guillermo Antonio Bolaños Ventura
- Center for Human Development at the Southwest Trifinio, Finca Mojarras, aldea Los Encuentros, Caballo Blanco, Retalhuleu, Guatemala.
| | - Allison Kempe
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, B065, 13123 E 16th Ave, Aurora, CO 80045, USA; Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, F443, 13199 E Montview Blvd, Suite 300, Aurora, CO 80045, USA.
| | - Edwin J Asturias
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, B065, 13123 E 16th Ave, Aurora, CO 80045, USA; Center for Global Health, Colorado School of Public Health, A090, 13199 E Montview Blvd, Suite 310, Aurora, CO 80045, USA; Department of Epidemiology, Colorado School of Public Health, B119, 13001 E 17th Place, Aurora, CO 80045, USA.
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292
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Head KJ, Biederman E, Sturm LA, Zimet GD. A retrospective and prospective look at strategies to increase adolescent HPV vaccine uptake in the United States. Hum Vaccin Immunother 2018; 14:1626-1635. [PMID: 29359986 PMCID: PMC6067847 DOI: 10.1080/21645515.2018.1430539] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/20/2017] [Accepted: 01/15/2018] [Indexed: 01/06/2023] Open
Abstract
The HPV vaccine debuted more than ten years ago in the United States and many strategies have been evaluated to increase HPV vaccination rates, which include not only improving current vaccination behaviors but also sustaining these behaviors. Researchers and practitioners from a variety of backgrounds have engaged in this work, which has included efforts directed at public health and government policies, health education and health promotion programs, and clinical and patient-provider approaches, as well as work aimed to respond to and combat anti-HPV vaccination movements in society. Using a previously developed conceptual model to organize and summarize each of these areas, this paper also highlights the need for future HPV vaccine promotion work to adopt a multi-level and, when possible, integrated approach in order to maximize impact on vaccination rates.
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Affiliation(s)
- Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | | | - Lynne A. Sturm
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gregory D. Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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293
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Daley MF, Narwaney KJ, Shoup JA, Wagner NM, Glanz JM. Addressing Parents' Vaccine Concerns: A Randomized Trial of a Social Media Intervention. Am J Prev Med 2018; 55:44-54. [PMID: 29773490 PMCID: PMC8606186 DOI: 10.1016/j.amepre.2018.04.010] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/01/2018] [Accepted: 04/02/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Successful strategies are needed to address parental vaccine hesitancy, a significant public health issue. The study objective was to assess whether an Internet-based platform with vaccine information and interactive social media components improved parents' vaccine-related attitudes. STUDY DESIGN A three-arm RCT. SETTING/PARTICIPANTS The study was conducted in a large Colorado integrated healthcare organization. Parents were enrolled during September 2013 through October 2015 and followed through November 2016; data were analyzed in 2017. Parents, recruited during pregnancy, were given a survey about vaccine-related attitudes at enrollment (i.e., baseline) and when their child was aged 3-5 months and 12-15 months (Timepoints 1 and 2, respectively). Parental vaccine hesitancy was assessed at baseline. INTERVENTION Study participants were randomized to the following: a study website with vaccine information and social media components (VSM arm); a website with vaccine information only (VI); or usual care. MAIN OUTCOME MEASURES Change in parental vaccine attitudes over time by baseline degree of vaccine hesitancy. RESULTS Among 1,093 study participants, 945 (86.5%) completed all three surveys. Comparing baseline with Timepoint 1 among vaccine-hesitant parents, the VSM and VI arms were associated with significant improvements in attitudes regarding vaccination benefits compared to usual care (VSM mean change 0.23 on a 5-point scale, 95% CI=0.05, 0.40, VI mean change 0.22, 95% CI=0.04, 0.40). Comparing baseline with Timepoint 2 among hesitant parents, the VSM and VI arms were also associated with significant reductions in parental concerns about vaccination risks compared to usual care (VSM mean change -0.37, 95% CI= -0.60, -0.14, VI mean change -0.31, 95% CI= -0.55, -0.07). Self-efficacy around vaccine decision making also improved among vaccine-hesitant parents. No intervention effect was observed among parents not vaccine-hesitant at baseline. CONCLUSIONS Among vaccine-hesitant parents, an Internet-based intervention improved parents' attitudes about vaccines. TRIAL REGISTRATION This study was registered at www.clinicaltrials.gov NCT01873040.
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Affiliation(s)
- Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
| | - Komal J Narwaney
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Nicole M Wagner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
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294
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Gagneur A, Lemaître T, Gosselin V, Farrands A, Carrier N, Petit G, Valiquette L, De Wals P. A postpartum vaccination promotion intervention using motivational interviewing techniques improves short-term vaccine coverage: PromoVac study. BMC Public Health 2018; 18:811. [PMID: 29954370 PMCID: PMC6022497 DOI: 10.1186/s12889-018-5724-y] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the increasing number of vaccine-hesitant parents, new effective immunization promotion strategies need to be developed to improve the vaccine coverage (VC) of infants. This study aimed to assess the impact of an educational strategy of vaccination promotion based on motivational interviewing (MI) techniques targeting parents and delivered at the maternity ward, for the VC of infants at 3, 5, and 7 months of age. METHODS An individual educational information session, administered using MI techniques, regarding immunization of infants aged 2, 4, and 6 months was (experimental group) or was not (control group) proposed to parents during the postpartum stay at the maternity ward. Immunization data were obtained through the Eastern Townships Public Health registry for infants at 3, 5, and 7 months of age. Absolute VC increases at 3, 5, and 7 months in the experimental group were calculated and the relative risks with the respective 95% confidence intervals were computed using univariate logistic regression with the generalized estimating equations (GEE) procedure. Multivariate regression using GEE was used to adjust for confounding variables. RESULTS In the experimental and control groups, 1140 and 1249 newborns were included, respectively. A significant increase in VC of 3.2, 4.9, and 7.3% was observed at 3, 5, and 7 months of age (P < 0.05), respectively. The adjusted relative risk of the intervention's impact on vaccination status at 7 months of age was 1.08 (95% confidence interval: 1.03-1.14) (P = 0.002). CONCLUSIONS An educational strategy using MI techniques delivered at the maternity ward may be effective in increasing VC of infants at ages 3, 5, and 7 months. MI could be an effective tool to overcome vaccine hesitancy.
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Affiliation(s)
- Arnaud Gagneur
- Department of Pediatrics, Neonatology Unit, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada. .,Centre de Recherche du Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - Thomas Lemaître
- Centre de Recherche du Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada
| | - Virginie Gosselin
- Centre de Recherche du Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada
| | - Anne Farrands
- Centre de Recherche du Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada
| | - Nathalie Carrier
- Centre de Recherche du Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada
| | - Geneviève Petit
- Eastern Townships Public Health Department, 300 King Est, bureau 300, Sherbrooke, Quebec, J1G 1B1, Canada
| | - Louis Valiquette
- Centre de Recherche du Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada.,Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada
| | - Philippe De Wals
- Department of Social and Preventive Medicine, Laval University, Quebec City, Quebec, Canada
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295
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Browne M. Epistemic divides and ontological confusions: The psychology of vaccine scepticism. Hum Vaccin Immunother 2018; 14:2540-2542. [PMID: 29863949 DOI: 10.1080/21645515.2018.1480244] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Vaccine scepticism is an increasingly important barrier to optimal coverage in developed countries. In this commentary, we make the case that negative attitudes towards vaccines reflect a broader and deeper set of beliefs about health and wellbeing. We suggest that this alternative worldview is influenced by ontological confusions (e.g. regarding purity, natural energy), and knowledge based on personal lived experience and trusted peers, rather than the positivist epistemological framework. Our view is supported by recent social-psychological research, including strong correlations of vaccine scepticism with adherence to complementary and alternative medicine, magical health beliefs, and conspiracy ideation. For certain well-educated and well-resourced individuals, opposition to vaccines represents an expression of personal intuition and agency, in achieving a positive and life-affirming approach to health and wellbeing. These core beliefs are not amenable to change - and especially resistant to communications from orthodox, authoritative sources. Although this view does suggest tactical improvements to messaging, we suggest that a better long-term strategy is to combine with other disciplines in order to address the root causes of vaccine scepticism. Vaccine scepticism is unlikely to thrive in a cultural context that trusts and values the scientific consensus.
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Affiliation(s)
- Matthew Browne
- a School of Medical, Health & Applied Sciences, Central Queensland University , Bundaberg , Australia
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296
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Pottinger HL, Jacobs ET, Haenchen SD, Ernst KC. Parental attitudes and perceptions associated with childhood vaccine exemptions in high-exemption schools. PLoS One 2018; 13:e0198655. [PMID: 29902199 PMCID: PMC6002085 DOI: 10.1371/journal.pone.0198655] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/21/2018] [Indexed: 11/21/2022] Open
Abstract
Previous work demonstrates that individuals who obtain exemptions from school immunization requirements are geographically clustered, making regional differences in vaccination coverage a significant concern. Even where exemption levels are high, there are still parents that vaccinate. School-level assessments have determined that exemptors are more likely to attend wealthier schools with fewer minorities. Few studies have assessed divergent opinions within the context of a higher-exemption community to examine subtle differences in opinion surrounding vaccinations. Therefore, the objective of this work was to assess attitudes and perceptions towards vaccinations and compare them for exemptors and non-exemptors. We administered surveys to parents in high-exemption (>10%) elementary schools in Arizona during the 2012–13 school year. A total of 404 surveys were completed by parents among schools in Maricopa (n = 7) and Yavapai (n = 2) counties. Of these, 35% (n = 141) were exemptors and 65% (n = 261) were non-exemptors. Exemptors were more likely than non-exemptors to be concerned about serious side-effects (p<0.001). They were more likely to report knowing someone who had been diagnosed with a vaccine-preventable disease (p<0.001) but less likely to report that this had been a serious illness in that person (p<0.001) and they believed it is better for a child to develop immunity through illness than vaccination (p<0.001). They were less likely to trust physicians (p<0.001) and information about vaccines (p<0.001) and were more likely to obtain their health care from a naturopath (p<0.001). In summary, exemptors in these Arizona schools do not appear to be exempting their children from vaccinations due to convenience, as has been hypothesized in other settings. Based on the divergent views within high-exemption schools and reported distrust of the medical establishment, target interventions for high-exemption schools are discussed. Additionally, given the lack of effective non-policy based interventions to-date, the negligible declines in personal belief exemption rates, and vaccine preventable disease rate increases in Arizona, especially in high-exemption areas, legislative action in Arizona may also warrant further investigation.
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Affiliation(s)
- Heidi L. Pottinger
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
- * E-mail:
| | - Elizabeth T. Jacobs
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
- University of Arizona Cancer Center, University of Arizona, Tucson, Arizona, United States of America
| | - Steven D. Haenchen
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Kacey C. Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
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297
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Fokoun C. Strategies implemented to address vaccine hesitancy in France: A review article. Hum Vaccin Immunother 2018; 14:1580-1590. [PMID: 29608390 DOI: 10.1080/21645515.2018.1458807] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Vaccination has been identified many decades ago as an effective means to prevent several diseases. However, in France, there is an emergence of vaccine hesitancy, that has caused a reduction of vaccination coverage rates. This issue reduces the effectiveness of the immunization process, and represents a real threat to public health that should be urgently addressed. The purpose of this review is to present actions that have been taken to fight against vaccine hesitancy and thus enhance vaccine uptake. The results indicate that different strategies have been proposed to reach this goal, mainly by vaccination campaigns. These findings highlight the strong implication of national health authorities and the medical staff of hospitals and health-care centers. However, actions implemented should be part of a long-term approach, and further studies are required to identify the most effective strategies to address vaccine hesitancy.
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Affiliation(s)
- Cécile Fokoun
- a Hospices Civils de Lyon, Lyon Public Health Institute , Lyon , France
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298
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Implementation of maternal influenza immunization in El Salvador: Experiences and lessons learned from a mixed-methods study. Vaccine 2018; 36:4054-4061. [PMID: 29859803 DOI: 10.1016/j.vaccine.2018.05.096] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/10/2018] [Accepted: 05/23/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The World Health Organization (WHO) recommends that countries prioritize pregnant women for influenza vaccination, yet few low- or middle-income countries (LMICs) have implemented maternal influenza immunization programs. To inform vaccine decision-making and operational planning in LMICs, there is a need to document and share experiences from countries that provide seasonal influenza vaccine to pregnant women, particularly those with high coverage, like El Salvador. METHODS In 2015 and 2016, PATH and country researchers conducted a mixed-methods study to document the experience and lessons learned from maternal influenza immunization delivery and acceptance in El Salvador as part of a collaborative effort between WHO and PATH. Researchers conducted focus group discussions, semi-structured interviews, antenatal clinic exit interviews, and key informant interviews with 326 participants from two municipalities in each of the country's three regions. Respondents included pregnant and recently pregnant women, family members, community leaders, health personnel, public health managers and partners, and policymakers. RESULTS Factors perceived as positively influencing maternal influenza immunization delivery and acceptance in El Salvador include the use of multiple vaccine delivery strategies, targeted education and community engagement efforts, and a high degree of trust between the community and health care providers. Influenza vaccine acceptance by pregnant women is high and has improved over time, largely attributed to education targeting health care advisors. Perceived challenges to pregnant women receiving health care and vaccination include the need for permission to attend services and limited access to health services in insecure areas related to the presence of criminal gang activity. CONCLUSIONS We identified approaches and barriers perceived to affect maternal influenza vaccine delivery in El Salvador. This information will be useful to public health decision-makers and implementers in El Salvador and other countries considering introduction of new maternal vaccines or striving to increase coverage of vaccines currently provided.
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299
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Park B, Choi EJ, Park B, Han H, Cho SJ, Choi HJ, Lee S, Park H. Factors Influencing Vaccination in Korea: Findings From Focus Group Interviews. J Prev Med Public Health 2018; 51:173-180. [PMID: 30071704 PMCID: PMC6078915 DOI: 10.3961/jpmph.18.063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/25/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives Immunization is considered one of the most successful and cost-effective public health interventions protecting communities from preventable infectious diseases. The Korean government set up a dedicated workforce for national immunization in 2003, and since then has made strides in improving vaccination coverage across the nation. However, some groups remain relatively vulnerable and require intervention, and it is necessary to address unmet needs to prevent outbreaks of communicable diseases. This study was conducted to characterize persistent challenges to vaccination. Methods The study adopted a qualitative method in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist. Three focus group interviews were conducted with 15 professionals in charge of vaccination-related duties. The interviews were conducted according to a semi-structured guideline, and thematic analysis was carried out. Data saturation was confirmed when the researchers agreed that no more new codes could be found. Results A total of 4 main topics and 11 subtopics were introduced regarding barriers to vaccination. The main topics were vaccine hesitancy, personal circumstances, lack of information, and misclassification. Among them, vaccine hesitancy was confirmed to be the most significant factor impeding vaccination. It was also found that the factors hindering vaccination had changed over time and disproportionately affected certain groups. Conclusions The study identified ongoing unmet needs and barriers to vaccination despite the accomplishments of the National Immunization Program. The results have implications for establishing tailored interventions that target context- and group-specific barriers to improve timely and complete vaccination coverage.
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Affiliation(s)
- Bomi Park
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Eun Jeong Choi
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Bohyun Park
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyejin Han
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Su Jin Cho
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hee Jung Choi
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Seonhwa Lee
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyesook Park
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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300
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Parents' preferences for interventions to improve childhood immunization uptake in northern Nigeria. Vaccine 2018; 36:2833-2841. [PMID: 29661582 DOI: 10.1016/j.vaccine.2018.03.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Routine childhood immunization coverage has been low in northern Nigeria. While local authorities and international partners have been working hard to improve coverage, population preferences for interventions have not been documented. This study aimed to understand parents' preferences and identify possible interventions to improve uptake of childhood immunization. METHODS Preferences for immunization interventions were elicited using a best-worst scaling (BWS) instrument among parents with children under five. We explored the value of six program attributes (each varying across three levels) identified through a literature review and engagement with local stakeholders. In each of 18 hypothetical programs identified through a main effect orthogonal design, respondents selected the best and worst attributes that may facilitate vaccination of children. Assuming sequential best-worst responses, we used conditional logit to estimate preferences. We employed latent class analysis (LCA) to categorize and examine respondents' preferences across interventions. RESULTS 97 men and 101 women in 198 households were surveyed. The most preferred level for each attribute included door-to-door vaccinations, free food supplements, bundling with nutritional support programs, involvement of religious leaders, information dissemination through media campaigns, and strengthening of health services by the government. Three types of preferences were recognized in the LCA. The value-driven group (14%) characterized by youngest age, predominantly female, and lower education perceived bundled services with food and nutritional programs as the most important feature of an intervention. Convenience and information seekers (28%) characterized by oldest age and the lowest employment preferred door-to-door vaccinations and media campaigns. The remaining complacent group (58%), characterized by highest education and highest employment, did not show strong preferences to any intervention compared to the other two groups. CONCLUSIONS Routine immunization programs should consider joining forces with food and nutritional programs to improve vaccination uptake. Incorporating door-to-door visits and media campaigns to target older and unemployed populations may increase childhood immunization uptake in northern Nigeria.
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