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Burns S, Bhoyroo R, Leavy JE, Jancey J, Saltis H, Millar L, Hendriks J, Portsmouth L, Tohotoa J, Seewoo D, Pollard C. Parents' attitudes towards the No Jab No Play legislation in Western Australia: a mixed methods study. BMC Public Health 2024; 24:1514. [PMID: 38840254 PMCID: PMC11155006 DOI: 10.1186/s12889-024-18995-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 05/29/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Mandates provide a relatively cost-effective strategy to increase vaccinate rates. Since 2014, five Australian states have implemented No Jab No Play (NJPlay) policies that require children to be fully immunised to attend early childhood education and childcare services. In Western Australia, where this study was conducted, NJNPlay legislation was enacted in 2019. While most Australian families support vaccine mandates, there are a range of complexities and unintended consequences for some families. This research explores the impact on families of the NJNPlay legislation in Western Australia (WA). METHODS This mixed-methods study used an online parent/carer survey (n = 261) representing 427 children and in-depth interviews (n = 18) to investigate: (1) the influence of the NJNPlay legislation on decision to vaccinate; and (2) the financial and emotional impacts of NJNPlay legislation. Descriptive and bivariate tests were used to analyse the survey data and open-ended questions and interviews were analysed using reflexive thematic analysis to capture the experience and the reality of participants. RESULTS Approximately 60% of parents intended to vaccinate their child. Parents who had decided not to vaccinate their child/ren were significantly more likely to experience financial [p < 0.001] and emotional impacts [p < 0.001], compared to those who chose to vaccinate because of the mandate. Qualitative data were divided with around half of participants supporting childhood immunisation and NJNPlay with others discussing concerns. The themes (a) belief in the importance of vaccination and ease of access, (b) individual and community protection, and (c) vaccine effectiveness, safety and alternatives help understand how parents' beliefs and access may influence vaccination uptake. Unintended impacts of NJNPlay included: (a) lack of choice, pressure and coercion to vaccinate; (b) policy and community level stigma and discrimination; (c) financial and career impacts; and (d) loss of education opportunities. CONCLUSIONS Parents appreciation of funded immunisation programs and mandates which enhance individual and community protection was evident. However for others unintended consequences of the mandate resulted in significant social, emotional, financial and educational impacts. Long-term evidence highlights the positive impact of immunisation programs. Opinions of impacted families should be considered to alleviate mental health stressors.
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Affiliation(s)
- Sharyn Burns
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA, 6102, Australia.
| | - Ranila Bhoyroo
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA, 6102, Australia
| | - Justine E Leavy
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA, 6102, Australia
| | - Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA, 6102, Australia
| | - Hanna Saltis
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA, 6102, Australia
| | - Lynne Millar
- Telethon Kids Institute, Perth, WA, 6102, Australia
| | - Jacqueline Hendriks
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA, 6102, Australia
| | - Linda Portsmouth
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA, 6102, Australia
| | - Jenny Tohotoa
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA, 6102, Australia
| | - Danveer Seewoo
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA, 6102, Australia
| | - Christina Pollard
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA, 6102, Australia
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Sharif-Nia H, She L, Allen KA, Marôco J, Kaur H, Arslan G, Gorgulu O, Osborne JW, Rahmatpour P, Khoshnavay Fomani F. Parental hesitancy toward children vaccination: a multi-country psychometric and predictive study. BMC Public Health 2024; 24:1348. [PMID: 38762744 PMCID: PMC11102617 DOI: 10.1186/s12889-024-18806-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/09/2024] [Indexed: 05/20/2024] Open
Abstract
AIM Understanding vaccine hesitancy, as a critical concern for public health, cannot occur without the use of validated measures applicable and relevant to the samples they are assessing. The current study aimed to validate the Vaccine Hesitancy Scale (VHS) and to investigate the predictors of children's vaccine hesitancy among parents from Australia, China, Iran, and Turkey. To ensure the high quality of the present observational study the STROBE checklist was utilized. DESIGN A cross-sectional study. METHOD In total, 6,073 parent participants completed the web-based survey between 8 August 2021 and 1 October 2021. The content and construct validity of the Vaccine Hesitancy Scale was assessed. Cronbach's alpha and McDonald's omega were used to assess the scale's internal consistency, composite reliability (C.R.) and maximal reliability (MaxR) were used to assess the construct reliability. Multiple linear regression was used to predict parental vaccine hesitancy from gender, social media activity, and perceived financial well-being. RESULTS The results found that the VHS had a two-factor structure (i.e., lack of confidence and risk) and a total of 9 items. The measure showed metric invariance across four very different countries/cultures, showed evidence of good reliability, and showed evidence of validity. As expected, analyses indicated that parental vaccine hesitancy was higher in people who identify as female, more affluent, and more active on social media. CONCLUSIONS The present research marks one of the first studies to evaluate vaccine hesitancy in multiple countries that demonstrated VHS validity and reliability. Findings from this study have implications for future research examining vaccine hesitancy and vaccine-preventable diseases and community health nurses.
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Affiliation(s)
- Hamid Sharif-Nia
- Psychosomatic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Nursing, Amol School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Long She
- Sunway Business School, Sunway University, Sunway City, Malaysia
| | - Kelly-Ann Allen
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Clayton, Australia
- Centre for Wellbeing Science, Faculty of Education, University of Melbourne, Parkville, Australia
| | - João Marôco
- William James Centre for Research ISPA - Instituto Universitário, Lisboa, Portugal
| | - Harpaljit Kaur
- Business School, Taylor's University Lakeside Campus, Subang Jaya, Malaysia
| | - Gökmen Arslan
- Department of Psychological Counseling, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
| | - Ozkan Gorgulu
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | | | - Pardis Rahmatpour
- School of Nursing, Alborz University of Medical Sciences, Karaj, Iran
| | - Fatemeh Khoshnavay Fomani
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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Jordan Z, Rowland E. Parental perceptions of chickenpox and the varicella vaccine: A qualitative systematic review. Vaccine 2024; 42:75-83. [PMID: 38129287 DOI: 10.1016/j.vaccine.2023.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND In countries where varicella vaccination is not on the routine childhood immunisation schedule, such as those in the United Kingdom (UK), chickenpox is an almost universal disease of childhood. Chickenpox can cause serious complications, particularly in infants, pregnant women, and the immunocompromised. In November 2023 the varicella vaccine was recommended for inclusion in the UK routine childhood immunisation schedule. Successful rollout of the vaccine may be hindered by parental concerns about vaccine safety and efficacy, and perceptions of chickenpox as a mild illness. OBJECTIVE To examine parental perceptions of chickenpox and varicella vaccination, which may be crucial to effective vaccination campaigns. DESIGN Qualitative systematic review and thematic analysis. METHODS Six electronic databases were systematically searched for studies published between 2016 and 2023: CINAHL, EMBASE, MEDLINE, PsycInfo, PubMed, and Web of Science. The included studies were appraised against the Critical Appraisal Skills Program checklist for qualitative studies. Thematic analysis was used to analyse qualitative data, through the development of themes. RESULTS 22 articles were included in this review, and five themes identified: perceptions that chickenpox is a mild illness, that parents have concerns about varicella vaccine efficacy and safety, a notion of natural immunity as superior, social determinants of health influence vaccine decision making, and vaccination is overwhelming perceived as a parental decision. CONCLUSIONS Whilst some parents displayed an acceptance and willingness to vaccinate against chickenpox, many expressed concerns, and perceived chickenpox as a routine unworrying childhood illness. Analysis demonstrated a knowledge gap in understanding UK parental opinions regarding chickenpox and varicella vaccination, highlighting the need for research in this area, particularly given ongoing reconsideration for inclusion in the UK vaccination schedule. REGISTRATION The review was registered on PROSPERO, registration ID CRD42021236120.
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Affiliation(s)
- Zoe Jordan
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK; University Hospitals Bristol and Weston NHS Foundation Trust, UK.
| | - Emma Rowland
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
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Tabak BM, Froner MB, Corrêa RS, Silva TC. The Intersection of Health Literacy and Public Health: A Machine Learning-Enhanced Bibliometric Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6951. [PMID: 37887689 PMCID: PMC10606076 DOI: 10.3390/ijerph20206951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023]
Abstract
In recent decades, health literacy has garnered increasing attention alongside a variety of public health topics. This study aims to explore trends in this area through a bibliometric analysis. A Random Forest Model was utilized to identify keywords and other metadata that predict average citations in the field. To supplement this machine learning analysis, we have also implemented a bibliometric review of the corpus. Our findings reveal significant positive coefficients for the keywords "COVID-19" and "Male", underscoring the influence of the pandemic and potential gender-related factors in the literature. On the other hand, the keyword "Female" showed a negative coefficient, hinting at possible disparities that warrant further investigation. Additionally, evolving themes such as COVID-19, mental health, and social media were discovered. A significant change was observed in the main publishing journals, while the major contributing authors remained the same. The results hint at the influence of the COVID-19 pandemic and a significant association between gender-related keywords on citation likelihood, as well as changing publication strategies, despite the fact that the main researchers remain those who have been studying health literacy since its creation.
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Affiliation(s)
- Benjamin Miranda Tabak
- School of Public Policy and Government, Getulio Vargas Foundation, SGAN 602 Módulos A,B,C, Asa Norte, Brasília 70830-020, Brazil
| | - Matheus B. Froner
- School of Public Policy and Government, Getulio Vargas Foundation, SGAN 602 Módulos A,B,C, Asa Norte, Brasília 70830-020, Brazil
| | - Rafael S. Corrêa
- School of Public Policy and Government, Getulio Vargas Foundation, SGAN 602 Módulos A,B,C, Asa Norte, Brasília 70830-020, Brazil
| | - Thiago C. Silva
- Graduate Programme of Economics, Catholic University of Brasília, Taguatinga 71966-700, Brazil
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Sarbakhsh P, Jafari N, Salemi S, Akbarnejad R. Predictors of Pediatric COVID-19 vaccination: a case-control study in Tabriz, Iran. BMC Pediatr 2023; 23:379. [PMID: 37525177 PMCID: PMC10388523 DOI: 10.1186/s12887-023-04202-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/22/2023] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION COVID-19 vaccination of children can help reduce the severity of the infection and the death rate caused by it and also helps achieve herd immunity. The level of acceptance and high vaccination coverage is the main elements in the success of immunization programs. Children's vaccination is dependent on their parent's decision. This study aims to identify predictors of the children's COVID-19 vaccination accomplishment by their parents. METHOD In this case-control study, 577 vaccinated children as cases and 366 un-vaccinated children as controls were randomly selected from the general population of Tabriz, Iran 2022, and their data were collected by telephone calls and interviews with the children's parents. Cases and controls were compared in terms of clinical and demographic factors of the child as well as the socioeconomic status (SES) of their parents by using a multivariable mixed-effect logistic regression model. RESULTS According to the results of the multivariable logistic regression, the age of the child (OR = 1.26 95% CI (1.14, 1.40), p-value < 0.001), previous COVID-19 infection of the child (OR = 1.92, 95% CI (1.21, 3.04), p-value < 0.001), having no underlying disease in the child (OR = 1.76, 95% CI (1.02, 3.02), p-value = 0.04), the dwelling place of the household (the high-level dwelling in compared to a low level (OR = 3.34, 95% CI (1.6, 6.64), p-value = 0.001), the middle level of dwelling compared with low level (OR = 4.87, 95% CI (2.46, 9.51), p-value < 0.001)), and Father's job (Employee and technician Fathers compared to worker fathers (OR = 2.99, 95% CI (1.55, 5.77), p-value = 0.001)) were significant independent predictors of children COVID-19 vaccination. CONCLUSION Several demographic and socioeconomic factors were associated with children's vaccination. Older children, children without any underlying disease, children with a history of COVID-19 infection, and children of parents with higher levels of SES were more likely to receive the COVID-19 vaccine. This finding can be considered in children's vaccination policymaking.
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Affiliation(s)
- Parvin Sarbakhsh
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Nasrin Jafari
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saman Salemi
- Department of Medicine, Islamic Azad University Tehran Medical Sciences, Tehran, Iran
| | - Reza Akbarnejad
- Department of Knowledge and Information Science, Education and Psychology Faculty, Azarbaijan Shahid Madani University, Tabriz, Iran
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Burns S, Bhoyroo R, Leavy JE, Portsmouth L, Millar L, Jancey J, Hendriks J, Saltis H, Tohotoa J, Pollard C. The Impact of the No Jab No Play and No Jab No Pay Legislation in Australia: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6219. [PMID: 37444067 PMCID: PMC10341108 DOI: 10.3390/ijerph20136219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/16/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
Australia has a long history of population-based immunisation programs including legislations. This paper reports on a review of evaluations of the impact of the federal No Jab No Pay (NJNPay) and state implemented No Jab No Play (NJNPlay) legislations on childhood immunisation coverage and related parental attitudes. Five databases were searched for peer-review papers (Medline (Ovid); Scopus; PsycInfo; ProQuest; and CINAHL). Additional searches were conducted in Google Scholar and Informit (Australian databases) for grey literature. Studies were included if they evaluated the impact of the Australian NJNPay and/or NJNPlay legislations. Ten evaluations were included: nine peer-review studies and one government report. Two studies specifically evaluated NJNPlay, five evaluated NJNPay, and three evaluated both legislations. Findings show small but gradual and significant increases in full coverage and increases in catch-up vaccination after the implementation of the legislations. Full coverage was lowest for lower and higher socio-economic groups. Mandates are influential in encouraging vaccination; however, inequities may exist for lower income families who are reliant on financial incentives and the need to enrol their children in early childhood centres. Vaccine refusal and hesitancy was more evident among higher income parents while practical barriers were more likely to impact lower income families. Interventions to address access and vaccine hesitancy will support these legislations.
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Affiliation(s)
- Sharyn Burns
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Ranila Bhoyroo
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Justine E. Leavy
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Linda Portsmouth
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Lynne Millar
- Telethon Kids Institute, Perth, WA 6102, Australia
| | - Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Jacqueline Hendriks
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Hanna Saltis
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Jenny Tohotoa
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Christina Pollard
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA 6102, Australia
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Dudley MZ, Schuh HB, Shaw J, Salmon DA. Attitudes and Values of US Adults Not Yet Up-to-Date on COVID-19 Vaccines in September 2022. J Clin Med 2023; 12:3932. [PMID: 37373627 PMCID: PMC10299362 DOI: 10.3390/jcm12123932] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Periodic resurgences in COVID-19 due to more contagious variants highlight the need to increase coverage of booster doses. (2) Methods: Our September 2022 nationally representative survey of US adults measured COVID-19 vaccination status, intentions, attitudes, values, and confidence in information sources. (3) Findings: Although 85% of the weighted sample reported receiving at least one dose of a COVID-19 vaccine, only 63% reported being up-to-date on COVID-19 vaccines (e.g., received a booster dose). Only 12% of those not yet up-to-date indicated they were likely to get up-to-date as soon as possible, whereas 42% were unlikely to ever get up-to-date, and 46% were still uncertain. Most of those not up-to-date on their COVID-19 vaccines were under 45 years of age (58%), without a bachelor's degree (76%), making under $75,000 annually (53%), and Republican or Independent (82%). Prevalent concerns about COVID-19 vaccines among those uncertain about getting up-to-date included: potential side effects that have not been figured out yet (88%), speed of development (77%), newness (75%), ingredients (69%), drug companies making money (67%), allergic reactions (65%), and experimenting on people (63%). (4) Conclusions: Nearly half of adults not yet up-to-date on COVID-19 vaccines were uncertain about doing so, indicating an opportunity to support their decision-making.
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Affiliation(s)
- Matthew Z. Dudley
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (H.B.S.); (D.A.S.)
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Holly B. Schuh
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (H.B.S.); (D.A.S.)
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Jana Shaw
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210, USA;
| | - Daniel A. Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (H.B.S.); (D.A.S.)
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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8
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Wand H, Vujovich-Dunn C, Moodley J, Reddy T, Naidoo S. Population-level impact of beliefs and attitudes on vaccine decision-making in South Africa: results from the COVID-19 Vaccine Survey (2021/2022). Public Health 2023; 216:58-65. [PMID: 36801593 PMCID: PMC9829597 DOI: 10.1016/j.puhe.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 12/11/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVES In addition to being home to more than seven million HIV-infected individuals, South Africa also has a high burden of COVID-19 and related comorbidities worldwide. We aimed to identify the most influential "beliefs" and "attitudes" on vaccine decision-making behavior. STUDY DESIGN This study used panel data from cross-sectional surveys. METHODS We used the data from Black South Africans who participated in the "COVID-19 Vaccine Surveys" (November 2021 and February/March 2022) in South Africa. Besides standard risk factor analysis, such as multivariable logistic regression models, we also used the modified version of population attributable risk percent and estimated the population-level impacts of beliefs and attitudes on vaccine decision-making behavior using the methodology in multifactorial setting. RESULTS A total of 1399 people (57% men and 43% women) who participated in both surveys were analyzed. Of these, 336 (24%) reported being vaccinated in survey 2. Overall low perceived risk, concerns around efficacy, and safety were identified as the most influential factors and associated with 52%-72% (<40 years) and 34%-55% (40+ years) of the unvaccinated individuals. CONCLUSION Our findings highlighted the most influential beliefs and attitudes on vaccine decision-making and their population-level impacts, which are likely to have significant public health implications exclusively for this population.
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Affiliation(s)
- H Wand
- Kirby Institute, University of New South Wales, Kensington, 2052, New South Wales, Australia. http://kirby.unsw.edu.au
| | - C Vujovich-Dunn
- Kirby Institute, University of New South Wales, Kensington, 2052, New South Wales, Australia.
| | - J Moodley
- The Aurum Institute, Johannesburg, South Africa.
| | - T Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, Kwazulu-Natal, South Africa.
| | - S Naidoo
- Numolux Group, Pretoria, South Africa.
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Sharif Nia H, Allen KA, Arslan G, Kaur H, She L, Khoshnavay Fomani F, Gorgulu O, Sivarajan Froelicher E. The predictive role of parental attitudes toward COVID-19 vaccines and child vulnerability: A multi-country study on the relationship between parental vaccine hesitancy and financial well-being. Front Public Health 2023; 11:1085197. [PMID: 36875362 PMCID: PMC9980903 DOI: 10.3389/fpubh.2023.1085197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/03/2023] [Indexed: 02/18/2023] Open
Abstract
Background and purpose Recent new mutations and increases in transmission of COVID-19 among adolescents and children highlight the importance of identifying which factors influence parental decisions regarding vaccinating their children. The current study aims to explore whether child vulnerability and parents' attitudes toward vaccines mediate the association between perceived financial well-being and vaccine hesitancy among parents. Method A predictive, cross-sectional, multi-country online questionnaire was administered with a convenience sample of 6,073 parents (Australia, 2,734; Iran, 2,447; China, 523; Turkey, 369). Participants completed the Parent Attitude About Child Vaccines (PACV), the Child Vulnerability Scale (CVS), a Financial Well-being (FWB) measure, and Parental Vaccine Hesitancy (PVH) questionnaire. Results The current study revealed that perceived financial well-being had significant and negative associations with parents' attitudes toward COVID-19 vaccines and child vulnerability among the Australian sample. Contrary to the Australian findings, results from Chinese participants indicated that financial well-being had significant and positive predictive effects on parent attitudes toward vaccines, child vulnerability, and parental vaccine hesitancy. The results of the Iranian sample revealed that parents' attitudes toward vaccines and child vulnerability significantly and negatively predicted parental vaccine hesitancy. Conclusion The current study revealed that a parents' perceived financial well-being had a significant and negative relationship with parental attitudes about vaccines and child vulnerability; however, it did not significantly predict parental vaccine hesitancy among Turkish parents as it did for parents in Australia, Iran, and China. Findings of the study have policy implications for how certain countries may tailor their vaccine-related health messages to parents with low financial wellbeing and parents with vulnerable children.
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Affiliation(s)
- Hamid Sharif Nia
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Kelly-Ann Allen
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Melbourne, VIC, Australia
| | - Gökmen Arslan
- Department of Psychological Counselling and Guidance, Mehmet Akif Ersoy University, Burdur, Türkiye.,Centre for Wellbeing Science, University of Melbourne, Melbourne, VIC, Australia
| | - Harpaljit Kaur
- School of Management and Marketing, Faculty of Business and Law, Taylor's University, Subang Jaya, Malaysia
| | - Long She
- Faculty of Business, Design and Arts, Swinburne University of Technology, Kuching, Sarawak, Malaysia
| | | | - Ozkan Gorgulu
- Department of Biostatistics and Medical Informatics, Kirşehir Ahi Evran University Faculty of Medicine, Kırşehir, Türkiye
| | - Erika Sivarajan Froelicher
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
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10
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Carcelen AC, Prosperi C, Mutembo S, Chongwe G, Mwansa FD, Ndubani P, Simulundu E, Chilumba I, Musukwa G, Thuma P, Kapungu K, Hamahuwa M, Mutale I, Winter A, Moss WJ, Truelove SA. COVID-19 vaccine hesitancy in Zambia: a glimpse at the possible challenges ahead for COVID-19 vaccination rollout in sub-Saharan Africa. Hum Vaccin Immunother 2022; 18:1-6. [PMID: 34227914 PMCID: PMC8920139 DOI: 10.1080/21645515.2021.1948784] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 12/17/2022] Open
Abstract
With unprecedented speed, multiple vaccines against SARS-CoV-2 are available 1 year after the COVID-19 pandemic was first identified. As we push to achieve global control through these new vaccines, old challenges present themselves, including cold-chain storage, the logistics of mass vaccination, and vaccine hesitancy. Understanding how much hesitancy toward COVID-19 vaccines might occur and what factors may be driving these concerns can improve the ability of public health workers and communicators to maximize vaccine uptake. We nested a survey within a measles-rubella mass vaccination campaign in Zambia in November 2020 and asked about sentiments and beliefs toward COVID-19 and COVID-19 vaccines. Among parents bringing their children to receive a measles-rubella vaccine, we found high acceptability of COVID-19 vaccination of their children, but substantial uncertainty and hesitancy about receiving the vaccine themselves. COVID-19 vaccination hesitancy was correlated with beliefs around COVID-19 severity and risk, as well as vaccine safety and effectiveness.
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Affiliation(s)
- Andrea C. Carcelen
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Simon Mutembo
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Laboratory Science, Macha Research Trust, Choma, Zambia
| | - Gershom Chongwe
- Department of Immunology, Tropical Diseases Research Center, Ndola, Zambia
| | - Francis D. Mwansa
- Ministry of the Health, Government of the Republic of Zambia, Lusaka, Zambia
| | | | | | - Innocent Chilumba
- Department of Immunology, Tropical Diseases Research Center, Ndola, Zambia
| | | | - Phil Thuma
- Laboratory Science, Macha Research Trust, Choma, Zambia
| | - Kelvin Kapungu
- Department of Immunology, Tropical Diseases Research Center, Ndola, Zambia
| | | | - Irene Mutale
- Department of Immunology, Tropical Diseases Research Center, Ndola, Zambia
| | - Amy Winter
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - William J. Moss
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- W Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shaun A. Truelove
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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11
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Smith SE, Sivertsen N, Lines L, De Bellis A. Decision making in vaccine hesitant parents and pregnant women - An integrative review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100062. [PMID: 38745627 PMCID: PMC11080481 DOI: 10.1016/j.ijnsa.2022.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/03/2022] [Accepted: 01/14/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives : Vaccine refusal is increasing in Australia and is a major concern in high- and middle-income countries. There is evidence to suggest that some parents, even those who elect to immunise, may be vaccine hesitant with some manipulating the schedule by excluding or delaying some vaccines. The aim of this review was to gain an understanding of factors that influence vaccine decision-making in pregnant women and parents of children. Design : An integrative review approach was used to produce an analysis of existing literature on vaccine decision-making in pregnancy and parents. As the broadest of review methods, an integrative review can include a range of experimental and non-experimental research, thereby ensuring the inclusion of data from multiple perspectives. Data Sources : Online databases were searched for research related to vaccine decision-making in pregnant women and parents. Original and review articles were sought that were published in English between 2015 and 2021. Reviewed articles included qualitative and quantitative studies and systematic reviews. No mixed methods papers were located or excluded from this review. Review methods : The review method was an integrative review informed by Coughlan. Results : Papers from thirteen predominantly high- and middle-income countries were selected for this review. A total of 31 articles fit the inclusion/exclusion criteria, including qualitative, quantitative and review articles. Three main themes were identified including the role of healthcare professionals, vaccine safety concerns and alternative influences. Alternative influences included: social media, friends and family, religion, conspiracy theories and salutogenic parenting. Findings suggest that high levels of anxiety are involved in vaccine decision-making with parents seeking information from multiple sources including healthcare professionals, friends and family and social media. Conclusions : Pregnancy is an ideal time to provide education on both pregnancy and childhood vaccinations. However, some parents reported dissatisfaction in their therapeutic relationships with healthcare professionals. As a result, parents can resort to their own information seeking, in the main via social media which has been linked to vaccine refusal. Additionally, some healthcare professionals report feeling inadequately prepared for the role of immunisation promotion and provision. Parental information seeking from non-traditional sources has been shown to result in the acquisition of misinformation, exposure to conspiracy theories, the inevitable loss of vaccine confidence and subsequent vaccine refusal.
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Affiliation(s)
- Susan E Smith
- Flinders University College of nursing and health science, Australia
| | - Nina Sivertsen
- Flinders University College of nursing and health science, Australia
- Arctic University of Norway, Rural and Remote Arctic Health, Campus Hammersfest
| | - Lauren Lines
- Flinders University College of nursing and health science, Australia
| | - Anita De Bellis
- Flinders University College of nursing and health science, Australia
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12
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Debela MS, Garrett APN, Charania NA. Vaccine hesitancy and its determinants among refugee parents resettled in Aotearoa New Zealand. Hum Vaccin Immunother 2022; 18:2131336. [PMID: 36315907 PMCID: PMC9746517 DOI: 10.1080/21645515.2022.2131336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/09/2022] [Accepted: 09/29/2022] [Indexed: 11/04/2022] Open
Abstract
Vaccine hesitancy is an important factor underpinning suboptimal vaccine uptake and evidence on marginalized subgroups, such as refugees, is limited. This cross-sectional survey was conducted in 2020/21 with former refugee parents who resettled in Aotearoa New Zealand (NZ). The Parent Attitudes about Childhood Vaccines (PACV) was offered in Somali, Oromo, Arabic, and English languages, and the reliability of the four versions were evaluated. The prevalence of parental vaccine hesitancy was explored and the association between vaccine hesitancy and sociodemographic factors was examined using logistic regression. One hundred and seventy-eight responses were included in the analysis. The Cronbach's alpha scores for Somali, Oromo, Arabic, and English PACV were 0.89, 0.64, 0.53, and 0.77, respectively. The rate of parental vaccine hesitancy was 16.3%, 95% CI (10.7, 21.3). Most caregivers were concerned about vaccine side effects (47%), safety (43%), and efficacy (40%). Less than a quarter (21%) of parents had delayed their child receiving a vaccine and 12% had refused to vaccinate their child for reasons other than medical exemptions. After adjusting for covariate/s, parents' primary source of information and education status were significantly associated with vaccine hesitancy. Media as a primary source of vaccine information and low education status were associated with higher vaccine hesitancy. Vaccine hesitancy is relatively low among former refugees and is influenced by modifiable factors, including educational level and primary source of vaccine information. Vaccine information tailored to former refugee parents' concerns are required to reduce vaccine hesitancy and improve vaccine uptake.
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Affiliation(s)
- Mulisa Senbeta Debela
- Department of Public Health, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - A. P. Nick Garrett
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nadia A. Charania
- Department of Public Health, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Migrant and Refugee Health Research Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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13
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Analysis on vaccine hesitation and its associated factors among parents of preschool children in Songgang Street, Shenzhen. Sci Rep 2022; 12:9467. [PMID: 35676508 PMCID: PMC9176158 DOI: 10.1038/s41598-022-12530-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 04/20/2022] [Indexed: 11/28/2022] Open
Abstract
China has the largest number of vaccinated population around the world. However, there has been few research on the prevalence and associated factors of vaccine hesitation among parents of preschool children. Therefore, we conducted this study to evaluate the status of vaccine hesitation and its associated factors among children’s parents. A cluster random sampling method was adopted to select six community health service centers in Shenzhen, and parents of preschool children who were immunized in the vaccination outpatient department of the selected community health centers were surveyed using a structured self-administered questionnaire. Vaccine hesitation was assessed by the Parent Attitudes about Childhood Vaccines (PACV) scale. A multiple linear regression analysis was used to assess the associated factors for vaccine hesitance among children's parents. A total of 1025 parents (response rate, 93.18%) filled out the questionnaires. The average score of vaccine hesitancy was 43.37 (SD = 10.34) points. 23.61% of parents wanted children to get all the recommended shots, 53.76% of them did not believe that many of the illnesses shots prevent were severe, and 75.41% of them could not guarantee the information they receive about shots. The results of multiple linear regression showed that the number of children in the family (β = −0.93, 95% CI: −1.31 to 0.54), health status of the child (β = 0.47, 95% CI: 0.07 to 0.87), education level of the parents (Father: β = −0.84, 95%CI: −1.37 to 0.31; Mother: = −1.59, 95%CI:−2.13 to −1.05), and annual family income (β = 1.64, 95%CI: 1.13–2.16) were significantly associated with vaccine hesitation. The average score of parents' vaccine hesitation in Shenzhen was 43.37. The results showed that the number of children in the family, health status of the children, education level of the parents and annual family income were important factors associated with the parents' vaccine hesitation.
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14
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Bono SA, Siau CS, Chen WS, Low WY, Faria de Moura Villela E, Pengpid S, Hasan MT, Sessou P, Ditekemena JD, Amodan BO, Hosseinipour MC, Dolo H, Siewe Fodjo JN, Colebunders R. Adults' Acceptance of COVID-19 Vaccine for Children in Selected Lower- and Middle-Income Countries. Vaccines (Basel) 2021; 10:11. [PMID: 35062672 PMCID: PMC8778348 DOI: 10.3390/vaccines10010011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022] Open
Abstract
Since emergency approval of COVID-19 vaccines for children aged between 12 and 15 years old was recently obtained in the United States and Europe, we aimed to assess the willingness to vaccinate children with a COVID-19 vaccine in lower- and middle-income countries (LMICs). Therefore, we launched an online cross-sectional survey in several LMICs. Questions relating to socio-demographic information, knowledge of COVID-19, level of fear/worry of being infected with COVID-19, and willingness to vaccinate children with the COVID-19 vaccine at 50%, 75% and 95% effectiveness levels, were asked. Of the 6571 participants (mean age = 39 ± 14 years), 64.0%, 72.6%, and 92.9% were willing to vaccinate children at 50%, 75%, and 95% effectiveness levels, respectively. Respondents who were undergraduates, who were more worried/fearful about COVID-19, had higher knowledge scores regarding COVID-19, and a higher belief that COVID-19 vaccination is important to protect others, were more willing to accept COVID-19 vaccination of children. COVID-19 vaccination of children will limit the spread of the virus, especially in schools; it may decrease the need for school closures which has a negative effect on child development. Findings from this study are useful for health promotion strategies during COVID-19 vaccination implementation among children in LMICs.
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Affiliation(s)
- Suzanna Awang Bono
- School of Social Science, Universiti Sains Malaysia, Gelugor 11800, Malaysia;
| | - Ching Sin Siau
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
| | - Won Sun Chen
- Department of Health Science and Biostatistics, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC 3122, Australia;
| | - Wah Yun Low
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
- Asia Europe Institute, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Edlaine Faria de Moura Villela
- Disease Control Coordination, Sao Paulo State Health Department, São Paulo 01246-000, Brazil;
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiania 74690-900, Brazil
| | - Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom 73170, Thailand;
| | - M Tasdik Hasan
- Jeeon Bangladesh Ltd., Dhaka 1207, Bangladesh;
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool L69 3BX, UK
| | - Philippe Sessou
- Research Unit on Communicable Diseases, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Cotonou 01 BP 526, Benin;
| | - John D. Ditekemena
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa 7948, Democratic Republic of the Congo;
| | - Bob Omoda Amodan
- Uganda Public Health Fellowship Program, Loudel Towers, Level 4, Kampala 7272, Uganda;
| | - Mina C. Hosseinipour
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- University of North Carolina Malawi, Lilongwe 999119, Malawi
| | - Housseini Dolo
- International Center of Excellence in Research, Faculty of Medicine and Odonto Stomatology, University of Sciences, Techniques and Technology of Bamako, Bamako BP 1805, Mali;
| | - Joseph Nelson Siewe Fodjo
- Global Health Institute, University of Antwerp, 2000 Antwerp, Belgium; (J.N.S.F.); (R.C.)
- Brain Research Africa Initiative (BRAIN), Yaounde P.O. Box 25625, Cameroon
| | - Robert Colebunders
- Global Health Institute, University of Antwerp, 2000 Antwerp, Belgium; (J.N.S.F.); (R.C.)
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15
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Ecker F, Kutalek R. 'I'm not an anti-vaxer!'-vaccine hesitancy among physicians: a qualitative study. Eur J Public Health 2021; 31:1157-1163. [PMID: 34580713 PMCID: PMC8675240 DOI: 10.1093/eurpub/ckab174] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Over the last years, research interest in vaccine hesitancy has increased. Studies usually focus on perceptions of parents and have largely neglected the group of health care providers. However, doctors' notions on vaccination have a major impact on the decision-making process of their patients. We were interested to understand the phenomenon of vaccine hesitancy among physicians, with a particular focus on the measles vaccine. Furthermore, we aimed to understand the underlying perceptions of measles that may be associated with vaccine hesitant decisions. METHODS In order to get an in-depth view, semi-structured interviews with physicians were conducted. Doctors were eligible for the study if they articulated vaccine hesitant views and/or demonstrated vaccine hesitancy in their medical practice. RESULTS We interviewed 12 physicians, of whom 11 had a medical practice with no contract with the Austrian social insurance ('Wahlarzt') and additional training in complementary and alternative medicine. We found perceptions of immunology, health and illness that were discordant with evidence-based medicine and closely related to alternative and complementary medicine. All participants argued for a delayed administration of the measles vaccine. We found a consistent inclination towards 'individual vaccination', which was explained as empowering parents and to strengthen their decision-making competencies. Most participants expressed doubts about the reliability of vaccine studies and were concerned with possible long-term effects. CONCLUSIONS Paying closer attention to doctors' concerns on vaccination might help to design target-oriented interventions to specifically strengthen vaccine confidence.
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Affiliation(s)
- Franziska Ecker
- Department of Social and Preventive Medicine, Center
for Public Health, Medical University of Vienna, Vienna, Austria
| | - Ruth Kutalek
- Department of Social and Preventive Medicine, Center
for Public Health, Medical University of Vienna, Vienna, Austria
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16
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Cooper S, Schmidt BM, Sambala EZ, Swartz A, Colvin CJ, Leon N, Wiysonge CS. Factors that influence parents' and informal caregivers' views and practices regarding routine childhood vaccination: a qualitative evidence synthesis. Cochrane Database Syst Rev 2021; 10:CD013265. [PMID: 34706066 PMCID: PMC8550333 DOI: 10.1002/14651858.cd013265.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Childhood vaccination is one of the most effective ways to prevent serious illnesses and deaths in children. However, worldwide, many children do not receive all recommended vaccinations, for several potential reasons. Vaccines might be unavailable, or parents may experience difficulties in accessing vaccination services; for instance, because of poor quality health services, distance from a health facility, or lack of money. Some parents may not accept available vaccines and vaccination services. Our understanding of what influences parents' views and practices around childhood vaccination, and why some parents may not accept vaccines for their children, is still limited. This synthesis links to Cochrane Reviews of the effectiveness of interventions to improve coverage or uptake of childhood vaccination. OBJECTIVES - Explore parents' and informal caregivers' views and practices regarding routine childhood vaccination, and the factors influencing acceptance, hesitancy, or nonacceptance of routine childhood vaccination. - Develop a conceptual understanding of what and how different factors reduce parental acceptance of routine childhood vaccination. - Explore how the findings of this review can enhance our understanding of the related Cochrane Reviews of intervention effectiveness. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, and three other databases for eligible studies from 1974 to June 2020. SELECTION CRITERIA We included studies that: utilised qualitative methods for data collection and analysis; focused on parents' or caregivers' views, practices, acceptance, hesitancy, or refusal of routine vaccination for children aged up to six years; and were from any setting globally where childhood vaccination is provided. DATA COLLECTION AND ANALYSIS We used a pre-specified sampling frame to sample from eligible studies, aiming to capture studies that were conceptually rich, relevant to the review's phenomenon of interest, from diverse geographical settings, and from a range of income-level settings. We extracted contextual and methodological data from each sampled study. We used a meta-ethnographic approach to analyse and synthesise the evidence. We assessed methodological limitations using a list of criteria used in previous Cochrane Reviews and originally based on the Critical Appraisal Skills Programme quality assessment tool for qualitative studies. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We integrated the findings of this review with those from relevant Cochrane Reviews of intervention effectiveness. We did this by mapping whether the underlying theories or components of trial interventions included in those reviews related to or targeted the overarching factors influencing parental views and practices regarding routine childhood vaccination identified by this review. MAIN RESULTS We included 145 studies in the review and sampled 27 of these for our analysis. Six studies were conducted in Africa, seven in the Americas, four in South-East Asia, nine in Europe, and one in the Western Pacific. Studies included urban and rural settings, and high-, middle-, and low-income settings. Many complex factors were found to influence parents' vaccination views and practices, which we divided into four themes. Firstly, parents' vaccination ideas and practices may be influenced by their broader ideas and practices surrounding health and illness generally, and specifically with regards to their children, and their perceptions of the role of vaccination within this context. Secondly, many parents' vaccination ideas and practices were influenced by the vaccination ideas and practices of the people they mix with socially. At the same time, shared vaccination ideas and practices helped some parents establish social relationships, which in turn strengthened their views and practices around vaccination. Thirdly, parents' vaccination ideas and practices may be influenced by wider political issues and concerns, and particularly their trust (or distrust) in those associated with vaccination programmes. Finally, parents' vaccination ideas and practices may be influenced by their access to and experiences of vaccination services and their frontline healthcare workers. We developed two concepts for understanding possible pathways to reduced acceptance of childhood vaccination. The first concept, 'neoliberal logic', suggests that many parents, particularly from high-income countries, understood health and healthcare decisions as matters of individual risk, choice, and responsibility. Some parents experienced this understanding as in conflict with vaccination programmes, which emphasise generalised risk and population health. This perceived conflict led some parents to be less accepting of vaccination for their children. The second concept, 'social exclusion', suggests that some parents, particularly from low- and middle-income countries, were less accepting of childhood vaccination due to their experiences of social exclusion. Social exclusion may damage trustful relationships between government and the public, generate feelings of isolation and resentment, and give rise to demotivation in the face of public services that are poor quality and difficult to access. These factors in turn led some parents who were socially excluded to distrust vaccination, to refuse vaccination as a form of resistance or a way to bring about change, or to avoid vaccination due to the time, costs, and distress it creates. Many of the overarching factors our review identified as influencing parents' vaccination views and practices were underrepresented in the interventions tested in the four related Cochrane Reviews of intervention effectiveness. AUTHORS' CONCLUSIONS Our review has revealed that parents' views and practices regarding childhood vaccination are complex and dynamic social processes that reflect multiple webs of influence, meaning, and logic. We have provided a theorised understanding of the social processes contributing to vaccination acceptance (or not), thereby complementing but also extending more individualistic models of vaccination acceptance. Successful development of interventions to promote acceptance and uptake of childhood vaccination will require an understanding of, and then tailoring to, the specific factors influencing vaccination views and practices of the group(s) in the target setting. The themes and concepts developed through our review could serve as a basis for gaining this understanding, and subsequent development of interventions that are potentially more aligned with the norms, expectations, and concerns of target users.
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Affiliation(s)
- Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Bey-Marrié Schmidt
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Evanson Z Sambala
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Alison Swartz
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christopher J Colvin
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, 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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17
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Vujovich-Dunn C, Skinner SR, Brotherton J, Wand H, Sisnowski J, Lorch R, Veitch M, Sheppeard V, Effler P, Gidding H, Venn A, Davies C, Hocking J, Whop LJ, Leask J, Canfell K, Sanci L, Smith M, Kang M, Temple-Smith M, Kidd M, Burns S, Selvey L, Meijer D, Ennis S, Thomson CA, Lane N, Kaldor J, Guy R. School-Level Variation in Coverage of Co-Administered dTpa and HPV Dose 1 in Three Australian States. Vaccines (Basel) 2021; 9:vaccines9101202. [PMID: 34696310 PMCID: PMC8537995 DOI: 10.3390/vaccines9101202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/14/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Australian adolescents are routinely offered HPV and dTpa (diphtheria, tetanus, pertussis) vaccines simultaneously in the secondary school vaccination program. We identified schools where HPV initiation was lower than dTpa coverage and associated school-level factors across three states. METHODS HPV vaccination initiation rates and dTpa vaccination coverage in 2016 were calculated using vaccine databases and school enrolment data. A multivariate analysis assessed sociodemographic and school-level factors associated with HPV initiation being >5% absolute lower than dTpa coverage. RESULTS Of 1280 schools included, the median school-level HPV initiation rate was 85% (interquartile range (IQR):75-90%) and the median dTpa coverage was 86% (IQR:75-92%). Nearly a quarter (24%) of all schools had HPV vaccination initiation >5% lower than dTpa coverage and 11 % had >10% difference. School-level factors independently associated with >5% difference were remote schools (aOR:3.5, 95% CI = 1.7-7.2) and schools in major cities (aOR:1.8, 95% CI = 1.0-3.0), small schools (aOR:3.3, 95% CI = 2.3-5.7), higher socioeconomic advantage (aOR:1.7, 95% CI = 1.1-2.6), and lower proportions of Language-background-other-than-English (aOR:1.9, 95% CI = 1.2-3.0). CONCLUSION The results identified a quarter of schools had lower HPV than dTpa initiation coverage, which may indicate HPV vaccine hesitancy, and the difference was more likely in socioeconomically advantaged schools. As hesitancy is context specific, it is important to understand the potential drivers of hesitancy and future research needs to understand the reasons driving differential uptake.
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Affiliation(s)
- Cassandra Vujovich-Dunn
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
- Correspondence: ; Tel.: +61-2-9348-0033
| | - Susan Rachel Skinner
- Children’s Hospital Westmead, Sydney Children’s Hospitals Network, Sydney 2145, Australia; (S.R.S.); (C.D.)
- Faculty of Medicine and Health, University of Sydney, Specialty of Child and Adolescent Health, Sydney 2006, Australia
| | - Julia Brotherton
- Population Health, VCS Foundation Ltd., East Melbourne, Melbourne 3053, Australia;
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Melbourne 3010, Australia;
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
| | - Jana Sisnowski
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
- National Centre for Epidemiology & Population Health, Australian National University, Canberra 0200, Australia;
| | - Rebecca Lorch
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
| | - Mark Veitch
- Department of Health and Human Services, Tasmanian Government, Hobart 7001, Australia; (M.V.); (N.L.)
| | - Vicky Sheppeard
- Communicable Diseases Branch, Health Protection NSW, St Leonards, Sydney 2065, Australia;
- School of Public Health, University of Sydney, Camperdown, Sydney 2006, Australia;
| | - Paul Effler
- Department of Health, Communicable Disease Control Directorate, East Perth 6000, Australia; (P.E.); (C.A.T.)
| | - Heather Gidding
- School of Population Health, University of New Souh Wales, Sydney 2052, Australia;
- Norther Clinical School of Sydney, University of Sydney, Camperdown, Sydney 2006, Australia
- Women and Babies Research, Kollin Intstitye, Northern Sydney Local Health District, St Leaonards, Sydney 2064, Australia
- National Centre for Immunisation Research and Surveillance, Westmead, Sydney 2145, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Tasmanian 7000, Australia;
| | - Cristyn Davies
- Children’s Hospital Westmead, Sydney Children’s Hospitals Network, Sydney 2145, Australia; (S.R.S.); (C.D.)
- Faculty of Medicine and Health, University of Sydney, Specialty of Child and Adolescent Health, Sydney 2006, Australia
| | - Jane Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Melbourne 3010, Australia;
| | - Lisa J. Whop
- National Centre for Epidemiology & Population Health, Australian National University, Canberra 0200, Australia;
- Menzies School of Health Research, Charles Darwin University, Brisbane 4000, Australia
| | - Julie Leask
- Faculty of Medicine and Health, Sydney Nursing School, University of Sydney, Camperdown, Sydney 2006, Australia;
| | - Karen Canfell
- Cancer Research Division, Cancer Council, Brisbane 2011, Australia;
| | - Lena Sanci
- Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Melbourne 3010, Australia; (L.S.); (M.T.-S.)
| | - Megan Smith
- School of Public Health, University of Sydney, Camperdown, Sydney 2006, Australia;
- Cancer Research Division, Cancer Council, Brisbane 2011, Australia;
| | - Melissa Kang
- Westmead Clinical School, University of Sydney, Sydney 2006, Australia;
| | - Meredith Temple-Smith
- Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Melbourne 3010, Australia; (L.S.); (M.T.-S.)
| | - Michael Kidd
- Southgate Institute for Health, Flinders University, Adelaide 5042, Australia;
| | - Sharyn Burns
- School of Population Health, Curtin University, Perth 6102, Australia;
| | - Linda Selvey
- School of Public Health, University of Queensland, Brisbane 4072, Australia;
| | - Dennis Meijer
- Immunisation Unit, Health Protection NSW, St Leonards, Sydney 2065, Australia; (D.M.); (S.E.)
| | - Sonya Ennis
- Immunisation Unit, Health Protection NSW, St Leonards, Sydney 2065, Australia; (D.M.); (S.E.)
| | - Chloe A. Thomson
- Department of Health, Communicable Disease Control Directorate, East Perth 6000, Australia; (P.E.); (C.A.T.)
| | - Nikole Lane
- Department of Health and Human Services, Tasmanian Government, Hobart 7001, Australia; (M.V.); (N.L.)
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
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18
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Odone A, Dallagiacoma G, Frascella B, Signorelli C, Leask J. Current understandings of the impact of mandatory vaccination laws in Europe. Expert Rev Vaccines 2021; 20:559-575. [PMID: 33896302 DOI: 10.1080/14760584.2021.1912603] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Vaccinations are among the most successful preventive tools to protect collective health. In response to alarming vaccines preventable diseases (VPDs) outbreaks resurgence, decreased vaccination coverage and vaccine refusal, several European countries have recently revised their vaccination policies introducing or extending mandatory vaccinations. This review examines the health, political and ethical aspects of mandatory vaccination.The authors first clarify terms and definitions and propose a conceptual framework of mandatory policies. Second, they describe the current status of mandatory childhood immunization programmes in Europe, assessing selected mandatory laws. Third, as the authors conduct a systematic review of the literature (retrieving from Medline 17 relevant records between 2010 and 2020), they take an analytical approach to measure the impact of mandatory vaccination policies on both VPDs control and immunization coverage, but also on population attitudes toward vaccines. 40% of European countries currently have mandatory vaccination policies; however, policies vary widely and, although there is evidence of increased vaccine uptake, their impact on informed adherence to preventive behaviors is scant.Although mandatory vaccination policies might be needed to protect collective health in times of emergency, public health goals of VPD prevention and health promotion should primarily be pursued through health education and population empowerment.
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Affiliation(s)
- Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Giulia Dallagiacoma
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | | | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery. Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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19
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Argyris YA, Kim Y, Roscizewski A, Song W. The mediating role of vaccine hesitancy between maternal engagement with anti- and pro-vaccine social media posts and adolescent HPV-vaccine uptake rates in the US: The perspective of loss aversion in emotion-laden decision circumstances. Soc Sci Med 2021; 282:114043. [PMID: 34147269 DOI: 10.1016/j.socscimed.2021.114043] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/05/2021] [Accepted: 05/13/2021] [Indexed: 01/01/2023]
Abstract
While Human Papillomavirus (HPV) is a prominent cause of cervical cancer and mortality among underserved women, HPV vaccine completion rates remain stagnant (54%) among US adolescents. Our objective is to identify how adolescents' mothers' engagement with anti-vaccine versus pro-vaccine social media content is associated with their children's HPV vaccination rates via increased vaccine hesitancy. We employ the notion of loss aversion escalated in an emotion-laden circumstance in consumer behavior literature given that HPV vaccination decisions directly affect children's well-being. Based on this escalated loss aversion tendency for an emotion-laden decision, we explain why anti-vaccine content disproportionately increases mothers' overarching vaccine hesitancy, while pro-vaccine content does not decrease vaccine hesitancy. We conducted a population-based survey among 426 mothers of US adolescents aged 13-18. Our sample closely mimics the socioeconomic and demographic factors of the population group of mothers of adolescents in the US census. Our results show that anti-vaccine social media posts are associated with increases in mothers' overarching vaccine hesitancy and with decreases in their children's HPV vaccination rates, while pro-vaccine content has no significant association with either.
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Affiliation(s)
- Young Anna Argyris
- Department of Media and Information, College of Communication Arts and Sciences, Michigan State University, East Lansing, MI, USA.
| | - Yongsuk Kim
- Department of Fintech, Sungkyunkwan University, Seoul, South Korea
| | - Alexa Roscizewski
- Department of Communication, College of Arts and Sciences, University of Delaware, Newark, DE, USA
| | - Won Song
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA
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20
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Ethics of Vaccination in Childhood-A Framework Based on the Four Principles of Biomedical Ethics. Vaccines (Basel) 2021; 9:vaccines9020113. [PMID: 33540732 PMCID: PMC7913000 DOI: 10.3390/vaccines9020113] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 02/07/2023] Open
Abstract
Although vaccination is recognised as the top public health achievement of the twentieth century, unequivocal consensus about its beneficence does not exist among the general population. In countries with well-established immunisation programmes, vaccines are “victims of their own success”, because low incidences of diseases now prevented with vaccines diminished the experience of their historical burdens. Increasing number of vaccine-hesitant people in recent years threatens, or even effectively disables, herd immunity levels of the population and results in outbreaks of previously already controlled diseases. We aimed to apply a framework for ethical analysis of vaccination in childhood based on the four principles of biomedical ethics (respect for autonomy, nonmaleficence, beneficence and justice) to provide a comprehensive and applicable model on how to address the ethical aspects of vaccination at both individual and societal levels. We suggest finding an “ethical equilibrium”, which means that the degree of respect for parents’ autonomy is not constant, but variable; it shall depend on the level of established herd immunity and it is specific for every society. When the moral obligation of individuals to contribute to herd immunity is not fulfilled, mandatory vaccination policies are ethically justified, because states bear responsibility to protect herd immunity as a common good.
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21
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Murphy J, Vallières F, Bentall RP, Shevlin M, McBride O, Hartman TK, McKay R, Bennett K, Mason L, Gibson-Miller J, Levita L, Martinez AP, Stocks TVA, Karatzias T, Hyland P. Psychological characteristics associated with COVID-19 vaccine hesitancy and resistance in Ireland and the United Kingdom. Nat Commun 2021; 12:29. [PMID: 33397962 PMCID: PMC7782692 DOI: 10.1038/s41467-020-20226-9] [Citation(s) in RCA: 697] [Impact Index Per Article: 232.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/13/2020] [Indexed: 12/30/2022] Open
Abstract
Identifying and understanding COVID-19 vaccine hesitancy within distinct populations may aid future public health messaging. Using nationally representative data from the general adult populations of Ireland (N = 1041) and the United Kingdom (UK; N = 2025), we found that vaccine hesitancy/resistance was evident for 35% and 31% of these populations respectively. Vaccine hesitant/resistant respondents in Ireland and the UK differed on a number of sociodemographic and health-related variables but were similar across a broad array of psychological constructs. In both populations, those resistant to a COVID-19 vaccine were less likely to obtain information about the pandemic from traditional and authoritative sources and had similar levels of mistrust in these sources compared to vaccine accepting respondents. Given the geographical proximity and socio-economic similarity of the populations studied, it is not possible to generalize findings to other populations, however, the methodology employed here may be useful to those wishing to understand COVID-19 vaccine hesitancy elsewhere.
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Affiliation(s)
- Jamie Murphy
- School of Psychology, Ulster University, Coleraine, BT52 1SA, Northern Ireland.
| | - Frédérique Vallières
- Centre for Global Health, Trinity College Dublin, Dublin, D02 PN40, Republic of Ireland
| | - Richard P Bentall
- Department of Psychology, University of Sheffield, Sheffield, S10 2TN, England
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, BT52 1SA, Northern Ireland
| | - Orla McBride
- School of Psychology, Ulster University, Coleraine, BT52 1SA, Northern Ireland
| | - Todd K Hartman
- Department of Psychology, University of Sheffield, Sheffield, S10 2TN, England
| | - Ryan McKay
- Department of Psychology, Royal Holloway, University of London, London, TW20 0EX, England
| | - Kate Bennett
- Department of Psychology, University of Liverpool, Liverpool, L69 3BX, England
| | - Liam Mason
- Division of Psychology and Language Sciences, University College London, London, WC1E 6BT, England
| | - Jilly Gibson-Miller
- Department of Psychology, University of Sheffield, Sheffield, S10 2TN, England
| | - Liat Levita
- Department of Psychology, University of Sheffield, Sheffield, S10 2TN, England
| | - Anton P Martinez
- Department of Psychology, University of Sheffield, Sheffield, S10 2TN, England
| | - Thomas V A Stocks
- Department of Psychology, University of Sheffield, Sheffield, S10 2TN, England
| | - Thanos Karatzias
- School of Health and Social Care, Napier University, Edinburgh, EH14 1DJ, Scotland
| | - Philip Hyland
- Department of Psychology, Maynooth University, County Kildare, W23 F2K8, Republic of Ireland
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22
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Hadjipanayis A, van Esso D, Del Torso S, Dornbusch HJ, Michailidou K, Minicuci N, Pancheva R, Mujkic A, Geitmann K, Syridou G, Altorjai P, Pasinato A, Valiulis A, Soler P, Cirstea O, Illy K, Mollema L, Mazur A, Neves A, Zavrsnik J, Lapii F, Efstathiou E, Kamphuis M, Grossman Z. Vaccine confidence among parents: Large scale study in eighteen European countries. Vaccine 2019; 38:1505-1512. [PMID: 31848051 DOI: 10.1016/j.vaccine.2019.11.068] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 11/18/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite the fact that vaccines save 2-3 million lives worldwide every year, a percentage of children are not getting appropriately vaccinated, thus leading to disease outbreaks. One of the major reasons of low vaccine uptake in Europe is vaccine hesitancy, contributing to the recent measles outbreaks. Monitoring of vaccine hesitancy is valuable in early identification of vaccine concerns. METHODS We performed an eighteen country European survey on parents' attitudes and behaviors regarding their children's immunization. Parents having at least one child 1-4 years old were mostly recruited by primary care paediatricians to reply to a web-based questionnaire. The questionnaire was developed by the European Academy of Paediatrics Research in Ambulatory Setting Network steering committee, based on similar surveys. An individual level hesitancy score was constructed using the answers to 21 questions, and correlations of the score with socio-demographic characteristics and types of providers were explored. To assess inter country differences, a country level self -reported confidence was defined. RESULTS Fifty six percent and 24% of 5736 respondents defined themselves as "not at all hesitant", and "somewhat hesitant", respectively. Parents who consulted general practitioners were more hesitant than parents who consulted pediatricians (p < 0.05). Consultation with homeopathists was associated with the highest reported hesitancy (p < 0.05). Vaccine confidence was highest in Portugal and Cyprus, and lowest in Bulgaria and Poland. CONCLUSION The majority of parents in Europe believe in the importance of childhood vaccination. However, significant lack of confidence was found in certain European countries, highlighting the need for continuous monitoring, awareness and response plans. The possible influence of different types of healthcare providers on parental decisions demonstrated for the first time in our survey, calls for further research. Monitoring and continuous medical education efforts aimed mostly at those professionals who might not be likely to recommend vaccination are suggested.
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Affiliation(s)
- Adamos Hadjipanayis
- Paediatric Department, Larnaca General Hospital, Inomenon Polition, Larnaca 6042, Cyprus; European University Medical School, 6, Diogenis Street, Engomi, 1516 Nicosia, Cyprus.
| | - Diego van Esso
- Primary Care Service, Catalan Institute of Health, Barcelona, Spain
| | | | | | - Kyriaki Michailidou
- Department of Electron Microscopy/Molecular Pathology and Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Cyprus.
| | | | - Ruzha Pancheva
- Department of Hygiene and Epidemiology, Faculty of Public Health, Prof. Paraskev Stoyanov Medical University, Bulgaria
| | - Aida Mujkic
- University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, Zagreb, Croatia.
| | | | - Garyfallia Syridou
- Paediatric Department, Thriasio General Hospital of Elefsina Athens, Greece
| | - Peter Altorjai
- Tóth Ilona Healthcare Service, Primary Paediatric Care Offices Görgey Artúr tér 8, Budapest H-1212, Hungary
| | - Angela Pasinato
- Pediatra di libera scelta, Azienda 8 Berica, Pediatra, Vicenza, Italy
| | - Arunas Valiulis
- Vilnius University Faculty of Medicine, Institute of Clinical Medicine and Institute of Health Sciences, Vilnius City Clinical Hospital, Vilnius, Lithuania.
| | - Paul Soler
- Department of Child & Adolescent Health, Mater Dei Hospital Msida, Malta.
| | - Olga Cirstea
- Department of Pediatrics, State University of Medicine and Pharmacy "Nicolae Testemitanu"Chisinau, Republic of Moldova.
| | - Károly Illy
- Department of Paediatrics, Ziekenhuis Rivierenland, Tiel, the Netherlands.
| | - Liesbeth Mollema
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
| | - Artur Mazur
- Medical Faculty, University of Rzeszów, Rzeszów, Poland.
| | - Ana Neves
- Pediatric Allergy Unit, Pediatric Department, University Hospital of Santa Maria, Faculty of Medicine, Lisbon University, Portugal
| | - Jernej Zavrsnik
- Community Health Center "dr. Adollf Drolc", Maribor, Slovenia.
| | - Fedir Lapii
- National Medical Academy of Postgraduate Education, Department of Pediatric Infectious Diseases and Pediatric Immunology, Kyiv, Ukraine
| | | | - Mascha Kamphuis
- Dutch Expertise Center Child Abuse, Utrecht, the Netherlands.
| | - Zachi Grossman
- Pediatric Clinic, Maccabi Healthcare Services, Tel Aviv, Israel.
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23
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Schneider R, Reinau D, Schur N, Blozik E, Früh M, Signorell A, Heininger U, Schwenkglenks M, Meier CR. Coverage rates and timeliness of nationally recommended vaccinations in Swiss preschool children: A descriptive analysis using claims data. Vaccine 2019; 38:1551-1558. [PMID: 31791812 DOI: 10.1016/j.vaccine.2019.11.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/07/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Low vaccination coverage as well as incomplete and delayed vaccinations pose a risk for the individual and population protection from vaccine-preventable diseases. AIM To describe vaccination patterns for nationally recommended basic and supplementary vaccinations in Swiss preschool children. METHODS We performed a descriptive study based on administrative claims data from a large Swiss health insurer (Helsana), in cohorts of children born between January 2010 and December 2016. We assessed coverage rates of nationally recommended basic vaccinations (i.e., diphtheria, tetanus, acellular pertussis [DTaP], Haemophilus influenzae type b [Hib], poliomyelitis [IPV], measles, mumps, and rubella [MMR]) and supplementary vaccinations (i.e., pneumococcal conjugate vaccine [PCV] and meningococcal group C conjugate vaccine [MCV]) for each birth cohort at the age of 13, 25, and 37 months. Additionally, we analysed timeliness of vaccinations using inverse Kaplan-Meier curves. Results were extrapolated to the Swiss population. RESULTS The study population comprised 563,216 children. We observed continuously increasing coverage rates for all vaccinations until the 2015 birth cohort. Overall, up-to-date status for the first dose of studied vaccinations at 37 months was as follows: DTaP: 95.4%; Hib: 94.9%; IPV: 95.5%; MMR: 86.8%; PCV: 83.2%; and MCV: 66.7%. On average, however, only seven out of ten children had an up-to-date status for completed basic vaccinations; even less (six out of ten) were up-to-date for recommended supplementary vaccinations at 37 months of age. Moreover, 4% of all analysed children received none of the recommended vaccinations and there were substantial regional differences. Delays in vaccine administration were common. The most frequently postponed basic vaccination was MMR; 22.6% of children vaccinated with the first dose experienced delays relative to age-appropriate standards. CONCLUSION To avoid future outbreaks and transmission of vaccine-preventable diseases, vaccination coverage in Switzerland must be further improved. In addition, more emphasis should be placed on timely vaccination.
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Affiliation(s)
- Rahel Schneider
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, CH-4031 Basel, Switzerland; Hospital Pharmacy, University Hospital Basel, Spitalstrasse 26, CH-4031 Basel, Switzerland
| | - Daphne Reinau
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, CH-4031 Basel, Switzerland; Hospital Pharmacy, University Hospital Basel, Spitalstrasse 26, CH-4031 Basel, Switzerland
| | - Nadine Schur
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Klingelbergstrasse 61, CH-4056 Basel, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Group, Zürichstrasse 130, CH-8600 Dübendorf, Switzerland
| | - Mathias Früh
- Department of Health Sciences, Helsana Group, Zürichstrasse 130, CH-8600 Dübendorf, Switzerland
| | - Andri Signorell
- Department of Health Sciences, Helsana Group, Zürichstrasse 130, CH-8600 Dübendorf, Switzerland
| | - Ulrich Heininger
- University of Basel Children's Hospital, Paediatric Infectious Diseases and Vaccinology, and University of Basel Medical Faculty, Spitalstrasse 33, CH-4056 Basel, Switzerland
| | - Matthias Schwenkglenks
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Klingelbergstrasse 61, CH-4056 Basel, Switzerland
| | - Christoph R Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, CH-4031 Basel, Switzerland; Hospital Pharmacy, University Hospital Basel, Spitalstrasse 26, CH-4031 Basel, Switzerland; Boston Collaborative Drug Surveillance Program, MA 11 Muzzey St, Lexington, MA 02421, USA.
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24
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Eun TJ, Hanchate A, Fenton AT, Clark JA, Aurora MN, Drainoni ML, Perkins RB. Relative contributions of parental intention and provider recommendation style to HPV and meningococcal vaccine receipt. Hum Vaccin Immunother 2019; 15:2460-2465. [PMID: 30862301 DOI: 10.1080/21645515.2019.1591138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We described the relative contributions of parental intention and provider recommendation style to HPV and meningococcal vaccine receipt. Parent-child dyads that were eligible for both meningococcal and HPV vaccines participated in pre-visit surveys and consented to audio recording of their clinical interactions with healthcare providers related to vaccination. Surveys were analyzed for parent and child demographics and parental intention to vaccinate children with HPV and/or meningococcal vaccines. Audio recordings were analyzed for provider recommendation style, defined as indicated (provider stated vaccine was due at that visit) or not, and for child receipt of vaccines. Linear and logistic regression models were used to determine the relative contributions of parental intention and provider recommendation style to vaccine receipt. 56 parents/child dyads participated. 79% of children received HPV vaccines, and 93% received meningococcal vaccines. After controlling for demographic variables, parental intention did not differ by vaccine type. However, providers were less likely to use an indicated recommendation for HPV than for meningococcal vaccine. After controlling for demographic factors, parental intention, and provider recommendation style, vaccine type (HPV or meningococcal) was no longer associated with vaccine receipt Differences that were previously attributed to vaccine-specific factors may be explained by parents' and providers' roles in vaccine receipt. These findings suggest that interventions and policy recommendations regarding adolescent vaccination should focus on increasing parental demand for vaccines and ensuring that providers present all vaccines as the medical standard of care.
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Affiliation(s)
- Terresa J Eun
- Department of Sociology, Stanford University , Palo Alto, CA , California , USA
| | - Amresh Hanchate
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA
| | - Anny T Fenton
- Department ofSociology, Harvard University , Cambridge, MA , USA.,Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute , Scarborough, ME , USA
| | - Jack A Clark
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA
| | - Marisa N Aurora
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA.,Department of Health Policy and Management, Boston University School of Public Health , Boston, MA , USA
| | - Mari-Lynn Drainoni
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA.,Department of Health Policy and Management, Boston University School of Public Health , Boston, MA , USA.,Center for Healthcare Organization and Implementation Research, ENRM VA Hospital , Bedford , MA , USA
| | - Rebecca B Perkins
- Department of General Internal Medicine, Boston University School of Medicine , Boston, MA , USA.,Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center , Boston, MA , USA
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