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Dudley MZ, Schuh HB, Forr A, Shaw J, Salmon DA. Changes in vaccine attitudes and recommendations among US Healthcare Personnel during the COVID-19 pandemic. NPJ Vaccines 2024; 9:49. [PMID: 38418562 PMCID: PMC10901873 DOI: 10.1038/s41541-024-00826-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/01/2024] [Indexed: 03/01/2024] Open
Abstract
A recommendation from healthcare personnel (HCP) is a strong predictor of vaccination. This study aimed to measure how HCP vaccine attitudes and recommendations changed during the COVID-19 pandemic. HCP were surveyed in January 2023 using a double opt-in network panel. Survey responses were summarized and stratified by HCP type and COVID-19 booster status. Multivariable logistic regression models were fitted. Comparisons were made to a September 2021 survey, with differences tested for significance (p < 0.05) using Pearson's χ2 Test. Nearly 82% of the 1207 HCP surveyed had received a COVID-19 booster, most commonly pediatricians (94%), followed by family medicine doctors (87%), pharmacists (74%), and nurses (73%) (p < 0.01). HCP with high trust in the Centers for Disease Control and Prevention (CDC) had nearly 6 times the odds (OR: 5.5; 95%CI: 3.9-7.7) of being boosted compared to HCP with low trust. From September 2021 to January 2023, the proportion of HCP recommending vaccines (COVID-19 and routine) to their patients decreased substantially for nearly all vaccines and patient populations specified. Trust in CDC also decreased (from 79 to 73%, p < 0.01), as did support for HCP COVID-19 vaccine mandates (from 65 to 46%, p < 0.01). HCP interest in additional online resources to improve their vaccine discussions with patients increased from 46 to 66% (p < 0.01). Additional regularly updated online resources from trusted medical sources that clarify progressing science and address dynamic public concerns are needed to improve vaccine confidence among HCP and help them support their patients' decision-making.
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Affiliation(s)
- Matthew Z Dudley
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Holly B Schuh
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amanda Forr
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Element A LLC, Hershey, PA, USA
| | - Jana Shaw
- Division of Infectious Diseases, Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Daniel A Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Omoleke SA, Bamidele M, de Kiev LC. Barriers to optimal AEFI surveillance and documentation in Nigeria: Findings from a qualitative survey. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001658. [PMID: 37682847 PMCID: PMC10490937 DOI: 10.1371/journal.pgph.0001658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/16/2023] [Indexed: 09/10/2023]
Abstract
Effective spontaneous AEFI reporting is the first step to ensuring vaccine safety. Half of the global population lives in countries with weak vaccine safety monitoring systems, especially in the African, Eastern Mediterranean, and Western Pacific regions. Further, Immunisation services have been upscaled without commensurate effective AEFI surveillance systems. Hence, this study aims to comprehensively investigate the impediments to an effective AEFI surveillance system. Given the programmatic and regulatory implications, understanding these impediments would facilitate the development and implementation of policies and strategies to strengthen the AEFI surveillance system in Nigeria. A qualitative research design (using a grounded theory approach) was employed by conducting ten key informant interviews and two Focus Group Discussion sessions among the study population to identify the barriers impeding optimal AEFI surveillance and documentation in Nigeria. This study found that the AEFI surveillance system is in place in Nigeria. However, its functionality is sub-optimal, and the potential capacity is yet to be fully harnessed due to health systems and socio-ecological impediments. The identified impediments are human-resource-related issues- knowledge gaps; limited training; lack of designated officers for AEFI; excessive workload; poor supportive supervision and attitudinal issues; caregiver's factor; governance and leadership- moribund AEFI committee; lack of quality supervisory visit and oversight and weak implementation of AEFI policy guidance. Others include funding and logistics issues- no dedicated budget provision and weak referral mechanism; insecurity; socio-economic and infrastructural deficits- poverty, geographical barriers, limited ICT skills, and infrastructure; and poor feedback and weak community engagement by the health workers. Findings from this study provide empirical evidence and serve as an advocacy tool for vaccine pharmacovigilance strengthening in Nigeria. Addressing the impediments requires health system strengthening and a whole-of-the-society approach to improve vaccine safety surveillance, restore public confidence and promote vaccine demand, strengthen PHC services, and contribute to attaining UHC and SDGs.
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Affiliation(s)
| | - Moyosola Bamidele
- School of Global Health and Bioethics, Euclid University, Bangui, Central African Republic
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Malhotra A, Whitley-Williams P. Training Residents and Medical Students to Overcome Parents' Vaccine Hesitancy. Pediatr Clin North Am 2023; 70:321-327. [PMID: 36841599 DOI: 10.1016/j.pcl.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Strong provider recommendations increase vaccine confidence. Medical students and pediatric residents, as future physicians, will play an important role in the messaging about vaccines to their parents and patients. The importance of inclusion of vaccine education and communication skills in the medical school curriculum and residency training programs must be recognized to ensure provider confidence in discussions with vaccine-hesitant parents and patients.
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Affiliation(s)
- Amisha Malhotra
- Division of Pediatric Allergy, Immunology and Infectious Diseases, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, New Brunswick, NJ 08901, USA
| | - Patricia Whitley-Williams
- Division of Pediatric Allergy, Immunology and Infectious Diseases, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, New Brunswick, NJ 08901, USA.
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Norton ZS, Olson KB, Sanguino SM. Addressing Vaccine Hesitancy Through a Comprehensive Resident Vaccine Curriculum. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11292. [PMID: 36654981 PMCID: PMC9792628 DOI: 10.15766/mep_2374-8265.11292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/10/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Vaccine hesitancy can lead to incomplete vaccination, increased risk of vaccine-preventable diseases, and distrust or conflict between physicians and patients. Yet many physicians are uncomfortable navigating vaccine hesitancy and educating vaccine-hesitant patients and families. We developed a vaccine hesitancy curriculum to increase vaccine knowledge, comfort, and communication skills in pediatric residents. METHODS The curriculum consisted of four interactive 40-minute sessions delivered to pediatric residents over 10 months. The first two sessions discussed recommended childhood vaccines, the third session examined common vaccine misconceptions, and the final session reviewed vaccine hesitancy-specific communication skills, incorporating practice through role-playing. Residents completed pre- and posttests assessing knowledge and comfort as well as receiving a standardized patient (SP) assessment of vaccine-specific communication skills after the curriculum. RESULTS Thirty-five residents were in the educational intervention group and 35 in a control group. Pretest scores did not differ significantly between the groups. The mean knowledge score for the intervention group increased from 47% on the pretest to 66% on the posttest. The mean self-reported comfort score (1 = low comfort, 5 = high comfort) for the intervention group increased from 2.9 on the pretest to 3.8 on the posttest. The control group showed no difference between pre- and posttest scores for knowledge or comfort. The mean postintervention SP assessment score was significantly higher for the intervention group (78%) than the control group (52%). DISCUSSION Implementation of a comprehensive vaccine hesitancy curriculum resulted in improved vaccine knowledge, self-reported comfort, and communication skills among pediatric residents.
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Affiliation(s)
- Zarina S. Norton
- Assistant Professor, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago; Assistant Professor, Department of Medical Education, Northwestern University Feinberg School of Medicine
| | - Kaitlyn B. Olson
- General Pediatrician, Department of Pediatrics, Cottage Children's Medical Center
| | - Sandra M. Sanguino
- Associate Professor, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago; Associate Professor, Department of Medical Education, and Senior Associate Dean for Medical Education, Northwestern University Feinberg School of Medicine
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Dayton L, Miller J, Strickland J, Davey-Rothwell M, Latkin C. A socio-ecological perspective on parents' intentions to vaccinate their children against COVID-19. Vaccine 2022; 40:4432-4439. [PMID: 35697575 PMCID: PMC9168003 DOI: 10.1016/j.vaccine.2022.05.089] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/21/2022] [Accepted: 05/31/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Vaccinating children against COVID-19 protects children's health and can mitigate the spread of the virus to other community members. OBJECTIVE The primary objective of this study was to use a socio-ecological perspective to identify multi-level factors associated with US parents' intention to vaccinate their children. METHODS This study used a longitudinal online cohort. Multinomial logistic regression models assessed socio-ecological predictors of negative and uncertain child COVID-19 vaccination intentions compared to positive intentions. RESULTS In June 2021, 297 parents were surveyed and 44% reported that they intended to vaccinate their children while 25% expressed uncertainty and 31% did not intend to vaccinate their children. The likelihood of reporting uncertain or negative intention, compared to positive intention to vaccinate their children was higher among parents who had not received a COVID-19 vaccination and those who did not have trusted information sources. Parents who talked to others at least weekly about the COVID-19 vaccine were less likely to endorse uncertain compared to positive vaccine intentions (aRRR: 0.44; 95% CI: 0.20-0.93). A sub-analysis identified that parents had significantly higher odds of intending to vaccinate older children compared to younger children (children ages 16-17 years v. 0-4 years OR: 2.01, 95% CI: 1.05-3.84). An additional sub-analysis assessed the stability of parents' intention to vaccinate their children between March 2021 and June 2021 (N=166). There was transition within each intention group between the study periods; however, symmetry and marginal homogeneity test results indicated that the shift was not statistically significant. Parents expressing uncertainty in March 2021 were the most likely to change their intention, with 24% transitioning to positive intention and 23% to negative intention in June 2021. CONCLUSION Study findings suggest that programs to promote vaccination uptake should be dyadic and work to promote child and parent vaccination. Peer diffusion strategies may be particularly effective at promoting child vaccination uptake among parents expressing uncertainty.
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Affiliation(s)
- Lauren Dayton
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, United States.
| | - Jacob Miller
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Justin Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, United States
| | - Melissa Davey-Rothwell
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Carl Latkin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, United States; Division of Infectious Diseases, Johns Hopkins University School of Medicine, United States
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Barton SM, Calhoun AW, Bohnert CA, Multerer SM, Statler VA, Bryant KA, Arnold DM, Felton HM, Purcell PM, Kinney MD, Parrish-Sprowl JM, Marshall GS. Standardized Vaccine-Hesitant Patients in the Assessment of the Effectiveness of Vaccine Communication Training. J Pediatr 2022; 241:203-211.e1. [PMID: 34699909 DOI: 10.1016/j.jpeds.2021.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine if training residents in a structured communication method elicits specific behaviors in a laboratory model of interaction with vaccine-hesitant parents. STUDY DESIGN Standardized patients portraying vaccine-hesitant parents were used to assess the effectiveness of training in the Announce, Inquire, Mirror, Secure (AIMS) Method for Healthy Conversations. Blinded pediatric residents were pseudorandomized to receive AIMS or control training and underwent pre- and post-training encounters with blinded standardized patients. Encounters were assessed by blinded raters using a novel tool. Participant confidence and standardized patient evaluations of the participants' general communication skills were assessed. RESULTS Ratings were available for 27 AIMS and 26 control participants. Statistically significant increases in post-training scores (maximum = 30) were detected in AIMS, but not in control, participants (median, 21.3 [IQR, 19.8-24.8] vs 18.8 [IQR, 16.9-20.9]; P < .001). Elements (maximum score = 6) with significant increases were Inquire (0.67 [IQR, 0-1.76] vs -0.33 [IQR, -0.67 to 0.33]; P < .001); Mirror (1.33 [IQR, 0 to 2] vs -0.33 [IQR, -0.92 to 0]; P < .001) and Secure (0.33 [IQR, 0 to 1.67] vs -0.17 [IQR, -0.67 to 0.33]; P = .017). Self-confidence increased equally in both groups. Standardized patients did not detect a difference in communication skills after training and between groups. Internal consistency and inter-rater reliability of the assessment tool were modest. CONCLUSIONS Standardized patients proved useful in studying the effectiveness of structured communication training, but may have been limited in their ability to perceive a difference between groups owing to the predetermined encounter outcome of vaccine refusal. AIMS training should be studied in real-world scenarios to determine if it impacts vaccine acceptance.
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Affiliation(s)
- Shanna M Barton
- Norton Children's Hospital, and University of Louisville School of Medicine, Louisville, KY
| | - Aaron W Calhoun
- Norton Children's Hospital, and University of Louisville School of Medicine, Louisville, KY
| | - Carrie A Bohnert
- Department of Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, KY
| | - Sara M Multerer
- Norton Children's Hospital, and University of Louisville School of Medicine, Louisville, KY
| | - Victoria A Statler
- Norton Children's Hospital, and University of Louisville School of Medicine, Louisville, KY
| | - Kristina A Bryant
- Norton Children's Hospital, and University of Louisville School of Medicine, Louisville, KY
| | - Daniel M Arnold
- Norton Children's Hospital, and University of Louisville School of Medicine, Louisville, KY
| | - Heather M Felton
- Norton Children's Hospital, and University of Louisville School of Medicine, Louisville, KY
| | - Patricia M Purcell
- Norton Children's Hospital, and University of Louisville School of Medicine, Louisville, KY
| | - Matthew D Kinney
- Norton Children's Hospital, and University of Louisville School of Medicine, Louisville, KY
| | - John M Parrish-Sprowl
- Department of Communication Studies, Global Health Communication Center, Indiana University Purdue University Indianapolis, Indianapolis, IN
| | - Gary S Marshall
- Norton Children's Hospital, and University of Louisville School of Medicine, Louisville, KY.
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Kelekar A, Rubino I, Kavanagh M, Lewis-Bedz R, LeClerc G, Pedell L, Afonso N. Vaccine Hesitancy Counseling-an Educational Intervention to Teach a Critical Skill to Preclinical Medical Students. MEDICAL SCIENCE EDUCATOR 2022; 32:141-147. [PMID: 35079448 PMCID: PMC8776394 DOI: 10.1007/s40670-021-01495-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION There has been a recent rise in public perception that vaccines are unsafe, fostering vaccine hesitancy (VH). Few interventions have focused on teaching medical students' communication skills for counseling vaccine-hesitant patients. METHODS Our educational intervention, designed for medical students, involved a self-study module followed by an interactive session on VH. Students practiced counseling vaccine-hesitant standardized patients (SPs). Faculty and SPs assessed student counseling skills. Students completed pre- and post-intervention surveys to assess attitudes and preparedness to counsel VH patients. RESULTS Students showed a better ability to talk to parents about Human Papillomavirus (HPV) vaccine concerns and Measles Mumps Rubella (MMR)/autism-related issues than to address patients' concerns related to the Varicella Zoster Virus (VZV) vaccine.Students' surveys pre- and post-intervention revealed significant improvement in their vaccination knowledge and comfort with counseling vaccine-hesitant patients. Student counseling skills as part of an Objective Structured Clinical Exam (OSCE) showed 73% of students asked about immunization and elicited SP concerns, but only 36% counseled appropriately. CONCLUSIONS In the face of emerging VH, physicians play a critical role in advising and influencing vaccination decisions. Therefore, it is a core responsibility of medical educators to train medical students on recommending vaccinations and responding effectively to vaccine-hesitant parents and patients. Our multifaceted interactive session provided preclinical students with knowledge and skills to improve communication skills with VH patients and parents and the need for ongoing practice of these VH counseling skills.
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Affiliation(s)
- Arati Kelekar
- Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309 USA
| | - Ida Rubino
- Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309 USA
| | - Maurice Kavanagh
- Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309 USA
| | | | - Gabrielle LeClerc
- Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309 USA
| | - Leon Pedell
- Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309 USA
| | - Nelia Afonso
- Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309 USA
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Williams SE, Adams LE, Sommer EC. Improving Vaccination for Young Children (IVY): A Stepped-Wedge Cluster Randomized Trial. Acad Pediatr 2021; 21:1151-1160. [PMID: 34118498 DOI: 10.1016/j.acap.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND High childhood vaccination rates are critical for public health. We hypothesized that implementation of a vaccine education and quality improvement (QI) program, Improving Vaccinations for Young Children (IVY), would improve childhood vaccine rates. METHODS Eight pediatric practices (3 academic-based, 5 community-based) were randomized to implement IVY within a stepped-wedge cluster randomized trial (SWCRT) in middle Tennessee. Two educational modules on vaccines were developed using best practices in instructional design. Modules were provided electronically and were tailored to providers or office staff. Practices completed in-person QI coaching sessions and selected at least 2 vaccination-related QI changes. Data were collected monthly. The primary analysis examined intervention effect on the primary outcome of Combination 10 vaccination status for children who turned 2 in the previous month. Combination 10 status without influenza vaccine was a secondary outcome, and exploratory analyses assessed intervention effects after adjusting for time and practice type. RESULTS Data from 4041 patients (1788 control; 2253 intervention) were collected. The intervention effect was not significant on the primary outcome (OR = 1.01; 95% CI [0.76, 1.34]; P > .9), however there were positive intervention effects in secondary and exploratory models analyzing Combination10 rates without flu, including models adjusting for variation over time (0.20; 95% CI [0.04,0.35]; P = .01) and practice type (higher vaccination rate in academic practices, 0.23; 95% CI [0.03,0.42]; P = .03). CONCLUSIONS Combination 10 rates were not significantly improved with IVY, yet evidence of beneficial effect on rates without flu vaccine was found. Future studies could evaluate effects over a longer time period and within a larger practice sample.
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Affiliation(s)
- S Elizabeth Williams
- Vanderbilt University Medical Center, Department of Pediatrics, Nashville, Tenn.
| | - Laura E Adams
- Vanderbilt University Medical Center, Department of Pediatrics, Nashville, Tenn
| | - Evan C Sommer
- Vanderbilt University Medical Center, Department of Pediatrics, Nashville, Tenn
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Shalansky RA, Wu M, Shen SC, Furness C, Morris SK, Reynolds D, Wong T, Pakes B, Crowcroft N. Evaluation of a pilot immunization curriculum to meet competency training needs of medical residents. BMC MEDICAL EDUCATION 2020; 20:442. [PMID: 33203404 PMCID: PMC7671185 DOI: 10.1186/s12909-020-02349-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/30/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Vaccination is the most cost-effective medical intervention known to prevent morbidity and mortality. However, data are limited on the effectiveness of residency programs in delivering immunization knowledge and skills to trainees. The authors sought to describe the immunization competency needs of medical residents at the University of Toronto (UT), and to develop and evaluate a pilot immunization curriculum. METHODS Residents at the University of Toronto across nine specialties were recruited to attend a pilot immunization workshop in November 2018. Participants completed a questionnaire before and after the workshop to assess immunization knowledge and compare baseline change. Feedback was also surveyed on the workshop content and process. Descriptive statistics were performed on the knowledge questionnaire and feedback survey. A paired sample T-test compared questionnaire answers before and after the workshop. Descriptive coding was used to identify themes from the feedback survey. RESULTS Twenty residents from at least six residencies completed the pre-workshop knowledge questionnaire, seventeen attended the workshop, and thirteen completed the post-workshop questionnaire. Ninety-five percent (19/20) strongly agreed that vaccine knowledge was important to their career, and they preferred case-based teaching. The proportion of the thirty-four knowledge questions answered correctly increased from 49% before the workshop to 67% afterwards, with a mean of 2.24 (CI: 1.43, 3.04) more correct answers (P < 0.001). Sixteen residents completed the post-workshop feedback survey. Three themes emerged: first, they found the content specific and practical; second, they wanted more case-based learning and for the workshop to be longer; and third, they felt the content and presenters were of high quality. CONCLUSIONS Findings from this study suggest current immunization training of UT residents does not meet their training competency requirements. The study's workshop improved participants' immunization knowledge. The information from this study could be used to develop residency immunization curriculum at UT and beyond.
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Affiliation(s)
- Rebecca A Shalansky
- Public Health and Preventive Medicine Residency, The University of Toronto, Toronto, Ontario, Canada.
| | - Margaret Wu
- Department of Family and Community Medicine, The University of Toronto, Toronto, Ontario, Canada
| | - Shixin Cindy Shen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Colin Furness
- Faculty of Information, University of Toronto, Toronto, Ontario, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Donna Reynolds
- Department of Family and Community Medicine, The University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tom Wong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Barry Pakes
- Public Health and Preventive Medicine Residency, The University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Natasha Crowcroft
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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A randomized controlled trial of an online immunization curriculum. Vaccine 2020; 38:7299-7307. [PMID: 32988690 DOI: 10.1016/j.vaccine.2020.09.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/29/2020] [Accepted: 09/14/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Immunization education for physicians-in-training is crucial to address vaccine concerns in clinical practice. Vaccine education is not standardized across residency programs. The Collaboration for Vaccination Education and Research (CoVER) team developed an online curriculum for pediatric (Peds) and family medicine (FM) residents. METHODS A cluster randomized controlled trial (RCT) was performed during the 2017-2018 academic year to evaluate the CoVER curriculum. A convenience sample of residency institutions were randomly allocated to the intervention or control group, with stratification by residency type. The intervention, the CoVER curriculum, consisted of four online modules and an in-person training guide. Control sites continued with their standard vaccine education. Pre-intervention and post-intervention surveys were emailed to residents in both groups. The primary outcomes compared between groups were changes in "vaccine knowledge," "vaccine attitudes/hesitancy," and "self-confidence" in immunization communication. The team assessing outcomes was unblinded to assignments. Hierarchical general linear model was used to adjust for residency type and residency year; residency site was modeled as a random effect. RESULTS Overall, 1444 residents from 31 residency programs were eligible to participate (734 intervention, 710 control). The pre-intervention response rate was 730 (51%) and post-intervention was 526 (36%). Average knowledge scores increased from pre-intervention (control 53%; CoVER 53%) to post-intervention (control 58%; CoVER 60%). Increases in vaccine knowledge among FM residents were greater for CoVER compared to controls (p = 0.041). Vaccine hesitancy was more common among FM (23%) than Peds (10%) residents. In all three residency years, residents in the CoVER group showed greater increases in self-confidence in ability to discuss vaccines with parents/patients (p < 0.03) compared to control group. CONCLUSION The CoVER curriculum is an effective model to standardize immunization education of physicians-in-training. This RCT demonstrated the effectiveness of the CoVER curriculum to improve resident confidence in their ability to discuss vaccines with parents and patients.
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Lewandowska A, Lewandowski T, Rudzki G, Rudzki S, Laskowska B. Opinions and Knowledge of Parents Regarding Preventive Vaccinations of Children and Causes of Reluctance toward Preventive Vaccinations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103694. [PMID: 32456267 PMCID: PMC7277597 DOI: 10.3390/ijerph17103694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 11/16/2022]
Abstract
Background: Despite the stability of global vaccination coverage, over 19 million children worldwide do not currently receive basic vaccines. Over the past several years, there has been a dramatic drop in the number of vaccinated children worldwide. The implementation of the vaccination program and the scope of protection depend on the parents or legal guardians, who decide whether to vaccinate their child or not. Studies were conducted to assess parents’ knowledge, attitudes, and beliefs about vaccines, as well as the role of healthcare providers in parents’ decisions. Methods: A population survey was conducted in 2018–2019. Parents or legal guardians of the children were invited to participate in the study during their visits to the clinic for healthy or sick children. The method used in the research was a diagnostic survey. Results: According to the conducted research, men and women constituted 45% and 55% of participants, respectively. The average age of men was 44, while, for women, it was 41. Internal research showed that as much as 71% of parents declared the need for vaccination, although 41% of parents vaccinated their children according to the vaccination calendar. The most frequently mentioned concerns included the possibility of adverse vaccination reactions (22%), the occurrence of autism (7%), and child death (6%). General practitioners had, by far, the greatest impact on the use of protective vaccination in children (73% women and 80% men), although there were cases of discouraging the performance of compulsory vaccinations (41%), and mentioning a doctor (38%) or nurse (3%). Conclusions: Modifiable determinants of the negative attitude toward vaccinations are caused mainly by the lack of knowledge. These obstacles in vaccinations can be overcome by improving health education in terms of the vaccination program.
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Affiliation(s)
- Anna Lewandowska
- Institute of Healthcare, State School of Technology and Economics, 37-500 Jaroslaw, Poland;
- Correspondence: ; Tel.: +48-6987-57926
| | - Tomasz Lewandowski
- Institute of Technical Engineering, State School of Technology and Economics, 37-500 Jaroslaw, Poland;
| | - Grzegorz Rudzki
- Chair and Department of Endocrinology, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Sławomir Rudzki
- Chair and Department of General and Transplant Surgery and Nutritional Treatment, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Barbara Laskowska
- Institute of Healthcare, State School of Technology and Economics, 37-500 Jaroslaw, Poland;
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Marshall GS. Vaccine Hesitancy, History, and Human Nature: The 2018 Stanley A. Plotkin Lecture. J Pediatric Infect Dis Soc 2019; 8:1-8. [PMID: 33513237 DOI: 10.1093/jpids/piy082] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/06/2018] [Indexed: 12/11/2022]
Abstract
Navigating the waters of vaccine hesitancy requires a view towards history and a deep understanding of how humans think. Getting children vaccinated is as much, or more, about connecting with people as it is about communicating scientific information.
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Affiliation(s)
- Gary S Marshall
- Division of Pediatric Infectious Diseases, University of Louisville School of Medicine, Kentucky
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Arora G, Lehman D, Charlu S, Ross N, Ardy A, Gordon B, Pannaraj PS. Vaccine health beliefs and educational influences among pediatric residents. Vaccine 2019; 37:857-862. [PMID: 30611603 DOI: 10.1016/j.vaccine.2018.12.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/15/2018] [Accepted: 12/18/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE A pilot study of pediatric residents to describe perceived benefits and effects of vaccines and educational influences on vaccine practice among pediatric residents. STUDY DESIGN Eighty-seven residents, from two institutions in a region with relatively high vaccine hesitancy, responded to a survey conducted in 2014-2015. RESULTS Residents identified professional experiences with vaccine preventable diseases (VPDs) and observing pediatricians as most impactful to their vaccine beliefs. Residents who had observed pediatric faculty agreeing to alternative or delayed vaccinations were more likely to believe this to be acceptable vaccine practice (70.1% vs. 21.1%, χ2 = 17.778, p < 0.001). Most residents (68 [79.1%]) reported feeling confident in their ability to discuss vaccines. CONCLUSIONS Pediatricians must be equipped with accurate vaccine health beliefs to impact parental vaccine hesitancy. This study identifies important gaps in medical education, with pediatric residents reporting limitations in their professional experience with VPDs and high rates of observing alternative vaccination practice.
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Affiliation(s)
- Gitanjli Arora
- Department of Pediatrics, Children's Hospital Los Angeles, United States.
| | - Deborah Lehman
- Department of Pediatrics, University of California Los Angeles, United States
| | - Sandhya Charlu
- Department of Pediatrics, Children's Hospital Los Angeles, United States
| | - Nicole Ross
- Department of Pediatrics, Children's Hospital Los Angeles, United States
| | - Adriana Ardy
- Department of Pediatrics, Children's Hospital Los Angeles, United States
| | - Bahareh Gordon
- Department of Pediatrics, University of California Los Angeles, United States
| | - Pia S Pannaraj
- Department of Pediatrics, Children's Hospital Los Angeles, United States; Department of Molecular Microbiology and Immunology, University of Southern California, United States
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Schnaith AM, Evans EM, Vogt C, Tinsay AM, Schmidt TE, Tessier KM, Erickson BK. An innovative medical school curriculum to address human papillomavirus vaccine hesitancy. Vaccine 2018; 36:3830-3835. [PMID: 29778518 DOI: 10.1016/j.vaccine.2018.05.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Vaccination rates against Human Papillomavirus (HPV) in the US remain alarmingly low. Physicians can significantly influence a parent's decision to vaccinate their children. However, medical education often lacks training on specific strategies for communicating with vaccine hesitant parents. METHODS We created an innovative curriculum designed to teach medical students how to address HPV vaccine hesitancy. The curriculum consisted of (1) a presentation on the epidemiology, biology, and disease morbidity associated with HPV, (2) a video that teaches specific communication strategies and (3) role-playing simulations. This curriculum was delivered to medical students at two separate sites. Medical students were surveyed before and after completing the educational curriculum. The surveys assessed student comfort talking to HPV vaccine hesitant parents and their likelihood to recommend the HPV vaccine. RESULTS Pre- and post-intervention surveys were completed by 101 of the 132 participants (77% response rate). After the intervention, student awareness of the benefits of the HPV vaccine increased by a mean of 0.82 points (Likert scale 1-5, p < 0.01) and student comfort talking to vaccine hesitant parents increased by a mean of 1.37 points (p < 0.01). Prior to the intervention, students more strongly recommended the HPV vaccine to females compared to males, but this gender disparity was eliminated after the intervention (p < 0.01). Personal vaccination status was independately associated with a higher likelihood of recommending the HPV vaccine both before and after the intervention. CONCLUSION Our innovative curriculum improved medical student comfort level discussing HPV vaccination with hesitant parents and increased the perceived likelihood of recommending HPV vaccination. The intervention is easy to implement, scalable, and requires minimal resources. Educating future providers on this important topic has the potential to improve vaccination rates nationwide and thus should be considered for all medical students.
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Affiliation(s)
- Abigail M Schnaith
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States.
| | - Erica M Evans
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States.
| | - Caleb Vogt
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States.
| | - Andrea M Tinsay
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States.
| | - Thomas E Schmidt
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States.
| | - Katelyn M Tessier
- Masonic Cancer Center Biostatistics Core, University of Minnesota, 717 Delaware St SE, Minneapolis, MN 55455, United States.
| | - Britt K Erickson
- Department of Obstetrics & Gynecology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, United States.
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15
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Whitaker JA, Poland CM, Beckman TJ, Bundrick JB, Chaudhry R, Grill DE, Halvorsen AJ, Huber JM, Kasten MJ, Mauck KF, Mehta RA, Olson T, Thomas KG, Thomas MR, Virk A, Wingo MT, Poland GA. Immunization education for internal medicine residents: A cluster-randomized controlled trial. Vaccine 2018; 36:1823-1829. [DOI: 10.1016/j.vaccine.2018.02.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/01/2018] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
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Abstract
Immunizations have led to a significant decrease in rates of vaccine-preventable diseases and have made a significant impact on the health of children. However, some parents express concerns about vaccine safety and the necessity of vaccines. The concerns of parents range from hesitancy about some immunizations to refusal of all vaccines. This clinical report provides information about addressing parental concerns about vaccination.
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Williams SE, Morgan A, Opel D, Edwards K, Weinberg S, Rothman R. Screening Tool Predicts Future Underimmunization Among a Pediatric Practice in Tennessee. Clin Pediatr (Phila) 2016; 55:537-42. [PMID: 26581360 PMCID: PMC7864550 DOI: 10.1177/0009922815615823] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Parent Attitudes about Childhood Vaccines (PACV) survey for identifying vaccine-hesitant parents was recently validated in Washington State but did not include all recommended childhood vaccines. The current study compares vaccination rates for all recommended childhood vaccines and PACV scores at one pediatric practice in Tennessee. Children were enrolled at the 2-week well visit, and vaccination rates were assessed at 19 months of age. Outcomes at 19 months of age included mean percentage of days underimmunized and up-to-date status (yes/no) compared with PACV scores. The impact of provider on immunization status was assessed. Complete vaccination data were available for 158 children of 183 enrolled (86%). Higher PACV scores were associated with more days underimmunized (P < .001) and being overdue for vaccine doses at 19 months of age (P < .001). No difference was seen between providers and up-to-date status. Our study supports the predictive validity of the PACV for underimmunization.
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Affiliation(s)
| | - Ashley Morgan
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Douglas Opel
- University of Washington School of Medicine, Seattle, WA, USA
| | - Kathryn Edwards
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Stuart Weinberg
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Russell Rothman
- Vanderbilt University School of Medicine, Nashville, TN, USA
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de St Maurice A, Edwards KM. Vaccine Hesitancy in Children-A Call for Action. CHILDREN-BASEL 2016; 3:children3020007. [PMID: 27417245 PMCID: PMC4934562 DOI: 10.3390/children3020007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 04/15/2016] [Accepted: 04/20/2016] [Indexed: 11/20/2022]
Abstract
Immunizations have made an enormous impact on the health of children by decreasing childhood morbidity and mortality from a variety of vaccine-preventable diseases worldwide. The eradication of polio from Nigeria and India is one of the most recent victories for one of the greatest technological advances in human history. Despite these international successes, the United States has experienced the re-emergence of measles, driven largely by increasing parental refusal of vaccines. Pediatricians should be trained to be very knowledgeable about vaccines and should continue to advocate for parents to immunize their children.
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Affiliation(s)
| | - Kathryn M Edwards
- Department of Pediatrics, Vanderbilt University, Nashville, TN 37232, USA.
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Meina L, Xiaodong L, Lulu Z. Hepatitis B vaccine adverse events in China: risk control and regulation. Hum Vaccin Immunother 2015; 10:2992-3. [PMID: 25483642 PMCID: PMC5443087 DOI: 10.4161/21645515.2014.971643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The death of 17 children raised public fears over infant hepatitis B vaccination in China. Though the relation between hepatitis B and children's death was denied after prudent investigation, the negative impact remained. In order to prevent or minimize adverse events after vaccination, special strategy including regulation and reimbursement should be developed.
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Affiliation(s)
- Li Meina
- a The Second Military Medical University ; Faculty of Health Service ; Institute of Military Health Management, PLA ; Shanghai , China
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Abstract
RATIONALE Recent studies on video laryngoscopy have demonstrated improvements in both safety and success of endotracheal intubation in the critically ill. OBJECTIVES We assessed the use of video laryngoscopy among internal medicine fellowship programs training physicians in critical care medicine. METHODS A 19-question survey was e-mailed to program directors of pulmonary/critical care and internal medicine critical care fellowship training programs. MEASUREMENTS AND MAIN RESULTS A completed survey was returned by 36% of invited program directors. Sixty-nine percent of respondents reported a change in their approach to intubation training over the prior 3 years, with 56% of changes attributed to the adoption of a video laryngoscope. Other reported changes include new training methods (23%) and adoption of a checklist (10%). A video laryngoscope is available for clinical use in 89% of the responding programs. The video scope is used as the primary device in 16% and is never used in 9%. In the remainder of programs, the video laryngoscope is only used for difficult intubations or after failure of direct laryngoscopy (32%) or the primary device is determined by the preference of the operator (32%). CONCLUSIONS The majority of internal medicine critical care program directors who recently responded to an e-mail survey reported that they have changed their approach to teaching endotracheal intubation, driven largely by the adoption of video laryngoscopy for upper airway visualization. Nevertheless, despite widespread availability, video laryngoscopy is used uncommonly as the primary visualization device for intubation at the programs represented by the respondents to this survey.
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