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Paul KT, Pichelstorfer A, Hansl N, Martin M, Pucker PM, Zhikharevich D. "I can't see the forest for the ticks, uhm, trees …": The role of online forums in parents' vaccination trajectories. Soc Sci Med 2024; 357:117183. [PMID: 39142142 DOI: 10.1016/j.socscimed.2024.117183] [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: 03/19/2024] [Revised: 07/05/2024] [Accepted: 08/02/2024] [Indexed: 08/16/2024]
Abstract
When it comes to health-related information-seeking behavior, online communities play a key role for some groups, such as parents. With a case study of online communities in a loosely organized vaccination system, that of Austria, we study how parents make use of a prominent online forum (parents.at) in their vaccination trajectories and situate this analysis in its socio-political context. Based on inductive qualitative analysis of relevant threads (n = 27), we find that parents use forums in three ways: First, the forum serves as a platform through which parents seek orientation in a loosely organized and fragmented vaccination system. Second, the forum offers space for sharing, collecting, and evaluating different forms of expertise. In doing so, parents carve out a space in which they can comfortably put lay expertise and credentialed expertise on a par, particularly in their advice to peers. Third, and on that basis, parents use the forum for deliberating on future or past vaccination-related decisions. In doing so, they frequently draw on idiosyncratic notions of individual risks and benefits. These three practices enable parents to accumulate and share what we label navigational capital. We conclude that parents resort to online spaces both out of a subjective need and, for some, as a result of a dysfunction of the national childhood vaccination program which offers little orientation for parents.
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Affiliation(s)
- Katharina T Paul
- Department of Political Science, Research Platform Governance of Digital Practices, University of Vienna, Kolingasse 14-16, 1090, Vienna, Austria.
| | - Anna Pichelstorfer
- Department of Political Science, Research Platform Governance of Digital Practices, University of Vienna, Kolingasse 14-16, 1090, Vienna, Austria
| | - Nora Hansl
- Department of Political Science, Research Platform Governance of Digital Practices, University of Vienna, Kolingasse 14-16, 1090, Vienna, Austria
| | - Maximilian Martin
- Department of Political Science, Research Platform Governance of Digital Practices, University of Vienna, Kolingasse 14-16, 1090, Vienna, Austria
| | - Paula-Marie Pucker
- Department of Political Science, Research Platform Governance of Digital Practices, University of Vienna, Kolingasse 14-16, 1090, Vienna, Austria
| | - Dmitrii Zhikharevich
- Department of Political Science, Research Platform Governance of Digital Practices, University of Vienna, Kolingasse 14-16, 1090, Vienna, Austria
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2
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Vega RA. Hesitation towards the COVID-19 vaccine in the United States: a digital ethnographic study. Salud Colect 2024; 20:e4541. [PMID: 38733976 DOI: 10.18294/sc.2024.4541] [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: 06/23/2023] [Accepted: 03/13/2024] [Indexed: 05/13/2024] Open
Abstract
Following the authorization the use of COVID-19 vaccines in babies age six months through children four years old in the United States, some individuals (parents, pediatricians, and communicators) framed COVID-19 vaccination as an issue of access, while many others expressed hesitancy and some resisted recommendations from the US Centers for Disease Control and Prevention. In this context, this study aimed to explore: 1) divergent reactions to the authorization of COVID-19 vaccine use in children aged six months to four years; and 2) opposing logics underlying attitudes towards pro-vaccination, anti-vaccination, and vaccine hesitancy regarding COVID-19 vaccines. To achieve this, a digital ethnography was conducted, involving monitoring of 5,700 reactions to a series of eight infographics published on social media by the John Hopkins Bloomberg School of Public Health, and participant observation in an online focus group over a one-year period, from December 2021 to December 2022, consisting of 18 mothers. The findings suggest that healthcare professionals should consider different notions of "risk" when interacting with patients, especially those who are hesitant to vaccinate.
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Affiliation(s)
- Rosalynn Adeline Vega
- Doctora en Antropología Médica. Profesora asociada, University of Texas Rio Grande Valle, Edinburg, EEUU
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3
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Divíšek T, Numerato D. Leaky bodies, vaccination and three layers of memory: bio-immune, social-collective and lived experience. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2024; 33:73-88. [PMID: 38442743 DOI: 10.1080/14461242.2024.2320223] [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: 06/09/2023] [Accepted: 02/13/2024] [Indexed: 03/07/2024]
Abstract
This paper focuses on the omnipresent yet analytically almost invisible role of memory and bodily experiences in childhood vaccination. Previous scholarship on the sociocultural aspects of vaccination has primarily focused on the individual and sociodemographic factors underpinning vaccine hesitancy, the role of healthcare professionals and the politicisation or mediatisation of vaccination. Social practices considering vaccination were primarily explored as a matter of the present. Only little consideration was given to the past, individual biographies and sociohistorical temporalities. To complement this body of work, we focus on cognitively-based, embodied and emotionally-experienced memory related to vaccination. Based on a qualitative study of childhood vaccination conducted in Czechia between 2017 and 2019 consisting of ethnographic observations, in-depth interviews and a document review, we identified three interconnected forms of vaccination memory: bio-immune, social-collective and lived experience. Bio-immune memory refers to the body's physical memory, gained to protect itself from diseases. Social-collective memory focuses on socially shared narratives about diseases and vaccination in the past. The memory of lived experience refers to feelings, embodied knowledge and pain. Our findings may inspire further analysis of childhood vaccination in other geographical contexts and amidst the reconfiguration of attitudes and newly established memories following the COVID-19 pandemic.
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Affiliation(s)
- Tereza Divíšek
- Institute of Sociological Studies, Faculty of Social Sciences, Charles University, Prague
| | - Dino Numerato
- Institute of Sociological Studies, Faculty of Social Sciences, Charles University, Prague
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4
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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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Ramaroson HJV, Mattern C, Huysmans E, Razafiarimanana H, Brazy-Nancy E, Haritiana Ranaivoharimina M, Pourette D. Obstacles to routine immunization in Madagascar: Structural, relational and cultural constraints. Vaccine X 2023; 15:100348. [PMID: 37533680 PMCID: PMC10391678 DOI: 10.1016/j.jvacx.2023.100348] [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: 09/19/2022] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023] Open
Abstract
This article proposes an overview of anthropological studies concerning childhood immunization in Madagascar, where vaccine coverage still remains low. The COVID-19 epidemic has heightened the reticence of populations to be vaccinated in the public health centres of this country. It appears necessary to study the factors which may impact immunization practices and its representations. The principal results of these studies describe immunization from the perspective of parents of children under five years of age. The role that they attribute to a vaccine is essentially that of reinforcing the health of children against illness. There is a misunderstanding of combination vaccines, one vaccine generally being associated with one disease. The findings also show a complex relationship with immunization, injections and the health passport. Finally, uptake of immunization or not is motivated by the structural and local context such as the perceived frailness of the newborn baby, the practice of post-partum confinement, or the lack of knowledge about the vaccine. Lack of understanding of immunization and mistrust of it are signs of a fragile health system. An in-depth analysis of immunization and the impact of COVID-19 on its perception will provide a clearer view of the fragility of the immunization programmes implemented in Madagascar.
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Affiliation(s)
- Henintsoa Joyce Valentina Ramaroson
- Health & Social Sciences, Epidemiology and Clinical Research Unit, Pasteur Institute of Madagascar (IPM), BP 1274 Ambatofotsikely Avaradoha, 101 Antananarivo, Madagascar
- Applied Human Sciences, Arts & Sciences Faculty, Montreal University, Montreal, Canada
| | - Chiarella Mattern
- Health & Social Sciences, Epidemiology and Clinical Research Unit, Pasteur Institute of Madagascar (IPM), BP 1274 Ambatofotsikely Avaradoha, 101 Antananarivo, Madagascar
| | - Elise Huysmans
- Prospective Anthropology Laboratory (LAAP), Catholic University of Louvain, Louvain-La-Neuve, Belgium
| | | | - Emilia Brazy-Nancy
- Health & Social Sciences, Epidemiology and Clinical Research Unit, Pasteur Institute of Madagascar (IPM), BP 1274 Ambatofotsikely Avaradoha, 101 Antananarivo, Madagascar
| | - Mendrika Haritiana Ranaivoharimina
- Health & Social Sciences, Epidemiology and Clinical Research Unit, Pasteur Institute of Madagascar (IPM), BP 1274 Ambatofotsikely Avaradoha, 101 Antananarivo, Madagascar
| | - Dolorès Pourette
- French National Research Institute for Sustainable Development – Ceped (IRD, Paris University, INSERM) – Paris, France
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Bellomo RK, Cerabona V, Massimi A, Migliara G, Sparano M, Novello F, Schilirò T, Siliquini R, Villari P, De Vito C. Who chooses alternative sources of information about childhood vaccinations? A cross-sectional study. Front Public Health 2023; 11:1225761. [PMID: 37771825 PMCID: PMC10525346 DOI: 10.3389/fpubh.2023.1225761] [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: 05/22/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction Vaccine hesitancy can lead to problematic outcomes in terms of public health. A factor playing a fundamental role in this dynamic is the source of information considered by parents in the decision-making progress that leads to the acceptance or refusal of childhood vaccinations. This study aims to investigate the sources of information considered by the parents of children attending primary and secondary schools in two large Italian cities and to identify predictors that led to choosing alternative sources of information. Methods An online questionnaire was administered to the parents of students attending elementary, middle, and high schools in Rome and Turin. Two validated tools were used: the Parent Attitudes about Childhood Vaccines Survey and the Vaccine Health Literacy of adults in Italian. Sources of information about vaccinations, trust toward the healthcare system, hesitancy and attitudes about COVID-19 vaccinations, were also investigated. A multivariable logistic regression model was built to identify predictors of the preferred sources of information on the topic. Results Totally, 2,301 answers to the survey were collected from June to October 2021. Of these, 1,127 came from parents in Rome (49%) and 1,174 from parents based in Turin (51%) with a mean age of 47.7 years (±6.4). The majority of the respondents were mothers (81%), married (73%), with two or more children (70.5%). The multivariable logistic regression model results showed that fathers were more inclined than mothers to use alternative sources of information (OR 1.48, 95% CI 1.29-2.00). Moreover, a higher level of vaccine hesitancy was a strong predictor for choosing alternative sources of information (OR 2.45, 95% CI 1.73-3.46). The HLVa-it scores show that parents with a lower Vaccine Literacy (VL) were more inclined to use alternative sources of information. Discussion Addressing health literacy issues and changing the official forms of communication could help improving vaccine acceptance. This study shows the importance of rebuilding a trusting relationship between patients and health care providers, which is fundamental in the fight against vaccine hesitancy.
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Affiliation(s)
- Rosa Katia Bellomo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Vito Cerabona
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Azzurra Massimi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Migliara
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Michele Sparano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Tiziana Schilirò
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Roberta Siliquini
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- A.O.U. City of Health and Science of Turin, Turin, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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7
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Fasce A, Schmid P, Holford DL, Bates L, Gurevych I, Lewandowsky S. A taxonomy of anti-vaccination arguments from a systematic literature review and text modelling. Nat Hum Behav 2023; 7:1462-1480. [PMID: 37460761 DOI: 10.1038/s41562-023-01644-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/25/2023] [Indexed: 09/23/2023]
Abstract
The proliferation of anti-vaccination arguments is a threat to the success of many immunization programmes. Effective rebuttal of contrarian arguments requires an approach that goes beyond addressing flaws in the arguments, by also considering the attitude roots-that is, the underlying psychological attributes driving a person's belief-of opposition to vaccines. Here, through a pre-registered systematic literature review of 152 scientific articles and thematic analysis of anti-vaccination arguments, we developed a hierarchical taxonomy that relates common arguments and themes to 11 attitude roots that explain why an individual might express opposition to vaccination. We further validated our taxonomy on coronavirus disease 2019 anti-vaccination misinformation, through a combination of human coding and machine learning using natural language processing algorithms. Overall, the taxonomy serves as a theoretical framework to link expressed opposition of vaccines to their underlying psychological processes. This enables future work to develop targeted rebuttals and other interventions that address the underlying motives of anti-vaccination arguments.
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Affiliation(s)
- Angelo Fasce
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Philipp Schmid
- Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Department of Implementation Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Dawn L Holford
- School of Psychological Science, University of Bristol, Bristol, UK
- Department of Psychology, University of Essex, Colchester, UK
| | - Luke Bates
- Ubiquitous Knowledge Processing Lab/Department of Computer Science and Hessian Center for AI (hessian.AI), Technical University of Darmstadt, Darmstadt, Germany
| | - Iryna Gurevych
- Ubiquitous Knowledge Processing Lab/Department of Computer Science and Hessian Center for AI (hessian.AI), Technical University of Darmstadt, Darmstadt, Germany
| | - Stephan Lewandowsky
- School of Psychological Science, University of Bristol, Bristol, UK
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
- Department of Psychology, University of Potsdam, Potsdam, Germany
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8
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Anderson A. Regional and neighbourhood-based variation in three types of vaccine attitude in Britain. Health Place 2023; 83:103098. [PMID: 37572542 DOI: 10.1016/j.healthplace.2023.103098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023]
Abstract
This study investigates the geographic patterning of attitudes towards vaccination in Britain (England, Wales, and Scotland). Using survey data from the 2018 Wellcome Monitor linked to lower super output areas and NUTS2 regions, this study provides evidence that negative attitudes regarding the risk of side-effects from vaccination and regarding the efficacy of vaccination are correlated with higher levels of local deprivation. While previous research has highlighted associations between vaccine uptake and deprivation for a variety of reasons, this study specifically contends that particular individualised types of caution about vaccines also tend to cluster in deprived areas.
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Affiliation(s)
- Alistair Anderson
- School of Sociology and Social Policy, Law and Social Sciences Building, University Park, Nottingham, NG7 2RD, UK.
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9
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Campeau K. Who's a Vaccine Skeptic? Framing Vaccine Hesitancy in Post-Covid News Coverage. WRITTEN COMMUNICATION 2023; 40:976-1023. [PMID: 38603019 PMCID: PMC10251182 DOI: 10.1177/07410883231169622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
U.S. print news coverage of Covid vaccine hesitancy represents a departure from previous depictions of vaccine skepticism as a problem of wrong belief. This article reports on a mixed methods study of 334 New York Times texts about Covid nonvaccination and vaccine hesitancy published between December 2020-December 2021. Texts were analyzed for common themes and compared with prior media depictions of vaccine skepticism. Findings show that texts published during phased Covid vaccine distribution framed nonvaccination as a response to structural inequities, while later texts returned to blaming individuals for their hesitancy. These findings attest to the durability of individualistic framings of health while also illustrating possibilities of alternative frames.
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Affiliation(s)
- Kari Campeau
- English Department, University of Colorado Denver, Denver, CO, USA
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10
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Abstract
OBJECTIVE To identify, describe and map the research tools used to measure COVID-19 vaccine hesitancy, refusal, acceptance and access in sub-Saharan Africa (SSA). DESIGN Scoping review. METHODS In March 2022, we searched PubMed, Scopus, Web of Science, Cochrane, Academic Search Premier, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Health Source Nursing, Africa Wide and APA PsychInfo for peer-reviewed literature in English related to COVID-19 vaccine hesitancy, refusal, acceptance and access in SSA. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews to guide evidence gathering and as a template to present the evidence retrieval process. RESULTS In the studies selected for review (n=72), several measurement tools were used to measure COVID-19 vaccine hesitancy, acceptance and refusal. These measurements were willingness and intent to vaccinate from the perspectives of the general population, special population groups such as mothers, students and staff in academic institutions and healthcare workers and uptake as a proxy for measuring assumed COVID-19 vaccine acceptance. Measurements of access to COVID-19 vaccination were cost and affordability, convenience, distance and time to travel or time waiting for a vaccine and (dis)comfort. Although all studies measured COVID-19 vaccine hesitancy, acceptance and refusal, relatively few studies (n=16, 22.2%) included explicit measurements of access to COVID-19 vaccination. CONCLUSIONS Based on the gaps identified in the scoping review, we propose that future research on determinants of COVID-19 vaccination in SSA should further prioritise the inclusion of access-related variables. We recommend the development and use of standardised research tools that can operationalise, measure and disentangle the complex determinants of vaccine uptake in future studies throughout SSA and other low- and middle-income country (LMIC) settings.
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Affiliation(s)
- Michael J Deml
- Institute of Sociological Research, Department of Sociology, University of Geneva, Geneva, Switzerland
- Division of Social and Behavioural Sciences, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jennifer Nyawira Githaiga
- Division of Social and Behavioural Sciences, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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11
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Gareau S, Bailey J, Halberstadt ES, James T, Kenison K, Robb SW, Rolke L, Taylor C, Wagner P. COVID-19 in South Carolina: Experiences Using Facebook as a Self-Organizing Tool for Grassroots Advocacy, Education, and Social Support. JOURNAL OF HUMANISTIC PSYCHOLOGY 2022. [DOI: 10.1177/00221678221130830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This retrospective case study describes our experiences, processes, and lessons learned using social media for pandemic response. Our team created and maintained a large Facebook group, and we used this platform to support grassroots advocacy, public health messaging, and health equity during the COVID-19 pandemic in South Carolina. The Facebook group was initially formed to urge local and state leaders to implement a stay-at-home order, but we recognized a continued need for our virtual space. Group leaders performed tasks including data tracking/reporting and content review/approval. Initial advocacy successes included the stay-at-home order, efforts to limit transmission, and social/mental health support. As the Delta variant emerged, we posted vaccine education and access information and supported school mitigation, including a successful litigation effort that led to a mask requirement on school buses. With the Omicron variant, our group’s focus shifted to educating about immune evasion, transmissibility, and individual protection. This included updates on mask use, antigen testing, vaccine boosters, treatment, data reports, and vaccines. Throughout the pandemic, we addressed health equity, especially for those identifying as disabled. We learned that virtual communities could support each other and improve public health, even when disinformation was present and elected officials emphasized politics over science.
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Affiliation(s)
- Sarah Gareau
- University of South Carolina, Columbia, SC, USA
- Group Founder, Caregiver, and Advocate, Columbia, SC, USA
| | - Jill Bailey
- Group Advocacy Moderator and Group Administrator (with complex healthcare needs), Greenville, SC, USA
| | | | - Tiffany James
- Community Engagement and Public Relations Consultant, Group Health Equity Moderator, and Advocate, Columbia, SC, USA
| | - Kelli Kenison
- University of South Carolina, Columbia, SC, USA
- Group Founder and Concerned Public Health Advocate, Hopkins, SC, USA
| | - Sara Wagner Robb
- Clemson University, Clemson, SC, USA
- Group Founder, Greenville, SC, USA
| | - Laura Rolke
- Duke University, Durham, NC, USA
- Group Administrator, Greenville, SC, USA
| | - Chris Taylor
- Group Data Moderator, Disabled Stay-at-Home Father, and Former Government Employee, Lexington, SC, USA
| | - Peggy Wagner
- School of Medicine Greenville, University of South Carolina, Greenville, SC, USA
- Group Mental Health Consultant, Greenville, SC, USA
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12
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Ebi SJ, Deml MJ, Jafflin K, Buhl A, Engel R, Picker J, Häusler J, Wingeier B, Krüerke D, Huber BM, Merten S, Tarr PE. Parents' vaccination information seeking, satisfaction with and trust in medical providers in Switzerland: a mixed-methods study. BMJ Open 2022; 12:e053267. [PMID: 35228281 PMCID: PMC8886431 DOI: 10.1136/bmjopen-2021-053267] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The aim of this study was to better understand parental trust in and satisfaction with information sources and medical providers regarding decision making about childhood vaccines. SETTING The study was part of a Swiss national research programme investigating vaccine hesitancy and underimmunisation. PARTICIPANTS We conducted qualitative interviews with 37 providers and 30 parents, observed 34 vaccination consultations, and then conducted quantitative surveys with 130 providers (both complementary and alternative medicine (CAM) oriented and biomedically oriented) and 1390 parents. MAIN OUTCOME MEASURES Participants' vaccination information sources used in their decision-making process, parents' trust in and satisfaction with these sources and providers. RESULTS Based on the Parent Attitudes about Childhood Vaccines scale, we considered 501 parents as vaccine-hesitant (VH) and 889 parents as non-VH. Whereas both groups mentioned providers as the most trusted source of information, VH-parents were less likely to mention paediatricians (N=358 (71%) vs N=755 (85%)) and public health authorities (N=101 (20%) vs N=333 (37%)) than non-VH-parents. VH-parents were more likely to have consulted another provider (N=196 (39%) vs N=173 (19%)) than non-VH-parents, to express less satisfaction with both their primary (N=342 (82%) vs N=586 (91%)) and other providers (N=82 (42%) vs N=142 (82%)) and less trust in their primary (N=368 (88%) vs N=632 (98%)) and other providers (N=108 (55%) vs N=146 (84%)). VH-parents were less likely to be satisfied with their biomedical primary provider than non-VH-parents (100 (69%) vs 467 (91%)). However, when the primary provider was CAM-oriented, there were similar levels of satisfaction among both groups (237 (89%) VH-parents vs 118 (89%) non-VH-parents). All differences were significant (p<0.05). CONCLUSIONS While the provider remains the main information source, VH parents turn to additional sources and providers, which is likely related to VH parents being rather dissatisfied with and distrusting in obtained information and their provider. ETHICS The local ethics committee (Ethikkommission Nordwest- und Zentralschweiz, EKNZ; project ID number 2017-00725) approved the study.
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Affiliation(s)
- Selina Jana Ebi
- Medizinische Universitätsklinik Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - Michael J Deml
- Department of Sociology, Institute of Sociological Research, University of Geneva, Geneva, Switzerland
- Division of Social and Behavioural Sciences, University of Cape Town School of Public Health and Family Medicine, Observatory, Western Cape, South Africa
| | - Kristen Jafflin
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Andrea Buhl
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Rebecca Engel
- Medizinische Universitätsklinik Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - Julia Picker
- Medizinische Universitätsklinik Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - Julia Häusler
- Medizinische Universitätsklinik Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | - Benedikt M Huber
- Department of Pediatrics, HFR Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Sonja Merten
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Philip E Tarr
- Medizinische Universitätsklinik Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
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Rozbroj T, Lyons A, Lucke J. Understanding how the Australian vaccine-refusal movement perceives itself. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:695-705. [PMID: 33002263 DOI: 10.1111/hsc.13182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/20/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
Public health responses to the vaccine-refusal (VR) movement are hindered by inadequate research about the movement's aims, identity and perceived value for its members. This study examined how members of the VR movement in Australia described the movement and what being part of it meant to them. Descriptions of the VR movement by 696 members from across Australia were collected between January and May in 2017 via an online survey. The data were analysed using thematic discourse analysis. Members' understandings of the movement and the beliefs underpinning these understandings were examined. Vaccine refusal was underpinned by distinct epistemic beliefs. Participants believed that mainstream vaccine promotion relies on dishonest communication of compromised research. They saw the VR movement as a science-based movement, researching both 'mainstream' and 'hidden' knowledge, promoting scientific values and advocating for better vaccine studies. Participants believed responsible parenting requires personally researching healthcare choices. Participants constructed the movement's identity in relation to common criticisms of vaccine refusal. These were discredited and repurposed to portray the movement as being brave and righteous. Participants believed people in the movement are astute, informed, responsible and courageous. They believed many members were impacted by vaccine-related harms, from which the movement now saves others. They saw themselves as fighting for an inconvenient truth that the mainstream ignores. Vaccine promotion needs to address the epistemic beliefs associated with vaccine refusal, yet these have been inadequately understood. Our findings contribute to understanding these beliefs. Furthermore, our findings suggest what messages targeting vaccine-refusing people should focus on. This may include acknowledging the significant effort that vaccine-refusing people invest in trying to protect their children, catering to vaccine-refusing people's high engagement and desire for detailed information, and avoiding stigmatising or confrontational vaccine-promotion strategies.
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Affiliation(s)
- Tomas Rozbroj
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, VIC, Australia
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, VIC, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, VIC, Australia
| | - Jayne Lucke
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, VIC, Australia
- School of Public Health, The University of Queensland, St Lucia, QLD, Australia
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14
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Deml MJ, Buhl A, Huber BM, Burton‐Jeangros C, Tarr PE. Trust, affect, and choice in parents' vaccination decision-making and health-care provider selection in Switzerland. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:41-58. [PMID: 34747500 PMCID: PMC9299032 DOI: 10.1111/1467-9566.13388] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 08/30/2021] [Accepted: 10/05/2021] [Indexed: 06/01/2023]
Abstract
This article examines the relationships between biomedicine, complementary and alternative medicine (CAM) and parents' vaccination decision-making in Switzerland. Our empirical evidence sheds light on an understudied phenomenon-parents switching from one doctor to another provider (often one offering CAM services) around issues that arise during vaccination consultations. This is important to understand since CAM is used by 25%-50% of the Swiss population and is integrated into the Swiss health-care system when offered by biomedically trained medical doctors with additional CAM training. Qualitative data gathered from in-depth semi-structured interviews with parents (N = 30) and ethnographic observations of vaccination consultations (N = 16 biomedical consultations, N = 18 CAM consultations) demonstrate how there was not always a clear-cut, direct relationship between (non)vaccination and parents' use of CAM and/or biomedicine. Borrowing from Hirschman (Exit, voice, and loyalty: Responses to decline in firms, organizations, and states, Harvard Univ. Press, 1970), we frame our analysis by using the concepts of exit, voice and loyalty to describe parents' provider selection and vaccination decision-making process, although only four families in the sample described switching solely because of vaccination-related issues. Findings add to vaccine decision-making literature by describing and analysing the underdiscussed provider-switching phenomenon and by demonstrating the importance of parents' experiences of trust, affect and choice in vaccination consultations as they pursue the best health outcomes for their children.
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Affiliation(s)
- Michael J. Deml
- Institute of Sociological ResearchDepartment of SociologyUniversity of GenevaGenevaSwitzerland
- Division of Social and Behavioural SciencesSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Andrea Buhl
- Swiss Tropical and Public Health Institute (Swiss TPH)BaselSwitzerland
- University of BaselBaselSwitzerland
| | - Benedikt M. Huber
- Department of PediatricsFribourg Cantonal HospitalFribourgSwitzerland
| | | | - Philip E. Tarr
- University of BaselBaselSwitzerland
- University Department of MedicineKantonsspital BasellandUniversity of BaselBruderholzSwitzerland
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15
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Boelsma F, Bektas G, Wesdorp CL, Seidell JC, Dijkstra SC. The perspectives of parents and healthcare professionals towards parental needs and support from healthcare professionals during the first two years of children's lives. Int J Qual Stud Health Well-being 2021; 16:1966874. [PMID: 34435540 PMCID: PMC8405107 DOI: 10.1080/17482631.2021.1966874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The first two years of a child's life have been found to be crucial for optimal growth and development. Support from healthcare professionals is especially important during this period. This study explored the perspectives of parents with children aged 0-2 years and healthcare professionals concerning parental needs and support provided by healthcare professionals. METHODS A qualitative research approach was adopted, which comprised semi-structured interviews with parents (N = 25) and focus group discussions with parents (N = 4) and healthcare professionals (N = 3). The data was analysed using the principles of inductive thematic analysis. RESULTS Overall, we found that parents preferred support that was tailored to their personal needs and practices. Building a trusting relationship between healthcare professionals and parents was also found to be important. The healthcare professionals recognized many of the parents' experiences. Some expressed that they felt bound to adhere to professional guidelines, which hindered them to provide customized support. CONCLUSIONS Recommendation for establishing tailored support and trust are self-disclosure by professionals, addressing possible misconceptions openly, and showing interest in someone's considerations or family and cultural customs. Further research into how professional support for parents can be improved is recommended.
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Affiliation(s)
- Femke Boelsma
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Gülcan Bektas
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Carline L. Wesdorp
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jacob C. Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - S. Coosje Dijkstra
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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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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Huel C, Harding J, MacKinnon K, Gordon C, MacDonald SE. Parental experiences of caring for their preschool children after declining vaccines: a qualitative systematic review protocol. JBI Evid Synth 2021; 20:196-203. [PMID: 34559698 DOI: 10.11124/jbies-21-00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This review will explore the experiences of parents after making the decision not to vaccinate their young children. This review aims to help health care providers understand parents' specific care strategies for their under-vaccinated or unvaccinated young children. INTRODUCTION Much of the current qualitative research literature on parents who hesitate or refuse to vaccinate their young children focuses on parental perceptions about the safety and efficacy of vaccines and decision-making. However, limited attention has been paid to measures taken by parents to help their young children avoid contracting communicable diseases, promote resistance, and enhance their children's health. INCLUSION CRITERIA This review will consider qualitative studies that describe parents' experiences of caring for their young children, aged 0 to 6 years, after making the decision not to vaccinate. Studies undertaken in any context will be considered. Studies that focus on young children who are unvaccinated or not fully vaccinated for reasons not related to parental refusal will be excluded. METHODS The JBI methodology for systematic reviews of qualitative evidence will be followed. Databases will be searched from 1998 onwards, and will include Web of Science, MEDLINE, CINAHL, PsycINFO, Google Scholar, and ProQuest Dissertations and Theses, with no language limits. Following critical appraisal, findings that describe parental experiences and the care activities they perform related to their young children will be extracted. The JBI process of meta-aggregation will be used to identify categories and synthesize findings. The ConQual approach will be used to assess confidence in the findings. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021241781.
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Affiliation(s)
- Christine Huel
- University of Victoria, Victoria, BC, Canada The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): A JBI Centre of Excellence University of British Columbia, Vancouver, BC, Canada University of Alberta, Edmonton, AB, Canada
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18
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Truong J, Bakshi S, Wasim A, Ahmad M, Majid U. What factors promote vaccine hesitancy or acceptance during pandemics? A systematic review and thematic analysis. Health Promot Int 2021; 37:6318107. [PMID: 34244738 DOI: 10.1093/heapro/daab105] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Examine the factors that promote vaccine hesitancy or acceptance during pandemics, major epidemics and global outbreaks. A systematic review and thematic analysis of 28 studies on the Influenza A/H1N1 pandemic and the global spread of Ebola Virus Disease. We found seven major factors that promote vaccine hesitancy or acceptance: demographic factors influencing vaccination (ethnicity, age, sex, pregnancy, education, and employment), accessibility and cost, personal responsibility and risk perceptions, precautionary measures taken based on the decision to vaccinate, trust in health authorities and vaccines, the safety and efficacy of a new vaccine, and lack of information or vaccine misinformation. An understanding of participant experiences and perspectives toward vaccines from previous pandemics will greatly inform the development of strategies to address the present situation with the COVID-19 pandemic. We discuss the impact vaccine hesitancy might have for the introduction and effectiveness of a potential COVID-19 vaccine. In particular, we believe that skepticism toward vaccines can still exist when there are no vaccines available, which is contrary to contemporary conceptualizations of vaccine hesitancy. We recommend conducting further research assessing the relationship between the accessibility and cost of vaccines, and vaccine hesitancy.
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Affiliation(s)
- Judy Truong
- Research & Development, MaRS Discovery District, Toronto, Ontario, Canada
| | - Simran Bakshi
- BSc Undergraduate Science Program, University of Western Ontario, London, Ontario, Canada
| | - Aghna Wasim
- BSc Undergraduate Psychology Program, University of Toronto, Ontario, Canada
| | - Mobeen Ahmad
- Department of Internal Medicine, Abington Memorial Hospital/Abington-Jefferson Health, Abington, PA, USA
| | - Umair Majid
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada
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19
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Dubé È, Ward JK, Verger P, MacDonald NE. Vaccine Hesitancy, Acceptance, and Anti-Vaccination: Trends and Future Prospects for Public Health. Annu Rev Public Health 2021; 42:175-191. [PMID: 33798403 DOI: 10.1146/annurev-publhealth-090419-102240] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An often-stated public health comment is that "vaccination is a victim of its own success." While the scientific and medical consensus on the benefits of vaccination is clear and unambiguous, an increasing number of people are perceiving vaccines as unsafe and unnecessary. The World Health Organization identified "the reluctance or refusal to vaccinate despite availability of vaccines" as one of the 10 threats to global health in 2019. The negative influence of anti-vaccination movements is often named as a cause of increasing vaccine resistance in the public. In this review, we give an overview of the current literature on the topic, beginning by agreeing on terminology and concepts before looking at potential causes, consequences, and impacts of resistance to vaccination.
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Affiliation(s)
- Ève Dubé
- Centre de Recherche du CHU de Québec, Université Laval, Québec G1V 4G2, Canada.,Institut National de Santé Publique du Québec, Québec G1E 7G9, Canada;
| | - Jeremy K Ward
- CERMES3, INSERM, CNRS, EHESS, Université de Paris, 94076 Villejuif, France; .,Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME, 13005 Marseille, France;
| | - Pierre Verger
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME, 13005 Marseille, France; .,Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 13005 Marseille, France
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia B3K 6R8, Canada;
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20
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Bradshaw AS, Shelton SS, Wollney E, Treise D, Auguste K. Pro-Vaxxers Get Out: Anti-Vaccination Advocates Influence Undecided First-Time, Pregnant, and New Mothers on Facebook. HEALTH COMMUNICATION 2021; 36:693-702. [PMID: 31920115 DOI: 10.1080/10410236.2020.1712037] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Social media has revolutionized health information-seeking behavior with crowd-based medical advice. Decreased vaccination uptake and subsequent disease outbreaks have generally occurred in localized clusters based on social norms; however, geographically unrestricted Facebook networks promote parental vaccination refusal congruent with digital identity formation. Interactions within the largest closed Facebook group for vaccination choice were analyzed through the lens of Social Influence Theory. Anti-vaccination advocates impacted first-time mothers' expressed vaccination intentions through both informational and normative influence processes. Six overarching themes were identified as strategies used by these individuals to persuade fence sitting parents to delay or decline vaccinations, including: natural solutions, maternal empowerment, distrust of conventional medicine establishment, fear appeals, 'Russian Roulette' risk benefit analysis, and misinformation and misunderstandings.
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Affiliation(s)
- Amanda S Bradshaw
- Department of Advertising, College of Journalism and Communications, University of Florida
| | - Summer S Shelton
- Department of Communication, Media, & Persuasion, Idaho State University
| | - Easton Wollney
- Department of Advertising, College of Journalism and Communications, University of Florida
| | - Debbie Treise
- Department of Advertising, College of Journalism and Communications, University of Florida
| | - Kendra Auguste
- Department of Communication, Media, & Persuasion, Idaho State University
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21
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Ashfield S, Donelle L. Parental Online Information Access and Childhood Vaccination Decisions in North America: Scoping Review. J Med Internet Res 2020; 22:e20002. [PMID: 33048055 PMCID: PMC7592069 DOI: 10.2196/20002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/14/2020] [Accepted: 09/02/2020] [Indexed: 01/17/2023] Open
Abstract
Background Immunizing children throughout their early years prevents the spread of communicable disease and decreases the morbidity and mortality associated with many vaccine-preventable diseases. Searching online allows individuals rapid access to health information. Objective The purpose of this review was to develop an understanding of the existing literature of parents’ online health information-seeking behaviors to inform their vaccination choices for their children and to identify gaps in the literature around parents’ use of online health information and their vaccination choices. Methods A scoping review of peer-reviewed literature from Canada and the United States was performed. The following databases were utilized to perform the search: PubMed, CINAHL, Nursing & Allied Health Database, Scopus, and PsycINFO. The purpose of this review was to examine parents’ use of online information seeking related to vaccine information and to understand how parents utilize this information to inform decisions about vaccinating their children. Of the 34 papers included in the review, 4 relevant themes and subthemes were identified: information seeking, online information resources, online vaccine content, and trust in health care providers. Results Examination of the literature revealed conflicting information regarding parents’ use of social media and online resources to inform decisions around vaccinating their children. There is evidence of significant misinformation regarding vaccine risks online. Parents’ digital health literacy levels are unknown and may affect their ability to appraise online vaccination information. Conclusions Parents are seeking vaccine information from online sources. However, the influence of online vaccine information on parental vaccine practices remains uncertain.
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22
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Hargreaves AL, Nowak G, Frew P, Hinman AR, Orenstein WA, Mendel J, Aikin A, Nadeau JA, McNutt LA, Chamberlain AT, Omer SB, Randall LA, Bednarczyk RA. Adherence to Timely Vaccinations in the United States. Pediatrics 2020; 145:peds.2019-0783. [PMID: 32086389 DOI: 10.1542/peds.2019-0783] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To estimate (1) the proportion of children not adhering to the Advisory Committee on Immunization Practices (ACIP) recommended early childhood immunization schedule and (2) associations between schedule adherence, sociodemographic characteristics, and up-to-date immunization status by 19 to 35 months of age. METHODS We used 2014 National Immunization Survey provider-verified vaccination data to classify vaccination patterns as "recommended" (ie, in line with ACIP dose- and age-specific recommendations), "alternate" (ie, in line with either limiting the number of shots per visit or skipping at least 1 vaccine series), or "unknown or unclassifiable" (ie, not in line with ACIP recommendations or clearly limiting shots per visit or vaccine series). We evaluated the association between vaccination patterns and up-to-date status for all ACIP-recommended vaccinations (including rotavirus and hepatitis A vaccines) using Poisson regression. RESULTS The majority of children's patterns were classified as "recommended" (63%), with 23% and 14% following alternate or unknown or unclassifiable patterns, respectively; 58% of children were up-to-date with all ACIP-recommended immunizations by 19 to 35 months. Not being up-to-date was associated with alternate (prevalence ratio = 4.2, 95% confidence interval: 3.9-4.5) and unknown or unclassifiable (prevalence ratio = 2.4, 95% confidence interval: 2.2-2.7) patterns. CONCLUSIONS High vaccine coverage by 19 to 35 months of age may miss nonadherence to the recommended immunization schedule in the first 18 months of life, leaving children vulnerable to preventable diseases. With more than one-third of US children not following the ACIP schedule, targeted interventions are needed to minimize vaccine delays and disease susceptibility.
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Affiliation(s)
- Allison L Hargreaves
- Hubert Department of Global Health and.,Division of Infectious Diseases, Department of Medicine, School of Medicine, and
| | - Glen Nowak
- Grady College of Journalism and Mass Communication, University of Georgia, Athens, Georgia
| | - Paula Frew
- Hubert Department of Global Health and.,Division of Infectious Diseases, Department of Medicine, School of Medicine, and
| | | | - Walter A Orenstein
- Division of Infectious Diseases, Department of Medicine, School of Medicine, and.,Emory Vaccine Center, Emory University, Atlanta, Georgia
| | - Judith Mendel
- National Vaccine Program Office, Department of Health and Human Services, Washington, DC; and
| | - Ann Aikin
- National Vaccine Program Office, Department of Health and Human Services, Washington, DC; and
| | - Jessica A Nadeau
- Institute for Health and the Environment, School of Public Health, State University of New York-University at Albany, Rensselaer, New York
| | - Louise-Anne McNutt
- Institute for Health and the Environment, School of Public Health, State University of New York-University at Albany, Rensselaer, New York
| | | | - Saad B Omer
- Hubert Department of Global Health and.,Emory Vaccine Center, Emory University, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health
| | - Laura A Randall
- Hubert Department of Global Health and.,Division of Infectious Diseases, Department of Medicine, School of Medicine, and
| | - Robert A Bednarczyk
- Hubert Department of Global Health and .,Emory Vaccine Center, Emory University, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health
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23
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Dubé E, Gagnon D, Vivion M. Optimizing communication material to address vaccine hesitancy. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2020; 46:48-52. [PMID: 32167088 PMCID: PMC7041657 DOI: 10.14745/ccdr.v46i23a05] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Vaccine hesitancy (the reluctance to accept recommended vaccines) is a complex issue that poses risk communication challenges for public health authorities and clinicians. Studies have shown that providing too much evidence on vaccine safety and efficacy to those who are vaccine-hesitant has done little to stem the growth of hesitancy-related beliefs and fears. The objective of this paper is to describe good practices in developing communication materials to address vaccine hesitancy. An inventory of vaccination communication materials in Canada was assessed according to the Council of Canadian Academies Expert Panel on Health Product Risk Communication Evaluation (2015). Many of the current communication products could be improved to better align with evidence-based risk communication best practices. Five best practices were identified. First, identify target audience and establish trust. Second, provide both the risks and benefits of vaccination, as most people are looking for balanced information. Third, give the facts before addressing the myths. Fourth, use visual aids. Fifth, test communication material prior to launch. Applying these best practices to current or future communication products will help vaccine providers (including physicians, nurse practitioners, pharmacists, public health professionals) to develop communication materials that are sensitive to the complex ways that people process and value information and thus more likely to optimize vaccine uptake in their communities.
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Affiliation(s)
- Eve Dubé
- Institut national de santé publique du Québec, Québec, QC
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC
- Correspondence:
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Propagandizing anti-vaccination: Analysis of Vaccines Revealed documentary series. Vaccine 2020; 38:2058-2069. [PMID: 31980194 DOI: 10.1016/j.vaccine.2019.12.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 11/20/2022]
Abstract
Politically charged health propaganda films may have public health ramifications through decreased vaccination uptake, especially with expansive dissemination potential on social media. The nine-episode documentary series Vaccines Revealed, touted as foremost truth within the largest anti-vaccination closed Facebook group, advocates for non-medical childhood vaccination exemptions - a policy actively opposed by the American Academy of Pediatrics. This series is recommended specifically to parents who are on the fence about whether or not to vaccinate their children as well as new, first-time, and expectant mothers. Fourteen 'expert' panelists included: six M.D,'s who reportedly prefer natural approaches for everything from chiropractic to cardiology practice, a vaccine injury attorney, two professors, one psychiatrist, the founder of natural search engine Greenmedinfo.com, a nationally-recognized clinical research expert on the HPV vaccine, the president of the National Vaccine Information Center, and three parents of vaccine-injured children. Additionally, voiceover clips from an epidemiologist and former senior scientist at the CDC were played throughout the series as evidence of governmental conspiracy. Inclusion of these testimonies, particularly from white coat doctors, led to a perception of high source credibility. Qualitative analysis of this documentary series revealed five overarching themes: (perceived) solidified science, collusion and conspiracy, canary in the coal mine, fear appeals, and the morality and necessity of individual choice. As opposed to formulating a priori theoretical assumptions, grounded theory allowed an integrative theoretical explanation to emerge from the data. Researchers expanded cognitive dissonance, parasocial interaction, and social identification theories and described how viewers of Vaccines Revealed could come to align their views on vaccinations with those of the panelists featured in the videos.
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Affiliation(s)
- Kevin Dew
- School of Social and Cultural Studies, Victoria University of Wellington, Wellington, New Zealand,
| | - Sarah Donovan
- Department of Public Health, University of Otago, Wellington, New Zealand
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Vivion M, Hennequin C, Verger P, Dubé E. Supporting informed decision-making about vaccination: an analysis of two official websites. Public Health 2020; 178:112-119. [DOI: 10.1016/j.puhe.2019.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/02/2019] [Accepted: 09/10/2019] [Indexed: 12/26/2022]
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Deml MJ, Jafflin K, Merten S, Huber B, Buhl A, Frau E, Mettraux V, Sonderegger J, Kliem P, Cattalani R, Krüerke D, Pfeiffer C, Burton-Jeangros C, Tarr PE. Determinants of vaccine hesitancy in Switzerland: study protocol of a mixed-methods national research programme. BMJ Open 2019; 9:e032218. [PMID: 31678955 PMCID: PMC6830664 DOI: 10.1136/bmjopen-2019-032218] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Vaccine hesitancy is a complex public health issue referring to concerns about the safety, efficacy or need for vaccination. Relatively little is known about vaccine hesitancy in Switzerland. This ongoing study (2017-2021) focuses on biomedical and complementary and alternative medicine (CAM) providers and their patients since healthcare professionals play important roles in vaccination decision-making. This national research programme seeks to assess the sociocultural determinants of vaccine hesitancy regarding childhood and human papillomavirus vaccines in Switzerland. We aim to provide a detailed characterisation of vaccine hesitancy, including CAM and biomedical perspectives, patient-provider interactions, and sociocultural factors, to establish the mediating effects of vaccine hesitancy on underimmunisation, and to design an intervention to improve vaccination communication and counselling among physicians, parents and adolescents. METHODS AND ANALYSIS Our transdisciplinary team employs a sequential exploratory mixed-methods study design. We have established a network of more than 150 medical providers across Switzerland, including more than 40 CAM practitioners. For the qualitative component, we conduct interviews with parents, youth, and biomedical and CAM providers and observations of vaccination consultations and school vaccination information sessions. For the quantitative component, a sample of 1350 parents of young children and 722 young adults (15-26 years) and their medical providers respond to questionnaires. We measure vaccine hesitancy with the Parent Attitudes about Childhood Vaccines 15-item survey and review vaccination certificates to assess vaccination status. We administer additional questions based on findings from qualitative research, addressing communication with medical providers, vaccine information sources and perceptions of risk control vis-à-vis vaccine-preventable diseases. The questionnaires capture sociodemographics, political views, religion and spirituality, and moral foundations. ETHICS AND DISSEMINATION The study was approved by the local ethics committee. The results will be published in peer-reviewed journals and disseminated to healthcare professionals, researchers and the public via conferences and public presentations.
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Affiliation(s)
- Michael J Deml
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kristen Jafflin
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Benedikt Huber
- Department of Pediatrics, HFR Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Andrea Buhl
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Eleonora Frau
- University of Basel, Basel, Switzerland
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Valérie Mettraux
- University of Basel, Basel, Switzerland
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Joanna Sonderegger
- University of Basel, Basel, Switzerland
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Paulina Kliem
- University of Basel, Basel, Switzerland
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Rachele Cattalani
- University of Basel, Basel, Switzerland
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | | | - Constanze Pfeiffer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Philip E Tarr
- University of Basel, Basel, Switzerland
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
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Deml MJ, Notter J, Kliem P, Buhl A, Huber BM, Pfeiffer C, Burton-Jeangros C, Tarr PE. “We treat humans, not herds!”: A qualitative study of complementary and alternative medicine (CAM) providers’ individualized approaches to vaccination in Switzerland. Soc Sci Med 2019; 240:112556. [DOI: 10.1016/j.socscimed.2019.112556] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 08/30/2019] [Accepted: 09/12/2019] [Indexed: 11/27/2022]
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Beliefs around childhood vaccines in the United States: A systematic review. Vaccine 2019; 37:6793-6802. [PMID: 31562000 DOI: 10.1016/j.vaccine.2019.08.068] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/30/2019] [Accepted: 08/26/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND While childhood vaccines are safe and effective, some parents remain hesitant to vaccinate their children, which has led to outbreaks of vaccine preventable diseases. The goal of this systematic review was to identify and summarize the range of beliefs around childhood vaccines elicited using open-ended questions, which are better suited for discovering beliefs compared to closed-ended questions. METHODS PubMed, Embase, and PsycINFO were searched using keywords for childhood vaccines, decision makers, beliefs, and attitudes to identify studies that collected primary data using a variety of open-ended questions regarding routine childhood vaccine beliefs in the United States. Study designs, population characteristics, vaccine types, and vaccine beliefs were abstracted. We conducted a qualitative analysis to conceptualize beliefs into themes and generated descriptive statistics. RESULTS Of 1727 studies identified, 71 were included, focusing largely on parents (including in general, and those who were vaccine hesitant or at risk of hesitancy). Seven themes emerged: Adverse effects was most prominent, followed by mistrust, perceived lack of necessity, pro-vaccine opinions, skepticism about effectiveness, desire for autonomy, and morality concerns. The most commonly described beliefs included that vaccines can cause illnesses; a child's immune system can be overwhelmed if receiving too many vaccines at once; vaccines contain harmful ingredients; younger children are more susceptible to vaccine adverse events; the purpose of vaccines is profit-making; and naturally developed immunity is better than that acquired from vaccines. Nearly a third of the studies exclusively assessed minority populations, and more than half of the studies examined beliefs only regarding HPV vaccine. CONCLUSIONS Few studies used open-ended questions to elicit beliefs about vaccines. Many of the studies that did so, focused on HPV vaccine. Concerns about vaccine safety were the most commonly stated beliefs about childhood vaccines, likely because studies were designed to capture barriers and challenges to vaccination.
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Rozbroj T, Lyons A, Lucke J. Vaccine-Hesitant and Vaccine-Refusing Parents’ Reflections on the Way Parenthood Changed Their Attitudes to Vaccination. J Community Health 2019; 45:63-72. [DOI: 10.1007/s10900-019-00723-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Vaccine hesitancy and Web 2.0: Exploring how attitudes and beliefs about influenza vaccination are exchanged in online threaded user comments. Vaccine 2019; 37:1769-1774. [DOI: 10.1016/j.vaccine.2019.02.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/20/2018] [Accepted: 02/07/2019] [Indexed: 11/23/2022]
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Jamison AM, Quinn SC, Freimuth VS. "You don't trust a government vaccine": Narratives of institutional trust and influenza vaccination among African American and white adults. Soc Sci Med 2019; 221:87-94. [PMID: 30576982 PMCID: PMC6350921 DOI: 10.1016/j.socscimed.2018.12.020] [Citation(s) in RCA: 192] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 01/21/2023]
Abstract
Vaccine confidence depends on trust in vaccines as products and trust in the system that produces them. In the US, this system consists of a complex network connecting pharmaceutical companies, government agencies, and the healthcare system. We explore narratives from White and African American adults describing their trust in these institutions, with a focus on influenza vaccine. Our data were collected between 2012 and 2014 as part of a mixed-methods investigation of racial disparities in influenza immunization. We interviewed 119 adults, primarily in Maryland and Washington, DC, in three stages utilizing semi-structured interviews (12), focus groups (9, n = 91), and in-depth interviews (16). Analysis was guided by grounded theory. Trust in institutions emerged as a significant theme, with marked differences by race. In 2018, we contextualized these findings within the growing scholarship on trust and vaccines. Most participants distrusted pharmaceutical companies, which were viewed to be motivated by profit. Trust in government varied. Whites described implicit trust of federal institutions but questioned their competency. African Americans were less trusting of the government and were more likely to doubt its motives. Trust in institutions may be fragile, and once damaged, may take considerable time and effort to repair.
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Affiliation(s)
- Amelia M Jamison
- Maryland Center for Health Equity, University of Maryland, 4200 Valley Drive, College Park, MD, 20742, USA.
| | - Sandra Crouse Quinn
- Maryland Center for Health Equity, University of Maryland, 4200 Valley Drive, College Park, MD, 20742, USA; Department of Family Science, University of Maryland, 4200 Valley Drive, College Park, MD, 20742, USA.
| | - Vicki S Freimuth
- Center for Health and Risk Communication (Emeritus), University of Georgia, 107 Paul Coverdell Center, Athens, GA, 30602, USA.
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The politics of picking: Selective vaccinators and population-level policy. SSM Popul Health 2018; 7:100342. [PMID: 30793020 PMCID: PMC6370939 DOI: 10.1016/j.ssmph.2018.100342] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/05/2018] [Accepted: 12/13/2018] [Indexed: 11/23/2022] Open
Abstract
•Public health systems face tensions between individuals and the collective•Parents who selectively vaccinate demonstrate this tension•Parents in this study want vaccination programs to run differently•Implementing their wishes could put the system at risk.
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Frew PM, Murden R, Mehta CC, Chamberlain AT, Hinman AR, Nowak G, Mendel J, Aikin A, Randall LA, Hargreaves AL, Omer SB, Orenstein WA, Bednarczyk RA. Development of a US trust measure to assess and monitor parental confidence in the vaccine system. Vaccine 2018; 37:325-332. [PMID: 30503657 DOI: 10.1016/j.vaccine.2018.09.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To develop a Vaccine Confidence Index (VCI) that is capable of detecting variations in parental confidence towards childhood immunizations centered on trust and concern issues that impact vaccine confidence. METHODS We used a web-based national poll of 893 parents of children <7 years in 2016 to assess the measures created for the Emory VCI (EVCI). EVCI measures were developed using constructs related to vaccine confidence identified by the U.S. National Vaccine Advisory Committee (i.e., "Information Environment", "Trust", "Healthcare Provider", "Attitudes and Beliefs", and "Social Norms"). Reliability for EVCI was assessed using Cronbach's alpha. Using the variables related to each of the constructs, we calculated an overall EVCI score that was then assessed against self-reported childhood vaccine receipt using chi-square and the Cochrane-Armitage trend tests. RESULTS Respondents' EVCI scores could range from 0 to 24, and the full range of values was observed in this sample (Mean = 17.5 (SD 4.8)). EVCI scores were significantly different (p ≤ 0.006 for all comparisons) between parents who indicated their child(ren) received routinely recommended vaccines compared with parents who indicated they had delayed or declined recommended immunizations. There was also a significant, consistent association between higher EVCI scores and greater reported vaccine receipt. CONCLUSIONS We developed EVCI to reliably measure parental vaccine confidence, with individuals' scores linked to parental vaccine-related attitudes, intentions, and behaviors. As such, EVCI may be a useful tool for future monitoring of both population and individual confidence in childhood immunization.
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Affiliation(s)
- Paula M Frew
- Emory University, School of Medicine, 1760 Haygood Road, Atlanta, GA 30322, United States; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States.
| | - Raphiel Murden
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - C Christina Mehta
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Allison T Chamberlain
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Alan R Hinman
- Task Force for Global Health, 330 West Ponce de Leon Ave., Decatur, GA 30030, United States
| | - Glen Nowak
- University of Georgia Grady College of Journalism and Mass Communication, 120 Hooper St, Athens, GA 30602, United States
| | - Judith Mendel
- National Vaccine Program Office, Health and Human Services, Washington, D.C., United States
| | - Ann Aikin
- National Vaccine Program Office, Health and Human Services, Washington, D.C., United States
| | - Laura A Randall
- Emory University, School of Medicine, 1760 Haygood Road, Atlanta, GA 30322, United States; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Allison L Hargreaves
- Emory University, School of Medicine, 1760 Haygood Road, Atlanta, GA 30322, United States; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Saad B Omer
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Walter A Orenstein
- Emory University, School of Medicine, 1760 Haygood Road, Atlanta, GA 30322, United States
| | - Robert A Bednarczyk
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States
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Dubé E, Gagnon D, MacDonald N, Bocquier A, Peretti-Watel P, Verger P. Underlying factors impacting vaccine hesitancy in high income countries: a review of qualitative studies. Expert Rev Vaccines 2018; 17:989-1004. [DOI: 10.1080/14760584.2018.1541406] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Eve Dubé
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
- Axe maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Dominique Gagnon
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Aurélie Bocquier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Patrick Peretti-Watel
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Pierre Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
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Reich JA. "We are fierce, independent thinkers and intelligent": Social capital and stigma management among mothers who refuse vaccines. Soc Sci Med 2018; 257:112015. [PMID: 30442504 DOI: 10.1016/j.socscimed.2018.10.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/21/2018] [Accepted: 10/29/2018] [Indexed: 02/02/2023]
Abstract
Despite measurable benefits of childhood vaccines, mothers with high levels of social privilege are increasingly refusing some or all vaccines for their children. These mothers are often clustered geographically or networked socially, providing information, emotional support, and validation for each other. Mothers who reject vaccines may face disapproval from others, criticism in popular culture, negative interactions with healthcare providers, and conflicts with people they know, which serve to stigmatize them. This article uses qualitative data from in-depth interviews with parents who reject vaccines, ethnographic observations, and analyses of online discussions to examine the role of social capital in networks of vaccine-refusing mothers. Specifically, this article explores how mothers provide each other information critical of vaccines, encourage a sense of one's self as empowered to question social expectations around vaccination, provide strategies for managing stigma that results from refusing vaccines, and define a sense of obligation to extend social capital to other mothers. In examining these strategies and tensions, we see how social capital can powerfully support subcultural norms that contradict broader social norms and provide sources of social support. Even as these forces are experienced as positive, they work in ways that actively undermine community health, particularly for those who are the most socially vulnerable to negative health outcomes from infection.
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'The Unhealthy Other': How vaccine rejecting parents construct the vaccinating mainstream. Vaccine 2018; 36:1621-1626. [PMID: 29449097 DOI: 10.1016/j.vaccine.2018.01.076] [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: 10/27/2017] [Revised: 12/05/2017] [Accepted: 01/29/2018] [Indexed: 11/20/2022]
Abstract
To address the phenomenon of vaccine hesitancy and rejection, researchers increasingly recognise the need to engage with the social context of parents' decision-making. This study examines how vaccine rejecting parents socially construct the vaccinating mainstream in opposition to themselves. We analyse qualitative data from interviews with parents in Adelaide, South Australia. Applying insights from Social Identity Theory (SIT), we show how these parents bolster their own sense of identity and self-belief by employing a discourse that casts vaccinators as an Unhealthy Other. We demonstrate how the parents identify vaccination as a marker of parental conformity to the 'toxic practices of mass industrial society', linking it to other ways in which membership of the consumerist mainstream requires individuals to 'neglect their health.' This is explored through themes of appearance, diet, (over) consumption of pharmaceuticals, inadequate parenting values and wilful or misguided ignorance. This construction of the Unhealthy Other elevates the self-concept of vaccine hesitant and rejecting parents, who see themselves as part of an enlightened, but constantly besieged, group of healthy and virtuous parents. It is common for the vaccinating mainstream to present vaccine hesitant and rejecting parents as a group subject to epistemic closure, groupthink, confirmation bias and over-confidence in their own expertise. However, vaccine hesitant and rejecting parents also see mainstream society as a group-a much larger one-subject to the same problems. We suggest the need to mitigate the 'groupness' of vaccination and non-vaccination by extending the practice of vaccination to recognisable practitioners of holistic health.
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Deiner MS, Fathy C, Kim J, Niemeyer K, Ramirez D, Ackley SF, Liu F, Lietman TM, Porco TC. Facebook and Twitter vaccine sentiment in response to measles outbreaks. Health Informatics J 2017; 25:1116-1132. [PMID: 29148313 DOI: 10.1177/1460458217740723] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Social media posts regarding measles vaccination were classified as pro-vaccination, expressing vaccine hesitancy, uncertain, or irrelevant. Spearman correlations with Centers for Disease Control and Prevention-reported measles cases and differenced smoothed cumulative case counts over this period were reported (using time series bootstrap confidence intervals). A total of 58,078 Facebook posts and 82,993 tweets were identified from 4 January 2009 to 27 August 2016. Pro-vaccination posts were correlated with the US weekly reported cases (Facebook: Spearman correlation 0.22 (95% confidence interval: 0.09 to 0.34), Twitter: 0.21 (95% confidence interval: 0.06 to 0.34)). Vaccine-hesitant posts, however, were uncorrelated with measles cases in the United States (Facebook: 0.01 (95% confidence interval: -0.13 to 0.14), Twitter: 0.0011 (95% confidence interval: -0.12 to 0.12)). These findings may result from more consistent social media engagement by individuals expressing vaccine hesitancy, contrasted with media- or event-driven episodic interest on the part of individuals favoring current policy.
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Affiliation(s)
- Michael S Deiner
- University of California, San Francisco, USA.,University of California, San Francisco, USA
| | - Cherie Fathy
- Vanderbilt University, USA.,University of California, San Francisco, USA
| | - Jessica Kim
- University of California, San Francisco, USA.,University of California, San Francisco, USA
| | - Katherine Niemeyer
- Icahn School of Medicine at Mount Sinai, USA.,University of California, San Francisco, USA
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Ward PR, Attwell K, Meyer SB, Rokkas P, Leask J. Understanding the perceived logic of care by vaccine-hesitant and vaccine-refusing parents: A qualitative study in Australia. PLoS One 2017; 12:e0185955. [PMID: 29023499 PMCID: PMC5638294 DOI: 10.1371/journal.pone.0185955] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 09/24/2017] [Indexed: 11/23/2022] Open
Abstract
In terms of public health, childhood vaccination programs have benefits that far outweigh risks. However, some parents decide not to vaccinate their children. This paper explores the ways in which such parents talked about the perceived risks and benefits incurred by vaccinating (or not vaccinating) their children. Between 2013–2016 we undertook 29 in-depth interviews with non-vaccinating and/or ‘vaccine hesitant’ parents in Australia. Interviews were conducted in an open and non-judgmental manner, akin to empathic neutrality. Interviews focused on parents talking about the factors that shaped their decisions not to (or partially) vaccinate their children. All interviews were transcribed and analysed using both inductive and deductive processes. The main themes focus on parental perceptions of: 1. their capacity to reason; 2. their rejection of Western medical epistemology; and 3. their participation in labour intensive parenting practices (which we term salutogenic parenting). Parents engaged in an ongoing search for information about how best to parent their children (capacity to reason), which for many led to questioning/distrust of traditional scientific knowledge (rejection of Western medical epistemology). Salutogenic parenting spontaneously arose in interviews, whereby parents practised health promoting activities which they saw as boosting the natural immunity of their children and protecting them from illness (reducing or negating the perceived need for vaccinations). Salutogenic parenting practices included breastfeeding, eating organic and/or home-grown food, cooking from scratch to reduce preservative consumption and reducing exposure to toxins. We interpret our data as a ‘logic of care’, which is seen by parents as internally consistent, logically inter-related and inter-dependent. Whilst not necessarily sharing the parents’ reasoning, we argue that an understanding of their attitudes towards health and well-being is imperative for any efforts to engage with their vaccine refusal at a policy level.
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Affiliation(s)
- Paul R. Ward
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- * E-mail:
| | - Katie Attwell
- Political Science and International Relations, University of Western Australia, Perth, Western Australia, Australia
| | - Samantha B. Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Philippa Rokkas
- Discipline of Paediatrics, Adelaide University, Adelaide, South Australia, Australia
| | - Julie Leask
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
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Attwell K, Smith DT. Parenting as politics: social identity theory and vaccine hesitant communities. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2017. [DOI: 10.1108/ijhg-03-2017-0008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to develop a theoretical framework for understanding the identity politics associated with parental hesitancy and refusal of vaccines for their children (“vaccine hesitancy or refusal” or “VHR”). Understanding these identity politics helps policymakers to craft appropriate communication interventions that do not make the problem worse.
Design/methodology/approach
Social identity theory is a way of understanding how group identities develop around the lifestyle practices that often include refusal to vaccinate, and how this group identity is accentuated by conflict with the pro-vaccinating societal mainstream. This paper critically appraises existing studies of VHR to explore this groupness across many different contexts.
Findings
Groupness is evident across many different contexts. There are also key group characteristics: preference for natural birth and breastfeeding, nature as a concept and use of complementary and alternative medicine.
Research limitations/implications
The paper is speculative and theoretical, using existing sources. Future studies will need to demonstrate empirically with new data. However, this theoretical approach sets up a new research agenda.
Social implications
These findings can help governments and policymakers minimise social conflict that risks further polarising vaccine conversations and wedging parents on the fence.
Originality/value
This paper argues that the decision to vaccinate or not is an inherently social one, not a matter of pure individual rationality. This is a novel approach to engaging with what is often characterised and studied as an individual decision.
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Mahroum N, Watad A, Bragazzi NL, Amital H, Sharif K, Watad S, Adavastro G, Canepa G, Brigo F, Adawi M. On status epilepticus and pins: A systematic content analysis. Epilepsy Behav 2017; 74:130-134. [PMID: 28734196 DOI: 10.1016/j.yebeh.2017.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/06/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
Abstract
Status epilepticus (SE) can be defined as abnormally prolonged, persistent, or recurrent clinical and/or electrographic epileptic activity and, as such, is a challenging medical emergency requiring an aggressive treatment aimed at promptly terminating the seizures. It imposes a relevant clinical burden, both in terms of comorbidity and mortality. In the era of the Web 2.0, most people search the Web to obtain SE-related information. The current investigation aimed at qualitatively characterizing the pins related to SE: Pinterest, "the world's catalog of ideas", is a visual social networking site that enables users to freely upload visual material, to bookmark, and to share it (repin). Using SE as a keyword, 192 pins were extracted and analyzed on the basis of their content. Fifty-five were found to meet the inclusion criteria. Fifty-six point four percent of the pins reported at least one cause of SE, the most quoted of which being remote brain injuries (47.3% of the pins); 54.5% and 45.5% of the included pins reported SE symptoms and diagnosis, respectively; 72.7% and 40.0% of pins focused on SE treatment and on prognosis, respectively; and 50.9%, 30.9%, and 40.0% of the pins were intended for physicians, medical/nursing students, and lay people, respectively. Only 12.7% of pins were patient-centered and devoted to fund-raising and advocacy. In the field of neurological diseases, Pinterest, despite being a "pinstructive" tool, is too much overlooked and underused for advocacy purposes. Healthcare workers and stakeholders should be aware of the opportunities offered by Pinterest and exploit this visual social networking site for raising awareness of the life-threatening condition of SE, promoting fund-raising campaigns.
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Affiliation(s)
- Naim Mahroum
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abdulla Watad
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nicola Luigi Bragazzi
- Post-graduate School of Public Health Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.
| | - Howard Amital
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Kassem Sharif
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Samaa Watad
- Department of Statistics and Operations Research, Tel-Aviv University, Tel-Aviv, Israel
| | - Giulia Adavastro
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Giovanna Canepa
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Francesco Brigo
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Mohammad Adawi
- Padeh and Ziv Hospitals, Bar-Ilan Faculty of Medicine, Ramat Gan, Israel
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Ames HMR, Glenton C, Lewin S. Parents' and informal caregivers' views and experiences of communication about routine childhood vaccination: a synthesis of qualitative evidence. Cochrane Database Syst Rev 2017; 2:CD011787. [PMID: 28169420 PMCID: PMC5461870 DOI: 10.1002/14651858.cd011787.pub2] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Childhood vaccination is an effective way to prevent serious childhood illnesses, but many children do not receive all the recommended vaccines. There are various reasons for this; some parents lack access because of poor quality health services, long distances or lack of money. Other parents may not trust vaccines or the healthcare workers who provide them, or they may not see the need for vaccination due to a lack of information or misinformation about how vaccinations work and the diseases they can prevent.Communication with parents about childhood vaccinations is one way of addressing these issues. Communication can take place at healthcare facilities, at home or in the community. Communication can be two-way, for example face-to-face discussions between parents and healthcare providers, or one-way, for instance via text messages, posters or radio programmes. Some types of communication enable parents to actively discuss vaccines and their benefits and harms, as well as diseases they can prevent. Other communication types simply give information about vaccination issues or when and where vaccines are available. People involved in vaccine programmes need to understand how parents experience different types of communication about vaccination and how this influences their decision to vaccinate. OBJECTIVES The specific objectives of the review were to identify, appraise and synthesise qualitative studies exploring: parents' and informal caregivers' views and experiences regarding communication about childhood vaccinations and the manner in which it is communicated; and the influence that vaccination communication has on parents' and informal caregivers' decisions regarding childhood vaccination. SEARCH METHODS We searched MEDLINE (OvidSP), MEDLINE In-process and Other Non-Index Citations (Ovid SP), Embase (Ovid), CINAHL (EbscoHOST), and Anthropology Plus (EbscoHost) databases for eligible studies from inception to 30 August 2016. We developed search strategies for each database, using guidelines developed by the Cochrane Qualitative Research Methods Group for searching for qualitative evidence as well as modified versions of the search developed for three related reviews of effectiveness. There were no date or geographic restrictions for the search. SELECTION CRITERIA We included studies that utilised qualitative methods for data collection and analysis; focused on the views and experiences of parents and informal caregivers regarding information about vaccination for children aged up to six years; and were from any setting globally where information about childhood vaccinations was communicated or distributed. DATA COLLECTION AND ANALYSIS We used maximum variation purposive sampling for data synthesis, using a three-step sampling frame. We conducted a thematic analysis using a constant comparison strategy for data extraction and synthesis. We assessed our confidence in the findings using the GRADE-CERQual approach. High confidence suggests that it is highly likely that the review finding is a reasonable representation of the phenomenon of interest, while very low confidence indicates that it is not clear whether the review finding is a reasonable representation of it. Using a matrix model, we then integrated our findings with those from other Cochrane reviews that assessed the effects of different communication strategies on parents' knowledge, attitudes and behaviour about childhood vaccination. MAIN RESULTS We included 38 studies, mostly from high-income countries, many of which explored mothers' perceptions of vaccine communication. Some focused on the MMR (measles, mumps, rubella) vaccine.In general, parents wanted more information than they were getting (high confidence in the evidence). Lack of information led to worry and regret about vaccination decisions among some parents (moderate confidence).Parents wanted balanced information about vaccination benefits and harms (high confidence), presented clearly and simply (moderate confidence) and tailored to their situation (low confidence in the evidence). Parents wanted vaccination information to be available at a wider variety of locations, including outside health services (low confidence) and in good time before each vaccination appointment (moderate confidence).Parents viewed health workers as an important source of information and had specific expectations of their interactions with them (high confidence). Poor communication and negative relationships with health workers sometimes impacted on vaccination decisions (moderate confidence).Parents generally found it difficult to know which vaccination information source to trust and challenging to find information they felt was unbiased and balanced (high confidence).The amount of information parents wanted and the sources they felt could be trusted appeared to be linked to acceptance of vaccination, with parents who were more hesitant wanting more information (low to moderate confidence).Our synthesis and comparison of the qualitative evidence shows that most of the trial interventions addressed at least one or two key aspects of communication, including the provision of information prior to the vaccination appointment and tailoring information to parents' needs. None of the interventions appeared to respond to negative media stories or address parental perceptions of health worker motives. AUTHORS' CONCLUSIONS We have high or moderate confidence in the evidence contributing to several review findings. Further research, especially in rural and low- to middle-income country settings, could strengthen evidence for the findings where we had low or very low confidence. Planners should consider the timing for making vaccination information available to parents, the settings where information is available, the provision of impartial and clear information tailored to parental needs, and parents' perceptions of health workers and the information provided.
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Affiliation(s)
- Heather MR Ames
- Norwegian Institute of Public HealthGlobal Health UnitPilestredet Park 7OsloNorway0130
- University of OsloInstitute of Health and SocietyOsloNorway
| | - Claire Glenton
- Norwegian Institute of Public HealthGlobal Health UnitPilestredet Park 7OsloNorway0130
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
- Medical Research Council of South AfricaHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
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