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Bass T, Hill CM, Cully JL, Li SR, Chi DL. A cross-sectional study of physicians on fluoride-related beliefs and practices, and experiences with fluoride-hesitant caregivers. PLoS One 2024; 19:e0307085. [PMID: 39028748 PMCID: PMC11259263 DOI: 10.1371/journal.pone.0307085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/29/2024] [Indexed: 07/21/2024] Open
Abstract
The goal of this study was to describe medical providers' fluoride-related beliefs and practices, experiences with fluoride-hesitant caregivers, and barriers to incorporating oral health activities into their practice. In this cross-sectional study, we specifically tested the hypothesis of whether these factors differed between pediatric and family medicine providers. A 39-item online survey was administered to a convenience sample of pediatric and family medicine providers in Washington state and Ohio (U.S.A.). Responses to the fluoride survey were compared between pediatric and family medicine providers with a chi-square test (α = 0.05). Of the 354 study participants, 45% were pediatric providers and 55% were family medicine providers. About 61.9% of providers believed fluoridated water was highly effective at preventing tooth decay while only 29.1% believed prescription fluoride supplements were highly effective. Nearly all providers recommend over-the-counter fluoride toothpaste (87.3%), 44.1% apply topical fluoride in clinic, and 30.8% prescribe fluoride supplements. Most providers reported fluoride hesitancy was a small problem or not a problem (82.5%) and the most common concerns patients raise about fluoride were similar to those raised about vaccines. Lack of time was the most commonly reported barrier to incorporating oral health into practice, which was more commonly reported by family medicine providers than pediatric providers (65.6% vs. 50.3%; p = .005). Pediatric and family medicine providers have early and frequent access to children before children visit a dentist. Improving the use of fluorides through children's medical visits could improve pediatric oral health and reduce oral health inequities, especially for vulnerable populations at increased risk for tooth decay.
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Affiliation(s)
- Tiffany Bass
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, United States of America
| | - Courtney M. Hill
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, United States of America
| | - Jennifer L. Cully
- Division of Oral Health, Children’s National Hospital, Washington, DC, United States of America
- Department of Pediatrics, George Washington University, Washington, DC, United States of America
| | - Sophie R. Li
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, United States of America
| | - Donald L. Chi
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, United States of America
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, United States of America
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2
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Emlek Sert Z, Topçu S, Çelebioğlu A. Knowledge, Beliefs, and Behaviors of Turkish Parents about Childhood Vaccination. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1679. [PMID: 37892342 PMCID: PMC10604964 DOI: 10.3390/children10101679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Vaccination is critical to the prevention and control of infectious disease outbreaks and is also one of the most important public health successes. When it comes to childhood vaccinations, parents' consent is very important. For this reason, childhood vaccination rates are directly related to the knowledge, beliefs, and behaviors of the parents. Therefore, this study aimed to evaluate the knowledge, beliefs, and behaviors of parents of children aged 0-5 regarding childhood vaccinations and how these beliefs affect their vaccination behaviors. MATERIAL AND METHODS This descriptive, cross-sectional study was conducted on 302 parents from February to June 2020. Data were collected using a questionnaire form with 26 questions. Sociodemographic characteristics were reported as frequencies, means, and percentages. Multiple regression analysis was utilized to evaluate vaccination behaviors and affective factors. RESULTS About 87.1% of the parents know that vaccines protect their children from infectious diseases, and 76.8% know that vaccines can have side effects. Although 97.7% of the parents had their children fully vaccinated according to the Extended Immunization Program, 2.3% did not vaccinate their children. Moreover, 98% of the parents trust the information given by healthcare professionals about vaccination. The parents' beliefs explain 53% (R2 = 0.53) of the parents' child vaccination behavior. CONCLUSION This study found that although the knowledge level of parents about vaccines is quite good, negative knowledge and beliefs that may affect vaccination also exist. Considered by parents as a reliable source of information, healthcare professionals should impart their knowledge, beliefs, and concerns regarding immunization.
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Affiliation(s)
- Zuhal Emlek Sert
- Public Health Nursing Department, Faculty of Nursing, Ege University, Izmir 35040, Turkey
| | - Sevcan Topçu
- Public Health Nursing Department, Faculty of Nursing, Ege University, Izmir 35040, Turkey
| | - Aysun Çelebioğlu
- Department of Emergency and Disaster Management, Gordes Vocational School, Manisa Celal Bayar University, Manisa 45750, Turkey
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Albers AN, Wright E, Thaker J, Conway K, Daley MF, Newcomer SR. Childhood Vaccination Practices and Parental Hesitancy Barriers in Rural and Urban Primary Care Settings. J Community Health 2023; 48:798-809. [PMID: 37119349 PMCID: PMC10148012 DOI: 10.1007/s10900-023-01226-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/01/2023]
Abstract
The purpose of our study was to identify primary care providers' (PCPs') practices in promoting childhood vaccination and their perceptions regarding barriers to vaccination in a primarily rural state. In January-May 2022, we conducted a mail and online survey of PCPs across Montana (n = 829). The survey included modules on routine immunizations in children 0-2 years old and COVID-19 vaccination in children 5-17 years old. The survey response rate was 36% (298/829). We categorized PCPs as working in rural (n = 218) or urban areas (n = 80), based on Rural-Urban Commuting Area codes. We then compared responses between rural and urban PCPs using chi-square tests. Urban PCPs (90-94%, depending on vaccine) stocked routinely recommended vaccines more frequently than rural PCPs (71-84%), but stocked the COVID-19 vaccine less often than rural PCPs (44% vs. 71%, respectively, p < 0.001). A higher percentage of rural providers reported parental beliefs that vaccine-preventable diseases are not severe enough to warrant vaccination (48% vs. 31%, p = 0.01) and concerns that vaccination will weaken their child's immune system (29% vs. 6%, p < 0.001). More rural (74%) compared to urban (59%) PCPs identified a social media campaign from local health departments promoting early childhood vaccinations as an effective strategy to increase childhood vaccination rates (p = 0.01). We identified key differences in some childhood vaccination practices and barriers between rural and urban PCPs. Interventions to increase rural vaccination rates could include increasing the number of providers stocking all recommended vaccines, identifying strategies to address parents' concerns regarding vaccine necessity, and collaborations with public health departments.
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Affiliation(s)
- Alexandria N Albers
- Center for Population Health Research, University of Montana, Missoula, MT, USA.
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA.
- , 32 Campus Drive, Missoula, MT, 59812, USA.
| | - Emma Wright
- Family Medicine Residency of Western Montana, University of Montana, Missoula, MT, USA
- Partnership Health Center, Missoula, MT, USA
| | - Juthika Thaker
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Kathrene Conway
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sophia R Newcomer
- Center for Population Health Research, University of Montana, Missoula, MT, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
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Milionis C, Ilias I, Tselebis A, Pachi A. Psychological and Social Aspects of Vaccination Hesitancy-Implications for Travel Medicine in the Aftermath of the COVID-19 Crisis: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1744. [PMID: 37893462 PMCID: PMC10608755 DOI: 10.3390/medicina59101744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023]
Abstract
Vaccines are an important tool of preventive medicine. Although organized vaccination programs have saved large populations from serious infectious diseases, there is a considerable part of the population who oppose vaccinations. In particular, anti-vaccination perceptions, among travelers to countries with endemic diseases, are a major public health concern. Although hesitancy towards vaccinations is not a novel phenomenon, it came back to the forefront during the fight against the COVID-19 pandemic. This review explores the etiology of anti-vaccination beliefs among travelers and draws conclusions about their impact on public health and society in general. For this purpose, a purposeful search for data on the causative factors of vaccine hesitancy and their impact on people's health was conducted. A descriptive analysis of the findings and conclusions regarding possible implications in health policy and clinical practice are presented. A fear of side effects, lack of credence in the necessity of vaccines, and mistrust of medical authorities are important causative factors. Their interplay shapes hesitancy towards vaccines. However, anti-vaccination beliefs can also be an aspect of a more general unconventional stance of life. Health care professionals and organizations must be ready to tackle vaccine hesitancy by making the necessary interventions. Correcting misconceptions about vaccinations is a prerequisite for ensuring personal and public health, especially in the context of a pandemic or epidemic. Moreover, ensuring the efficacy and safety of vaccines, especially in cases of modern technology applications, is a fundamental factor in addressing people's concerns about vaccines. For this purpose, medical authorities and organizations must provide accurate and clear information on vaccines so as to eliminate misinformation. Furthermore, clinicians should cultivate their communication skills in order to convey the appropriate messages to prospective recipients of vaccinations.
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Affiliation(s)
- Charalampos Milionis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, GR-11521 Athens, Greece;
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, GR-11521 Athens, Greece;
| | - Athanasios Tselebis
- Department of Psychiatry, Sotiria Thoracic Diseases Hospital of Athens, GR-11527 Athens, Greece; (A.T.); (A.P.)
| | - Argyro Pachi
- Department of Psychiatry, Sotiria Thoracic Diseases Hospital of Athens, GR-11527 Athens, Greece; (A.T.); (A.P.)
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Albaker AR, Azer SA, AlKhorayef M, Dakheel NKB, AlMutairi S, AlHelal S, Aljohani R, Maghrabi S. Physicians' knowledge, attitude and perceptions towards vaccine-hesitant parents: a cross-sectional study. BMC MEDICAL EDUCATION 2023; 23:637. [PMID: 37667302 PMCID: PMC10478439 DOI: 10.1186/s12909-023-04590-w] [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: 11/27/2022] [Accepted: 08/16/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Research has shown that physicians are encountering an increase in vaccine-hesitant parents (VHPs) numbers. This study examined physicians' vaccination knowledge, vaccine-related discussions with VHPs, beliefs about and responses to vaccine hesitancy, and challenges faced while discussing immunization with VHPs. METHODS This cross-sectional, descriptive study was performed at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia, in September 2020. The data were collected through a questionnaire distributed via email. The sample comprised 90 physicians who routinely treat children and reported they frequently have appropriate vaccine discussions when encountering VHPs. RESULTS Ninety participants (59% were females) completed the questionnaire. Of these, 37.8% were from family medicine, 7.8% from primary care, and 54.4% from paediatrics. The most discussed topics were vaccine necessity, reasons for vaccine refusal, and vaccine safety. Seventeen participants (18.8%) reported being extremely confident, and (42.2%) were confident in their vaccine-specific knowledge. Regarding confidence in communication skills, 22.2% reported being extremely confident and (45.6%) were confident. Determinants of higher confidence in the knowledge and communication skills were physician age (p = 0.001 and p = 0.0001, respectively), years of practice (p = 0.002 and (p = 0.005), and patients seen per workday (p = 0.0001 and p = 0.024). Other factors such as physician sex (p = 0.062), the field of practice (p = 0.329), and hours of work per week (p = 0.061) were not significantly different. Forty-six (51%) physicians sometimes find it challenging to conduct appropriate vaccine-related discussions because of having too many other issues to discuss during the consultation. Furthermore, 53 (59%) participants agreed/strongly agreed that parental refusal to vaccinate would raise suspicions of negligence. On the other hand, 59 (65%) disagreed/strongly disagreed that parental refusal of vaccines is a parental right. Participants expressed the need to refer VHPs to a specialised advisory clinic with excellent experience and negotiation skills to overcome the challenges. CONCLUSION Vaccine safety and necessity are the topics of most concern to VHPs, and a knowledgeable physician with competent communication skills is critical in responding to such situations. This study highlights the most reported barriers to successful vaccine-related discussions. It raises underlying ethical principles such as parental autonomy and the need to train physicians in VHPs. To train physians for succucful vaccine counceling of VHPs.
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Affiliation(s)
- Asma R. Albaker
- Department of Paediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Samy A. Azer
- College of Medicine, Department of Medical Education, King Saud University, P O Box 2925, 11461 Riyadh, Saudi Arabia
| | | | | | | | - Sarah AlHelal
- King Saud University, College of Medicine, Riyadh, Saudi Arabia
| | - Roaa Aljohani
- King Saud University, College of Medicine, Riyadh, Saudi Arabia
| | - Sarah Maghrabi
- King Saud University, College of Medicine, Riyadh, Saudi Arabia
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6
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Nguyen CG, Pogemiller MI, Cooper MT, Garbe MC, Darden PM. Characteristics of Oklahoma Pediatricians Who Dismiss Families for Refusing Vaccines. Clin Pediatr (Phila) 2023; 62:24-32. [PMID: 35883261 DOI: 10.1177/00099228221108801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vaccine refusal is increasing. Objectives were to assess frequency of declining or dismissing patients who refuse vaccines, which vaccine(s) prompt pediatricians to decline/dismiss patients, and demographics of pediatricians who decline/dismiss patients. Active members of the Oklahoma American Academy of Pediatricians (AAP) were surveyed. Chi-square tests with non-overlapping 95% confidence intervals compared proportions of providers across various metrics. In all, 47% (48/103) versus 35% (34/98) reported declining versus dismissing patients for refusing vaccines, respectively. Pediatricians were unlikely to decline/dismiss patients if they refused influenza, human papilloma virus (HPV), or MenB vaccines. Pediatricians with more years in practice were less likely to decline 15% (9/62) versus 44% (16/36), P = 0.002 and dismiss 8% (5/62) versus 33% (12/36), P = 0.002 patients. Rural pediatricians were less likely than urban to decline 12% (2/17) versus 29% (26/89), P = NS and dismiss patients 0% (0/17) versus 21% (19/89), P = 0.04. Dismissing/declining patients for vaccine refusal is more common among Oklahoma pediatricians than nationally reported. Patterns differ by practice setting, years in practice, and specific vaccine refused.
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Affiliation(s)
| | - Mark I Pogemiller
- University of Oklahoma College of Medicine, Oklahoma City, OK, USA
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Section of General and Community Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Michael T Cooper
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Section of General and Community Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - M Connor Garbe
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Section of General and Community Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Paul M Darden
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Section of General and Community Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Reñosa MDC, Wachinger J, Bärnighausen K, Endoma V, Landicho-Guevarra J, Landicho J, Bravo TA, Aligato M, McMahon SA. Misinformation, infighting, backlash, and an 'endless' recovery; policymakers recount challenges and mitigating measures after a vaccine scare in the Philippines. Glob Health Action 2022; 15:2077536. [PMID: 35930464 PMCID: PMC9359158 DOI: 10.1080/16549716.2022.2077536] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Vaccine scares undermine longstanding global health achievements. Remarkably little data has documented the lived experiences of policymakers working amidst vaccine scares and navigating their fallout. As a result, chances and challenges of large-scale national recuperation efforts are poorly understood. Objective This study aims to explore the perspectives of policymakers involved in ongoing efforts to boost vaccine confidence in the Philippines following a 2017 Dengvaxia scare and the current COVID-19 pandemic. Methods Between August and November 2020, we conducted 19 semi-structured narrative interviews with purposively selected policymakers from governmental agencies and non-governmental organizations in the Philippines. Interviews were conducted online, transcribed, and analyzed following the tenets of reflexive thematic analysis. Results We present results as an emerging model that draws on a chronology conveyed by policymakers in their own words. The Dengvaxia scare proved ‘a decisive wedge’ that splintered Filipino society and pitted governmental agencies against one another. The scare stoked distorted vaccination narratives, which were ‘accelerated rapidly’ via social media, and ignited feelings of uncertainty among policymakers of how to convey clear, accurate health messaging and how to prevent drops in care-seeking more broadly. Conclusions Efforts to regain trust placed exceptional burdens on an already-strained health system. Respondent-driven recommendations on how to reinforce vaccine confidence and improve vaccination rollout include: developing clear vaccine messages, fostering healthcare providers’ and policymakers’ communication skills, and rebuilding trust within, toward and across governmental agencies. Further research on how to build enabling environments and rebuild trust in and across institutions remains paramount.
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Affiliation(s)
- Mark Donald C Reñosa
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Germany.,Department of Epidemiology and Biostatistics and Department of Health, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Germany
| | - Kate Bärnighausen
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Germany.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Vivienne Endoma
- Department of Epidemiology and Biostatistics and Department of Health, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Jhoys Landicho-Guevarra
- Department of Epidemiology and Biostatistics and Department of Health, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Jeniffer Landicho
- Department of Epidemiology and Biostatistics and Department of Health, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics and Department of Health, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Mila Aligato
- Department of Epidemiology and Biostatistics and Department of Health, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Germany.,International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Norton ZS, Olson KB, Sanguino SM. Addressing Vaccine Hesitancy Through a Comprehensive Resident Vaccine Curriculum. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11292. [PMID: 36654981 PMCID: PMC9792628 DOI: 10.15766/mep_2374-8265.11292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/10/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Vaccine hesitancy can lead to incomplete vaccination, increased risk of vaccine-preventable diseases, and distrust or conflict between physicians and patients. Yet many physicians are uncomfortable navigating vaccine hesitancy and educating vaccine-hesitant patients and families. We developed a vaccine hesitancy curriculum to increase vaccine knowledge, comfort, and communication skills in pediatric residents. METHODS The curriculum consisted of four interactive 40-minute sessions delivered to pediatric residents over 10 months. The first two sessions discussed recommended childhood vaccines, the third session examined common vaccine misconceptions, and the final session reviewed vaccine hesitancy-specific communication skills, incorporating practice through role-playing. Residents completed pre- and posttests assessing knowledge and comfort as well as receiving a standardized patient (SP) assessment of vaccine-specific communication skills after the curriculum. RESULTS Thirty-five residents were in the educational intervention group and 35 in a control group. Pretest scores did not differ significantly between the groups. The mean knowledge score for the intervention group increased from 47% on the pretest to 66% on the posttest. The mean self-reported comfort score (1 = low comfort, 5 = high comfort) for the intervention group increased from 2.9 on the pretest to 3.8 on the posttest. The control group showed no difference between pre- and posttest scores for knowledge or comfort. The mean postintervention SP assessment score was significantly higher for the intervention group (78%) than the control group (52%). DISCUSSION Implementation of a comprehensive vaccine hesitancy curriculum resulted in improved vaccine knowledge, self-reported comfort, and communication skills among pediatric residents.
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Affiliation(s)
- Zarina S. Norton
- Assistant Professor, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago; Assistant Professor, Department of Medical Education, Northwestern University Feinberg School of Medicine
| | - Kaitlyn B. Olson
- General Pediatrician, Department of Pediatrics, Cottage Children's Medical Center
| | - Sandra M. Sanguino
- Associate Professor, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago; Associate Professor, Department of Medical Education, and Senior Associate Dean for Medical Education, Northwestern University Feinberg School of Medicine
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Trends in Vaccine Refusal and Acceptance Using Electronic Health Records from a Large Pediatric Hospital Network, 2013-2020: Strategies for Change. Vaccines (Basel) 2022; 10:vaccines10101688. [PMID: 36298553 PMCID: PMC9610983 DOI: 10.3390/vaccines10101688] [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: 08/17/2022] [Revised: 09/27/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
Understanding trends in vaccine refusal is critical to monitor as small declines in vaccination coverage can lead to outbreaks of vaccine-preventable diseases. Using electronic heath record (EHR) data from the Children’s Hospital of Philadelphia’s 31 outpatient primary care sites, we created a cohort of 403,448 children less than age 20 years who received at least one visit from 1 January 2013 through 31 December 2020. The sample represented 1,449,061 annualized patient and 181,131 annualized preventive vaccination visits per year. We characterized trends in vaccine refusal and acceptance using a repeated cross-sectional observational analysis of electronic health records (EHR) data using a single annual merged observation measure for patients seen multiple times for preventive healthcare within a calendar year. Refusals were identified for 212,900 annualized patient-visit year observations, which represented 14.6% of annualized patient-visit year observations and 25.1% of annualized vaccine patient-year observations. The odds of having a refusal marker were significantly increased in patients seen in suburban practices (aOR [CI]: 2.35 [2.30−2.40, p < 0.001]), in patients with increased age 11−17 years (aOR [CI]: 3.85 [3.79−3.91], p < 0.001), and those eligible for the VFC program (aOR [CI]: 1.10 [1.08−1.11]. Parental refusal (61.0%) and provider decisions (32.0%) were the most common documented in progress notes for not administering vaccines, whereas contraindications (2.5%) and supply issues (1.8%) were the least common. When offered, vaccine acceptance increased for human papillomavirus, hepatitis B, measles-mumps-rubella-containing and varicella-containing vaccines and decreased for hepatitis A and meningococcal vaccines. Repeated offering of vaccines was central to increasing acceptance, in part due to increased opportunities to address specific concerns.
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10
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Salazar TL, Pollard DL, Pina-Thomas DM, Benton MJ. Parental vaccine hesitancy and concerns regarding the COVID-19 virus. J Pediatr Nurs 2022; 65:10-15. [PMID: 35367855 PMCID: PMC8970879 DOI: 10.1016/j.pedn.2022.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/11/2022] [Accepted: 03/23/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE This study assessed parental vaccine hesitancy in a metropolitan area of the United States. The study aimed to determine what characteristics and contributing factors influenced parental vaccine hesitancy and concerns regarding COVID-19. DESIGN AND METHODS An online survey was used to recruit 93 parents to answer demographic and vaccine hesitancy information. Vaccine hesitancy was measured using the Parent Attitudes about Childhood Vaccines survey. The study was conducted between June 2020 and September 2020 during the COVID-19 pandemic. RESULTS The rate of vaccine hesitancy was 15%. One hundred percent of vaccine hesitant parents were mothers, at least 30 years of age, married, and had completed at least some college. When characteristics of vaccine hesitant parents were compared to non-hesitant parents, the hesitant parents reported having more children, with 93% reporting two or more children compared to only 74% of non-hesitant parents (p = 0.046). Fifty percent of hesitant parents reported no concerns regarding COVID-19 compared to only 20% of non-hesitant parents (p = 0.006), and significantly less hesitant parents reported willingness to have their children receive a safe, effective COVID-19 vaccine if it were available compared to non-hesitant parents (p < 0.001). CONCLUSIONS Our findings indicate that older mothers with two or more children are more likely to be vaccine hesitant and this hesitancy extends to the current COVID-19 pandemic. PRACTICE IMPLICATIONS Healthcare providers can use the results of this study to identify parents at risk for vaccine hesitancy and initiate individualized education to promote on-time childhood vaccination.
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Affiliation(s)
- Teresa L Salazar
- Helen & Arthur E. Johnson Beth-El College of Nursing & Health Sciences, University of Colorado Colorado Springs, United States of America; Hampden Medical Group, Englewood, CO, United States of America
| | - Deborah L Pollard
- Helen & Arthur E. Johnson Beth-El College of Nursing & Health Sciences, University of Colorado Colorado Springs, United States of America
| | - Deborah M Pina-Thomas
- Helen & Arthur E. Johnson Beth-El College of Nursing & Health Sciences, University of Colorado Colorado Springs, United States of America
| | - Melissa J Benton
- Helen & Arthur E. Johnson Beth-El College of Nursing & Health Sciences, University of Colorado Colorado Springs, United States of America.
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Ossai C, Bedrick S, Orwoll B. Using Publicly Available Reddit Data to Understand How Parents Choose Pediatricians. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2022. [DOI: 10.1080/15398285.2022.2062659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Chionye Ossai
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children’s Hospital, Cleveland, Ohio, USA
| | - Steven Bedrick
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Benjamin Orwoll
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
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Pediatric primary care immunization policies in New York State. Vaccine 2022; 40:1458-1463. [DOI: 10.1016/j.vaccine.2022.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 11/18/2022]
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Guljaš S, Bosnić Z, Salha T, Berecki M, Krivdić Dupan Z, Rudan S, Majnarić Trtica L. Lack of Informations about COVID-19 Vaccine: From Implications to Intervention for Supporting Public Health Communications in COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116141. [PMID: 34200133 PMCID: PMC8201156 DOI: 10.3390/ijerph18116141] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 12/23/2022]
Abstract
Lack of knowledge and mistrust towards vaccines represent a challenge in achieving the vaccination coverage required for population immunity. The aim of this study is to examine the opinion that specific demographic groups have about COVID-19 vaccination, in order to detect potential fears and reasons for negative attitudes towards vaccination, and to gain knowledge on how to prepare strategies to eliminate possible misinformation that could affect vaccine hesitancy. The data collection approach was based on online questionnaire surveys, divided into three groups of questions that followed the main postulates of the health belief theory—a theory that helps understanding a behaviour of the public in some concrete surrounding in receiving preventive measures. Ordinary least squares regression analyses were used to examine the influence of individual factors on refusing the vaccine, and to provide information on the perception of participants on the danger of COVID-19 infection, and on potential barriers that could retard the vaccine utility. There was an equal proportion of participants (total number 276) who planned on receiving the COVID-19 vaccine (37%), and of those who did not (36.3%). The rest (26.7%) of participants were still indecisive. Our results indicated that attitudes on whether to receive the vaccine, on how serious consequences might be if getting the infection, as well as a suspicious towards the vaccine efficacy and the fear of the vaccine potential side effects, may depend on participants’ age (<40 vs. >40 years) and on whether they are healthcare workers or not. The barriers that make participants‘ unsure about of receiving the vaccine, such as a distrust in the vaccine efficacy and safety, may vary in different socio-demographic groups and depending on which is the point of time in the course of the pandemic development, as well as on the vaccine availability and experience in using certain vaccine formulas. There is a pressing need for health services to continuously provide information to the general population, and to address the root causes of mistrust through improved communication, using a wide range of policies, interventions and technologies.
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Affiliation(s)
- Silva Guljaš
- Department of Radiology, University Hospital Center Osijek, 31 000 Osijek, Croatia;
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia; (T.S.); (M.B.)
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia;
- Correspondence:
| | - Zvonimir Bosnić
- Department of Internal Medicine, Family Medicine and the History of Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia; (Z.B.); (L.M.T.)
| | - Tamer Salha
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia; (T.S.); (M.B.)
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia;
- Department of Teleradiology and Arteficial Intelligence, Health Center Osijek-Baranja County, 31 000 Osijek, Croatia
| | - Monika Berecki
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia; (T.S.); (M.B.)
| | - Zdravka Krivdić Dupan
- Department of Radiology, University Hospital Center Osijek, 31 000 Osijek, Croatia;
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia; (T.S.); (M.B.)
| | - Stjepan Rudan
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia;
| | - Ljiljana Majnarić Trtica
- Department of Internal Medicine, Family Medicine and the History of Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia; (Z.B.); (L.M.T.)
- Department of Public Health, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia
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Communicating with Parents About Vaccines. Vaccines (Basel) 2021. [DOI: 10.1007/978-3-030-58414-6_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Salter EK, Ross LF. Why Most Bad Decisions About Vaccines Do Not Constitute Child Neglect. Pediatr Neurol 2020; 113:85-87. [PMID: 33109430 DOI: 10.1016/j.pediatrneurol.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/02/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Erica K Salter
- Albert Gnaegi Center for Health Care Ethics, Saint Louis University, St. Louis, Missouri.
| | - Lainie F Ross
- Department of Pediatrics, University of Chicago, Chicago, Illinois; MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
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Mills K, Nilsen K. Kansas Family Physicians Perceptions of Parental Vaccination Hesitancy. Kans J Med 2020; 13:248-259. [PMID: 33173560 PMCID: PMC7651789 DOI: 10.17161/kjm.vol13.14761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/22/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction In the past few decades, patients expressing the idea that vaccines are unsafe or unneeded have been experienced increasingly by physicians and other healthcare providers. Discussions with patients regarding their reasons for vaccine refusals are important, as it may provide information that can be utilized in an intervention to increase vaccination rates and combat the spread of diseases that are making a resurgence in the United States. The main objective of this study was to explore the perceptions of family physicians as to why parents in Kansas may be vaccine hesitant. Methods An electronic survey was distributed to family physicians in the State of Kansas via the University of Kansas School of Medicine-Wichita Family Medicine Research and Data Information Office (FM RADIO). Several aspects of physician perceptions regarding patients’ vaccine hesitancy were measured in this study, including vaccines that are most often refused, reasons for refusing vaccinations, as well as what responses physicians employ when presented with vaccine concerns. Results The majority of physicians surveyed have experienced vaccine hesitancy or refusal in their practice, and the human papillomavirus (HPV) and flu vaccines were reported to be the primary vaccines refused for children. In addition, physicians reported frequently employing various practices in response to vaccine refusals, including requiring parents to sign a form (40%) and dismissing families from their practice (1.5%). Physician perceptions on the reasons as to why parents/guardians refuse vaccinations also were measured, and the most common response was that parents possess a fear of long-term complications for their children as a result of vaccines (74%). Additionally, the three most commonly refused vaccines were HPV, influenza, and measles, mumps, and rubella. Conclusion Physicians must not only deal with time constraints that vaccine hesitant discussions require, but also must try and implement discussions or interventions suited to the varying reasons why parents/guardians refuse vaccines to convince parents of their safety. The results suggested that vaccine refusals by parents/guardians seemed to be affecting Kansas family physicians’ clinics in more than one way. This study could be a useful tool to help physicians better understand why vaccine refusals occur and be able to combat unwarranted concerns about vaccines.
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Affiliation(s)
- Kale Mills
- University of Kansas School of Medicine-Wichita, Department of Family and Community Medicine, Wichita, KS
| | - Kari Nilsen
- University of Kansas School of Medicine-Wichita, Department of Family and Community Medicine, Wichita, KS
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Kaydirak MM, Gumusay M, Gulec Y, Sahin NH. Parental Opinions and Approaches about Childhood Vaccinations: Are Anti-vaccination Approaches and Indecisiveness Parental Rights? J Community Health Nurs 2020; 37:222-232. [PMID: 33150813 DOI: 10.1080/07370016.2020.1809860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study aimed to analyze parental opinions regarding immunization services and the factors that affect parental decisions regarding the vaccination of their children. We conducted descriptive study with 373 parents. The Parent Information Form and the Public Attitude Toward Vaccination Scale-Health Belief Model developed to evaluate vaccination approaches, were used. Of the parents who participated in the study, 35.9% stated that they found the information on childhood vaccinations unreliable or that they doubted the credibility of the information. In addition, most of the parents (71%) stated that they believed that the high number of immigrant children in the country causes contagious diseases to increase. It is found that there are statistically significant higher scores in the subscales of severity, susceptibility, and health motivation among the parents who disagree with the media statements on anti-vaccination attitudes (p < 0,001). Opinions and approaches of parents toward childhood vaccinations are affected by sociodemographic characteristics. In this study, the educational level of parents was found to be the most important variable affecting the approach of parents toward vaccinations.
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Affiliation(s)
- Meltem Mecdi Kaydirak
- Department of Women's Health and Diseases Nursing, Istanbul University - Cerrahpasa, Florence Nightingale Faculty of Nursing , Istanbul, Turkey
| | - Mehtap Gumusay
- Department of Women's Health and Diseases Nursing, Istanbul University - Cerrahpasa, Florence Nightingale Faculty of Nursing , Istanbul, Turkey
| | - Yağmur Gulec
- Department of Nursing, Koc University Hospital , Istanbul, Turkey
| | - Nevin Hotun Sahin
- Department of Women's Health and Diseases Nursing, Istanbul University - Cerrahpasa, Florence Nightingale Faculty of Nursing , Istanbul, Turkey
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18
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NAS MA, ATABAY G, ŞAKİROĞLU F, ÇAYIR Y. Vaccine Rejection In A University’s Training Family Health Centers. KONURALP TIP DERGISI 2020. [DOI: 10.18521/ktd.744687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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A qualitative study examining pediatric clinicians' perceptions of delayed vaccine schedules. Vaccine 2020; 38:4740-4746. [PMID: 32418792 DOI: 10.1016/j.vaccine.2020.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/24/2020] [Accepted: 05/06/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To explore pediatric clinicians' attitudes, beliefs, and perceived social norms about the impact of delayed vaccine schedules on the clinical management of their patients. METHODS We conducted 30 semi-structured qualitative interviews with academic (Infectious Diseases, Emergency Medicine) and community pediatric clinicians (General Pediatrics) to explore clinicians' perspectives on how delayed schedules influence their clinical management of patients. The interview guide was based on the Theory of Planned Behavior. We analyzed interview transcripts using both an inductive and deductive thematic approach. RESULTS The pediatric clinicians in our study overwhelmingly supported the recommended schedule, sought guidance on approaches to navigating conversations with vaccine hesitant families, and desired more evidence to effectively promote on-time vaccination. Clinicians described how delayed schedules have consequences for sick children (e.g., increased antibiotics, laboratory tests, emergency department visits) and healthy children (e.g., increased vaccine visits, out-of-pocket costs, fears among children receiving frequent shots). Clinicians stated that delayed schedules also negatively impact pediatric practices (e.g., increased time counseling patients, staff burden, clogged clinic space, unpredictable vaccine utilization, costs). CONCLUSIONS Pediatric clinicians perceive that delayed vaccine schedules negatively affect patients, pediatric practices, the healthcare system, and society. Future research should quantify the consequences of delayed schedules and identify strategies that promote vaccine adherence. Results from future studies can better support clinician-parent conversations about vaccine hesitancy, guide decision-makers about practice-level approaches to vaccine schedules, and advise payors and policymakers regarding vaccine-related policies.
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Díaz Crescitelli ME, Ghirotto L, Sisson H, Sarli L, Artioli G, Bassi MC, Appicciutoli G, Hayter M. A meta-synthesis study of the key elements involved in childhood vaccine hesitancy. Public Health 2019; 180:38-45. [PMID: 31838344 DOI: 10.1016/j.puhe.2019.10.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/26/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Immunization is one of the most successful and cost-effective interventions to improve health outcomes. However, internationally, the phenomenon of parental vaccine hesitancy is increasing and presents a growing challenge for health professionals. This article summarizes the evidence surrounding childhood vaccine hesitancy from the perspective of parents. STUDY DESIGN We conducted a systematic review and meta-synthesis of qualitative studies. METHODS We searched for qualitative research articles in electronic databases from inception to March 2018. In addition, a manual search of the retrieved articles and their references was conducted to identify other potential articles. We used the Critical Appraisal Skills Programme to examine study validity, adequacy and potential applicability of the results. No articles were excluded for reasons of quality. By performing a meta-synthesis, we identified descriptive themes and, subsequently, the conceptual elements of vaccine hesitancy. RESULTS The review included 27 studies involving a total of 1557 parents who were hesitant about vaccinating their child. Five overarching categories were identified: (1) risk conceptualization; (2) mistrust towards vaccine-related institutions, pharmaceutical companies, researchers, health professionals and the information from media; (3) parental alternative health beliefs about childhood immunity, vaccine scheduling and the perceived toxicity of vaccinations; (4) philosophical views on parental responsibility; and (5) parents' information levels about vaccination. CONCLUSIONS Healthcare providers need to approach this difficult situation considering that parents desire to do what they feel right for the child. Understanding the core elements of hesitancy will allow health professionals to adopt effective communication and behavioural strategies.
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Affiliation(s)
| | - L Ghirotto
- Azienda USL - IRCCS di Reggio Emilia, Italy
| | - H Sisson
- Faculty of Health Sciences, University of Hull, UK
| | - L Sarli
- Department of Medicine and Surgery, University of Parma, Italy
| | - G Artioli
- Azienda USL - IRCCS di Reggio Emilia, Italy
| | - M C Bassi
- Azienda USL - IRCCS di Reggio Emilia, Italy
| | | | - M Hayter
- Faculty of Health Sciences, University of Hull, UK
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21
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Physician Trust and Home Remedy Use Among Low-Income Blacks and Whites with Hypertension: Findings from the TRUST Study. J Racial Ethn Health Disparities 2019; 6:830-835. [PMID: 30915684 DOI: 10.1007/s40615-019-00582-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/25/2019] [Accepted: 03/12/2019] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Home remedies are used for the treatment of hypertension despite unsubstantiated claims of their effectiveness. Home remedy use is often attributed to mistrust towards healthcare providers. Few studies examine the relationship between home remedy use and physician trust. The objective of this study was to examine and compare the association between home remedy use and trust in physicians in a cohort of low-income Blacks and Whites with hypertension living in an inner city in Alabama. METHODS A cross-sectional examination was conducted among 925 Black and White patients receiving care at an urban hospital. Data was collected from in-person surveys. Trust in physicians was self-reported using the Hall General Trust Scale which included questions about honesty, confidentiality, and trust. Home remedy use was self-reported using the Brown and Segal scale which included questions about home remedy use and types of home remedies used. Covariates included demographic factors such as age, race, gender, and health outcomes. Data were analyzed using linear regression. RESULTS Twenty-eight percent of Black and 15% of White participants reported home remedy use (p = 0.001). Black home remedy users (38.9) and non-users (39.3) had similar trust scores (p = 0.582). Whites home remedy users (32.9) reported lower trust in physicians than White non-users (37.7) (p = 0.026). CONCLUSIONS Black home remedy users, non-users, and White non-users reported similar trust scores; the lowest trust scores were found among White home remedy users. Home remedy use was higher among Black participants. Future studies should examine the context of mistrust and home remedy use among Whites.
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Lisowski B, Yuvan S, Bier M. Outbreaks of the measles in the Dutch Bible Belt and in other places – New prospects for a 1000 year old virus. Biosystems 2019; 177:16-23. [DOI: 10.1016/j.biosystems.2019.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/01/2019] [Accepted: 01/02/2019] [Indexed: 11/24/2022]
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Hobson C, Maakaroun Z, Dieckmann K, Bernard L, Amsellem-Jager J, Lemaignen A. A preliminary prospective study: Could the labeling of a health-care message on a consumer product limit forgetfulness in parents confronted with immunization? Arch Pediatr 2018; 26:65-70. [PMID: 30573376 DOI: 10.1016/j.arcped.2018.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 08/30/2018] [Accepted: 11/10/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Parental hesitancy in immunization is an emerging and concerning problem owing to the serious consequences of a lack of vaccination. Few tools are available to combat this phenomenon. AIMS To evaluate the interest of parents in recording the vaccine schedule on a common consumer product as a solution to prevent immunization oversight. METHOD We conducted a preliminary prospective and monocentric study, in a parental population, using surveys to evaluate interest in this solution, and to define the sociodemographic characteristics of our population. Our population was clustered into three groups: against immunization, hesitant/negligent, and pro-immunization. This solution was evaluated using a univariate model between fearful and confident populations in respect of immunization, associated with a descriptive analysis of the population against immunization. RESULTS Of 825 surveys distributed, 709 were analyzed. There were 47 parents against immunization (6.6%), 284 hesitant/negligent parents (40%), and 378 pro-immunization parents (53.3%). We showed that the hesitant/negligent population reported more difficulties in remembering the immunization schedule (P<0.001; OR=0.36; 95% CI [0.25-0.51]), and was interested in discussions on immunization (P<0.001; OR=0.41; 95% CI [0.29-0.58]). This population prone to oversight was interested in the labeling of an everyday consumer product with the immunization schedule (P=0.03; OR=0.68; 95% CI [1.02-2.11]) to limit the number of missed injections. CONCLUSION There is no single or perfect solution to combat the current anti-immunization problem, although communication through everyday consumer products seems to be an interesting tool for raising parental awareness of the importance of immunization. Further studies are required to evaluate the effectiveness of this tool.
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Affiliation(s)
- C Hobson
- Infectious disease department, hôpital Bretonneau, university hospital of Tours, 2, boulevard Tonnellé, 37044 cedex 9 Tours, France; General pediatrics department, hôpital Saint Gatien de Clocheville, university hospital of Tours, 59, boulevard Béranger, 37000 Tours, France.
| | - Z Maakaroun
- Infectious disease department, hôpital Bretonneau, university hospital of Tours, 2, boulevard Tonnellé, 37044 cedex 9 Tours, France; General pediatrics department, hôpital Saint Gatien de Clocheville, university hospital of Tours, 59, boulevard Béranger, 37000 Tours, France
| | - K Dieckmann
- General pediatrics department, Blois Hospital Center, Mail Pierre Charcot, 41000 Blois, France
| | - L Bernard
- Infectious disease department, hôpital Bretonneau, university hospital of Tours, 2, boulevard Tonnellé, 37044 cedex 9 Tours, France
| | - J Amsellem-Jager
- General pediatrics department, Blois Hospital Center, Mail Pierre Charcot, 41000 Blois, France
| | - A Lemaignen
- Infectious disease department, hôpital Bretonneau, university hospital of Tours, 2, boulevard Tonnellé, 37044 cedex 9 Tours, France
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Krishnarajah G, Malangone-Monaco E, Palmer L, Riehle E, Buck PO. Age-appropriate compliance and completion of up to five doses of pertussis vaccine in US children. Hum Vaccin Immunother 2018; 14:2932-2939. [PMID: 30024829 PMCID: PMC6351022 DOI: 10.1080/21645515.2018.1502526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/20/2018] [Accepted: 07/08/2018] [Indexed: 11/09/2022] Open
Abstract
Background: In the United States (US), diphtheria, tetanus, and acellular pertussis (DTaP) vaccination is recommended at 2, 4, and 6 months (doses 1-3), 15-18 months (dose 4), and 4-6 years (dose 5). The objective of this study (GSK study identifier: HO-14-14383) was to examine DTaP completion and compliance rates among commercially insured and Medicaid-enrolled children. Secondarily, the study aimed at identifying predictors of compliance/completion. Methods: Truven Health MarketScan Commercial and Multi-State Medicaid databases (2005-2013) were analyzed separately. Children born during 2005-2011 with ≥ 2 years continuous enrollment from birth provided data for doses 1-4; those with continuous enrollment from birth to their seventh birthday provided dose 5 data. Series compliance (each recommended dose by 3, 5, and 7 months; 19 months; seventh birthday) and completion (3 doses by 8 months; 4 by 24 months; 5 by seventh birthday) were calculated. Predictors of compliance/completion were identified using multivariable logistic regression. Results: A total of 367,493 commercially insured and 766,153 Medicaid-enrolled children were followed for ≥ 2 years; and 23,574 and 41,284, respectively, for ≥ 7 years. Series compliance to doses 1-3, 1-4, and 1-5 were 67.2%, 55.3%, 47.5% (commercial) and 37.4%, 27.3%, 14.4% (Medicaid), respectively. Predictors of better compliance/completion included: later birth year (commercial/Medicaid) and higher household income (commercial); predictors of worse compliance/completion included: Northeast residence (commercial), birth hospitalization ≥ 14 days (commercial/Medicaid), and Black race/ethnicity (Medicaid). Conclusions: DTaP series compliance/completion improved over time, but appear to be suboptimal. As this could increase pertussis risk, greater awareness of the importance of timely vaccination completion is needed. GSK study identifier: HO-14-14383.
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Affiliation(s)
| | | | - Liisa Palmer
- Truven Health Analytics, an IBM Company, Bethesda, MD, USA
| | - Ellen Riehle
- Truven Health Analytics, an IBM company, Ann Arbor, MI, USA
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Connors JT, Slotwinski KL, Hodges EA. Provider-parent Communication When Discussing Vaccines: A Systematic Review. J Pediatr Nurs 2017; 33:10-15. [PMID: 27863734 DOI: 10.1016/j.pedn.2016.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/17/2016] [Accepted: 11/07/2016] [Indexed: 11/17/2022]
Abstract
PROBLEM Expert literature on communication practices with vaccine hesitant parents posits that a non-confrontational/participatory discussion with the parent would be the best approach to improve compliance. A prior literature review found limited evidence to recommend any particular face to face intervention other than to incorporate communication about vaccination effectiveness during an encounter. Hence, a systematic review was performed in an attempt to determine the most efficacious communication practices to use with parents with vaccination concerns. ELIGIBILITY CRITERIA Quantitative and qualitative studies written in English that assessed the communication framework/style of the provider-parent interaction and studies where provider communication was listed as an intervention were reviewed. SAMPLE Nine articles were included in the sample. RESULTS The majority of the studies were descriptive and qualitative in nature with only one randomized controlled trial. Five of the 9 studies utilized a descriptive cross-sectional design. Two main themes included message types recommended or given by the provider and message types that were requested by the parent. CONCLUSIONS Overall, findings showed that there is currently not enough information to definitively state the type of provider-parent communication style that should be employed to affect the parents' vaccination viewpoint. However, recurring themes of trust in the provider and a personalized provider-parent interaction were evident, which promotes a participatory type of interaction. IMPLICATIONS The literature indirectly supports providers engaging with vaccine hesitant parents in a more individualized, participatory format, though higher quality and more rigorous studies that focus specifically on provider-parent communication practices are needed.
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Affiliation(s)
- John T Connors
- University of North Carolina, School of Nursing, Chapel Hill, North Carolina, United States.
| | - Kate L Slotwinski
- University of North Carolina, School of Nursing, Chapel Hill, North Carolina, United States
| | - Eric A Hodges
- University of North Carolina, School of Nursing, Chapel Hill, North Carolina, United States
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26
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Faasse K, Chatman CJ, Martin LR. A comparison of language use in pro- and anti-vaccination comments in response to a high profile Facebook post. Vaccine 2016; 34:5808-5814. [PMID: 27707558 DOI: 10.1016/j.vaccine.2016.09.029] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vaccinations are important for controlling the spread of disease, yet an increasing number of people are distrustful of vaccines, and choose not to (fully) vaccinate themselves and their children. One proposed contributor to this distrust is anti-vaccination misinformation available on the internet, where people search for and discuss health information. The language people use in these discussions can provide insights into views about vaccination. METHODS Following a prominent Facebook post about childhood vaccination, language used by participants in a comment thread was analysed using LIWC (Linguistic Inquiry and Word Count). Percentage of words used across a number of categories was compared between pro-vaccination, anti-vaccination, and unrelated (control) comments. RESULTS Both pro- and anti-vaccination comments used more risk-related and causation words, as well as fewer positive emotion words compared to control comments. Anti-vaccine comments were typified by greater analytical thinking, lower authenticity, more body and health references, and a higher percentage of work-related word use in comparison to pro-vaccine comments, plus more money references than control comments. In contrast, pro-vaccination comments were more authentic, somewhat more tentative, and evidenced higher anxiety words, as well as more references to family and social processes when compared to anti-vaccination comments. CONCLUSION Although the anti-vaccination stance is not scientifically-based, comments showed evidence of greater analytical thinking, and more references to health and the body. In contrast, pro-vaccination comments demonstrated greater comparative anxiety, with a particular focus on family and social processes. These results may be indicative of the relative salience of these issues and emotions in differing understandings of the benefits and risks of vaccination. Text-based analysis is a potentially useful and ecologically valid tool for assessing perceptions of health issues, and may provide unique information about particular concerns or arguments expressed on social media that could inform future interventions.
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Affiliation(s)
- Kate Faasse
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.
| | - Casey J Chatman
- Psychology Department, La Sierra University, Riverside, CA, USA
| | - Leslie R Martin
- Psychology Department, La Sierra University, Riverside, CA, USA
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27
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Dáňová J, Šálek J, Kocourková A, Čelko AM. Factors Associated with Parental Refusal of Routine Vaccination in the Czech Republic. Cent Eur J Public Health 2016; 23:321-3. [PMID: 26841145 DOI: 10.21101/cejph.a4395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 10/13/2015] [Indexed: 11/15/2022]
Abstract
AIM Routine vaccination is one of the most important preventive methods which is responsible for the decreasing trend of morbidity and mortality of vaccine preventable infectious diseases, their complications and sequelae. The impact of vaccination on declining trend of these diseases is well known and confirmed by a large number of epidemiological studies. In the Czech Republic, there is high vaccination coverage in regards to most vaccine preventable diseases. However, during the last decade proportion of parents refusing routine vaccination of their children due to different factors is increasing. The presented study evaluates current situation in the Czech Republic and describes the most significant factors in parents decision making. METHODS The study was conducted between 1 July 2013 and 31 March 2014 as a questionnaire based survey (cross-sectional study). The questionnaire was created with multiple choice answers. Questions were addressed to parents or legal representatives of children aged 0-18 years. Types of questions were divided into several subgroups. The study was performed in the Czech Republic in two different districts of Prague and Zlín. RESULTS In the sample size (n=480) we detected 11 parents who refused vaccination of 11 children (2.29%). The most often refused vaccines in the prevalence study were hexavaccine (1st dose) and measles, mumps and rubella vaccine (1st dose). The hexavaccine includes tetanic anatoxin, diphtheric anatoxin, acellular pertussis vaccine, conjugate vaccine against Haemophilus influenzae b, inactivated polio vaccine, and recombinant vaccine against viral hepatitis B. The measles, mumps, rubella vaccine contains live attenuated viruses of measles, mumps, rubella. CONCLUSION We observed increasing trend of routine vaccination refusal in children during the last ten years (compared to situation in the year 2004, p<0.001). The most important factors associated with this progression were distrust to vaccination, fear of some vaccine components and fear of adverse reactions.
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Affiliation(s)
- Jana Dáňová
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Šálek
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Aneta Kocourková
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alexander M Čelko
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Kumar D, Chandra R, Mathur M, Samdariya S, Kapoor N. Vaccine hesitancy: understanding better to address better. Isr J Health Policy Res 2016; 5:2. [PMID: 26839681 PMCID: PMC4736490 DOI: 10.1186/s13584-016-0062-y] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 01/25/2016] [Indexed: 11/18/2022] Open
Abstract
Vaccine hesitancy is an emerging term in the socio-medical literature which describes an approach to vaccine decision making. It recognizes that there is a continuum between full acceptance and outright refusal of some or all vaccines and challenges the previous understanding of individuals or groups, as being either anti-vaccine or pro-vaccine. The behaviours responsible for vaccine hesitancy can be related to confidence, convenience and complacency. The causes of vaccine hesitancy can be described by the epidemiological triad i.e. the complex interaction of environmental- (i.e. external), agent- (i.e. vaccine) and host (or parent)- specific factors. Vaccine hesitancy is a complex and dynamic issue; future vaccination programs need to reflect and address these context-specific factors in both their design and evaluation. Many experts are of the view that it is best to counter vaccine hesitancy at the population level. They believe that it can be done by introducing more transparency into policy decision-making before immunization programs, providing up-to-date information to the public and health providers about the rigorous procedures undertaken before introduction of new vaccines, and through diversified post-marketing surveillance of vaccine-related events.
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Affiliation(s)
- Dewesh Kumar
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Basni-II, Jodhpur, Rajasthan 342005 India
| | - Rahul Chandra
- Department of Community Medicine, Rohilkhand Medical College and Hospital, Bareilly, U.P, 243006 India
| | - Medha Mathur
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Basni-II, Jodhpur, Rajasthan 342005 India
| | - Saurabh Samdariya
- Department of Radiation Oncology, All India Institute of Medical Sciences, Basni-II, Jodhpur, Rajasthan 342005 India
| | - Neelesh Kapoor
- RMNCH + A Scale up project, IPE Global/USAID, Sixth Floor, DSHM, B block, Vikas Bhawan-2, Civil Lines, New Delhi, 110054 India
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Kelley CA, Velazco CS, Delaney TV, Bensimhon A, Huang KN, Jarvis PR, Jolin JS, Schaberg KB, Burke M, Finley C, Carney JK. Factors contributing to suboptimal rates of childhood vaccinations in Vermont. J Child Health Care 2015; 19:558-68. [PMID: 24821076 DOI: 10.1177/1367493514530955] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Childhood immunizations are invaluable in preventing contagious diseases. Nonetheless, vaccines have become increasingly controversial with growing numbers of caregivers refusing to vaccinate their children. The percentage of fully vaccinated children in Vermont is one of the lowest nationally. This study set out to determine Vermont caregivers' attitudes toward immunizations to better explain why the percentage of fully vaccinated children has fallen in Vermont. A survey regarding caregivers' health care knowledge about children, their vaccination concerns, and their children's vaccination status was sent to participants in the Vermont Women, Infants and Children's Program from two districts. In total, 83% (n = 379) of respondents reported their children received all recommended vaccinations for their age. Respondents who considered themselves highly knowledgeable regarding their children's health care and confident about the safety of vaccinations were significantly associated with reporting their children as being current on vaccinations and with their intent to continue vaccinations. Respondents indicated highest concern regarding the safety and number of vaccinations administered during one visit. Primary care providers were indicated as important resources for addressing concerns about vaccinations and health care knowledge of children. The results help to understand low vaccination rates in Vermont and can be used for targeting health campaigns to improve vaccination rates.
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Affiliation(s)
- Catherine A Kelley
- University of Vermont College of Medicine, USAVermont Department of Health, USAUniversity of Vermont College of Medicine, USA
| | - Cristine S Velazco
- University of Vermont College of Medicine, USAVermont Department of Health, USAUniversity of Vermont College of Medicine, USA
| | - Thomas V Delaney
- University of Vermont College of Medicine, USAVermont Department of Health, USAUniversity of Vermont College of Medicine, USA
| | - Adam Bensimhon
- University of Vermont College of Medicine, USAVermont Department of Health, USAUniversity of Vermont College of Medicine, USA
| | - Kuang-Ning Huang
- University of Vermont College of Medicine, USAVermont Department of Health, USAUniversity of Vermont College of Medicine, USA
| | - Paul R Jarvis
- University of Vermont College of Medicine, USAVermont Department of Health, USAUniversity of Vermont College of Medicine, USA
| | - Jonathan S Jolin
- University of Vermont College of Medicine, USAVermont Department of Health, USAUniversity of Vermont College of Medicine, USA
| | - Kurt B Schaberg
- University of Vermont College of Medicine, USAVermont Department of Health, USAUniversity of Vermont College of Medicine, USA
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Wang E, Baras Y, Buttenheim AM. "Everybody just wants to do what's best for their child": Understanding how pro-vaccine parents can support a culture of vaccine hesitancy. Vaccine 2015; 33:6703-9. [PMID: 26518397 DOI: 10.1016/j.vaccine.2015.10.090] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/07/2015] [Accepted: 10/16/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although a large majority of parents vaccinate their children, vaccine hesitancy has become more widespread. It is not well understood how this culture of vaccine hesitancy has emerged and how it influences parents' decisions about vaccine schedules. OBJECTIVE We sought to examine how attitudes and beliefs of parents who self-report as pro-vaccine are developed and contribute to immunization decisions, including delaying or spacing vaccines. METHODS Open-ended, in-depth interviews (N=23) were conducted with upper-middle class parents with young children living in Philadelphia. Interview data were coded and key themes identified related to vaccine decision-making. RESULTS Parents who sought out vaccine information were often overwhelmed by the quantity and ambiguity when interpreting that information, and, consequently, had to rely on their own instinct or judgment to make vaccine decisions. In particular, while parents in this sample did not refuse vaccines, and described themselves as pro-vaccine, they did frequently delay or space vaccines. This experience also generated sympathy for and tolerance of vaccine hesitancy in other parents. Parents also perceived minimal severe consequences for deviating from the recommended immunization schedule. CONCLUSION These findings suggest that the rise in and persistence of vaccine hesitancy and refusal are, in part, influenced by the conflicts in the information parents gather, making it difficult to interpret. Considerable deviations from the recommended vaccination schedule may manifest even within a pro-vaccine population due to this perceived ambiguity of available information and resulting tolerance for vaccine hesitancy.
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Affiliation(s)
- Eileen Wang
- Department of History and Sociology of Science, University of Pennsylvania, Suite 303 Claudia Cohen Hall, 249 S. 36th Street, Philadelphia, PA 19104, USA.
| | - Yelena Baras
- School of Nursing, University of Pennsylvania, 416 Fagin Hall, 418 Curie Blvd, Philadelphia, PA 19014, USA.
| | - Alison M Buttenheim
- School of Nursing, University of Pennsylvania, 416 Fagin Hall, 418 Curie Blvd, Philadelphia, PA 19014, USA.
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Cheung S, Wang HL, Mascola L, El Amin AN, Pannaraj PS. Parental perceptions and predictors of consent for school-located influenza vaccination in urban elementary school children in the United States. Influenza Other Respir Viruses 2015; 9:255-62. [PMID: 26073870 PMCID: PMC4548995 DOI: 10.1111/irv.12332] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND School-located influenza vaccination (SLV) programs have the potential to mass-vaccinate all enrolled children, but parental consent is required. OBJECTIVE To examine parental attitudes and determine predictors of parental consent for vaccination of schoolchildren through SLV programs. PATIENTS/METHODS Surveys were distributed to parents of 4517 children during 2009-2010 (year 1) and 4414 children during 2010-2011 (year 2) in eight elementary schools in conjunction with a SLV program. RESULTS Participants included 1259 (27·9%) parents in year 1 and 1496 (33·9%) in year 2. Parental consent for 2009 H1N1, 2009 seasonal, and 2010 seasonal influenza vaccines was obtained from 738 (70·8%), 673 (64·5%), and 1151 (77·2%) respondents, respectively. During the 2009 pandemic, respondents concerned about influenza severity were twice as likely to consent for the 2009 H1N1 vaccination compared to unconcerned respondents (OR 2·04, 95% CI:1·19-3·51). During year 2, factors that predicted parental consent were the perception of high susceptibility to influenza infection (OR 2·19, 95% CI:1·50-3·19) and high benefit of vaccine (OR 2·23, 95% CI:1·47-3·40). In both years, college-educated parents were more likely to perceive vaccine risks (year 1: 83·6 versus 61·5%, P < 0·001 and year 2: 81·1% versus 60·6%, P < 0·001) and less likely to consent for seasonal influenza vaccine (year 1: OR 0·69, 95% CI:0·53-0·89 and year 2: OR 0·61, 95% CI:0·47-0·78) compared to non-college-educated parents. CONCLUSIONS Parents who appreciate the risks of influenza and benefits of vaccination are more likely to consent for SLV. More research is needed to determine how to address heightened safety concerns among college-educated parents.
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Affiliation(s)
- Susan Cheung
- Division of Infectious Diseases, Children’s Hospital Los AngelesLos Angeles, CA, USA
| | - Hai-Lin Wang
- Division of Infectious Diseases, Children’s Hospital Los AngelesLos Angeles, CA, USA
| | - Laurene Mascola
- Acute Communicable Disease Control, Los Angeles County Department of Public HealthLos Angeles, CA, USA
| | - Alvin Nelson El Amin
- Immunization Program, Los Angeles County Department of Public HealthLos Angeles, CA, USA
| | - Pia S Pannaraj
- Division of Infectious Diseases, Children’s Hospital Los AngelesLos Angeles, CA, USA
- Department of Pediatrics and Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA, USA
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Perkins RB, Lin M, Silliman RA, Clark JA, Hanchate A. Why are U.S. girls getting meningococcal but not human papilloma virus vaccines? Comparison of factors associated with human papilloma virus and meningococcal vaccination among adolescent girls 2008 to 2012. Womens Health Issues 2015; 25:97-104. [PMID: 25747517 DOI: 10.1016/j.whi.2014.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 12/17/2014] [Accepted: 12/19/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Human papilloma virus (HPV) vaccination rates in the United States remain low, compared with other recommended adolescent vaccines. We compared factors associated with intention to receive and receipt of HPV and meningococcal vaccines and completion of the HPV vaccine series among U.S. adolescent girls. METHODS Secondary analysis of data from the National Immunization Survey-Teen for 2008 through 2012 was performed. Multivariable logistic modeling was used to determine factors associated with intent to receive and receipt of HPV and meningococcal vaccination, completion of the HPV vaccine series among girls who started the series, and receipt of HPV vaccination among girls who received meningococcal vaccination. FINDINGS Provider recommendation increased the odds of receipt and intention to receive both HPV and meningococcal vaccines. Provider recommendation was also associated with a three-fold increase in HPV vaccination among girls who received meningococcal vaccination (p<.001), indicating a relationship between provider recommendation and missed vaccine opportunities. However, White girls were 10% more likely to report provider recommendation than Black or Hispanic girls (p<.01), yet did not have higher vaccination rates, implying a role for parental refusal. No factors predicted consistently the completion of the HPV vaccine series among those who started. CONCLUSION Improving provider recommendation for co-administration of HPV and meningococcal vaccines would reduce missed opportunities for initiating the HPV vaccine series. However, different interventions may be necessary to improve series completion.
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Affiliation(s)
- Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
| | - Mengyun Lin
- Department of Medicine, Division of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Rebecca A Silliman
- Department of Medicine, Division of Geriatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Jack A Clark
- Boston University School of Public Health, Edith Nourse Rogers Veterans Hospital, Boston, Massachusetts
| | - Amresh Hanchate
- Veterans Affairs Boston Healthcare System, Boston University School of Medicine, Boston, Massachusetts
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MacDonald SE, Schopflocher DP, Vaudry W. Parental concern about vaccine safety in Canadian children partially immunized at age 2: a multivariable model including system level factors. Hum Vaccin Immunother 2014; 10:2603-11. [PMID: 25483477 PMCID: PMC4977444 DOI: 10.4161/21645515.2014.970075] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Children who begin but do not fully complete the recommended series of childhood vaccines by 2 y of age are a much larger group than those who receive no vaccines. While parents who refuse all vaccines typically express concern about vaccine safety, it is critical to determine what influences parents of ‘partially’ immunized children. This case-control study examined whether parental concern about vaccine safety was responsible for partial immunization, and whether other personal or system-level factors played an important role. A random sample of parents of partially and completely immunized 2 y old children were selected from a Canadian regional immunization registry and completed a postal survey assessing various personal and system-level factors. Unadjusted odds ratios (OR) and adjusted ORs (aOR) were calculated with logistic regression. While vaccine safety concern was associated with partial immunization (OR 7.338, 95% CI 4.138– 13.012), other variables were more strongly associated and reduced the strength of the relationship between concern and partial immunization in multivariable analysis (aOR 2.829, 95% CI 1.151 – 6.957). Other important factors included perceived disease susceptibility and severity (aOR 4.629, 95% CI 2.017 – 10.625), residential mobility (aOR 3.908, 95% CI 2.075 – 7.358), daycare use (aOR 0.310, 95% CI 0.144 - 0.671), number of needles administered at each visit (aOR 7.734, 95% CI 2.598 – 23.025) and access to a regular physician (aOR 0.219, 95% CI 0.057 – 0.846). While concern about vaccine safety may be addressed through educational strategies, this study suggests that additional program and policy-level strategies may positively impact immunization uptake.
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Affiliation(s)
- Shannon E MacDonald
- a Faculty of Nursing ; University of Alberta ; Edmonton Clinic Health Academy ; Edmonton , Alberta , Canada
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Perceptions of personal belief vaccine exemption policy: a survey of Arizona vaccine providers. Vaccine 2014; 32:3630-5. [PMID: 24814551 DOI: 10.1016/j.vaccine.2014.04.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 04/17/2014] [Accepted: 04/23/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND As exemptions to school-entry requirements rise, vaccination rates in Arizona school children are approaching levels that may threaten public health. Understanding the interactions physicians have with vaccine-hesitant parents, as well as the opinions physicians hold regarding vaccination, exemption, and exemption policies, are critical to our understanding of, and ability to affect, vaccination exemption rates among children. METHODS Survey responses were elicited from practitioners listed in The Arizona Partnership for Immunization and the Arizona Medical Association databases using a multi-pronged recruitment approach. Respondents provided data regarding their practice, comfort with parental refusal of individual vaccines, opinions about the beliefs held by parents that seek exemptions, parent education strategies, issues regarding providing care to unvaccinated children, and potential changes to Arizona policy. RESULTS A total of 152 practitioners providing care to a wide geographic and economic population of Arizona responded to the survey. Respondents were generally strong advocates of all immunizations but were more accepting of parents' desires to refuse hepatitis B and rotavirus vaccines. Almost all providers indicated that they see patients whose parents request to refuse or delay from vaccinations at least occasionally (88% and 97%, respectively). Only 37% of respondents indicated that they would be supportive of a policy requiring them to sign off on a parent's decision to refuse vaccination. CONCLUSIONS Vaccination providers in Arizona are generally very supportive of childhood immunizations but have varying comfort with exemption from individual vaccines. Responding providers tended to not support a requirement for a physician's signature for vaccine exemptions due to varying concerns regarding the implementation of such a practice.
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Lasset C, Kalecinski J, Régnier V, Barone G, Leocmach Y, Vanhems P, Chauvin F, Lutringer-Magnin D. Practices and opinions regarding HPV vaccination among French general practitioners: evaluation through two cross-sectional studies in 2007 and 2010. Int J Public Health 2014; 59:519-28. [PMID: 24756880 DOI: 10.1007/s00038-014-0555-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 03/25/2014] [Accepted: 04/03/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To use both quantitative and qualitative methods to investigate the evolution of practices and opinions regarding human papillomavirus (HPV) vaccination among French general practitioners. METHODS A cross-sectional study (self-questionnaires) was performed in 2007 and repeated in 2010 among 271 general practitioners. Semi-structured interviews were conducted on 27 voluntary participants by a sociologist and analyzed according to content analysis. RESULTS Acceptability of HPV vaccination had increased from 2007 to 2010 (79.9 vs. 87.1%, respectively), just as the practice of HPV vaccination among 14-year-old girls (19.0 vs. 49.1%, respectively). Though about 60% reported complications associated with HPV vaccination, irrespective of year, the types of difficulties have varied: difficulties related to "questions asked by patients" had decreased, though concerns about side effects had remained stable. During interviews, difficulties related to "the reason for medical consultation" and "the target age" were often associated with addressing the issue of sexuality, especially when the parents were present. CONCLUSIONS Although the high level of acceptability of HPV vaccination among general practitioners, which increased from 2007 to 2010, there remain difficulties in addressing this practice.
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Affiliation(s)
- Christine Lasset
- Département de santé publique, Centre Léon Bérard, Université Lyon 1, CNRS UMR 5558, 28 rue Laennec, 69373, Lyon cedex 08, France,
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Should a Child be Discharged from a Pediatric Practice if the Parent Refuses Immunizations? MCN Am J Matern Child Nurs 2014; 39:78-9. [DOI: 10.1097/nmc.0000000000000020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Opel DJ, Heritage J, Taylor JA, Mangione-Smith R, Salas HS, Devere V, Zhou C, Robinson JD. The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics 2013; 132:1037-46. [PMID: 24190677 PMCID: PMC3838535 DOI: 10.1542/peds.2013-2037] [Citation(s) in RCA: 312] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2013] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To characterize provider-parent vaccine communication and determine the influence of specific provider communication practices on parent resistance to vaccine recommendations. METHODS We conducted a cross-sectional observational study in which we videotaped provider-parent vaccine discussions during health supervision visits. Parents of children aged 1 to 19 months old were screened by using the Parent Attitudes about Childhood Vaccines survey. We oversampled vaccine-hesitant parents (VHPs), defined as a score ≥50. We developed a coding scheme of 15 communication practices and applied it to all visits. We used multivariate logistic regression to explore the association between provider communication practices and parent resistance to vaccines, controlling for parental hesitancy status and demographic and visit characteristics. RESULTS We analyzed 111 vaccine discussions involving 16 providers from 9 practices; 50% included VHPs. Most providers (74%) initiated vaccine recommendations with presumptive (e.g., "Well, we have to do some shots") rather than participatory (e.g., "What do you want to do about shots?") formats. Among parents who voiced resistance to provider initiation (41%), significantly more were VHPs than non-VHPs. Parents had significantly higher odds of resisting vaccine recommendations if the provider used a participatory rather than a presumptive initiation format (adjusted odds ratio: 17.5; 95% confidence interval: 1.2-253.5). When parents resisted, 50% of providers pursued their original recommendations (e.g., "He really needs these shots"), and 47% of initially resistant parents subsequently accepted recommendations when they did. CONCLUSIONS How providers initiate and pursue vaccine recommendations is associated with parental vaccine acceptance.
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Dubé E, Vivion M, Sauvageau C, Gagneur A, Gagnon R, Guay M. How do Midwives and Physicians Discuss Childhood Vaccination with Parents? J Clin Med 2013; 2:242-59. [PMID: 26237146 PMCID: PMC4470147 DOI: 10.3390/jcm2040242] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 10/10/2013] [Accepted: 10/11/2013] [Indexed: 11/17/2022] Open
Abstract
Even if vaccination is often described as one of the great achievements of public health, results of recent studies have shown that parental acceptance of vaccination is eroding. Health providers' knowledge and attitudes about vaccines are important determinants of their own vaccine uptake, their intention to recommend vaccines to patients and the vaccine uptake of their patients. The purpose of this article is to compare how midwives and physicians address vaccination with parents during pregnancy and in postpartum visits. Thirty semi-structured interviews were conducted with midwives and physicians practicing in the province of Quebec, Canada. Results of our analysis have shown that physicians adopt an "education-information" stance when discussing vaccination with parents in the attempt to "convince" parents to vaccinate. In contrast, midwives adopted a neutral stance and gave information on the pros and cons of vaccination to parents while leaving the final decision up to them. Findings of this study highlight the fact that physicians and midwives have different views regarding their role and responsibilities concerning vaccination. It may be that neither of these approaches is optimal in promoting vaccination uptake.
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Affiliation(s)
- Eve Dubé
- Quebec National Institute of Public Health, Quebec G1E 7G9, Canada.
- Laval University Hospital Research Center, Quebec G1V 4G5, Canada.
| | - Maryline Vivion
- Quebec National Institute of Public Health, Quebec G1E 7G9, Canada.
| | - Chantal Sauvageau
- Quebec National Institute of Public Health, Quebec G1E 7G9, Canada.
- Laval University Hospital Research Center, Quebec G1V 4G5, Canada.
| | - Arnaud Gagneur
- Department of Pediatrics, Étienne Le-Bel Research Center of Sherbrooke University Hospital, Quebec J1H 5N4, Canada.
| | | | - Maryse Guay
- Quebec National Institute of Public Health, Quebec G1E 7G9, Canada.
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Bielicki JA, Achermann R, Berger C. In touch but not up-to-date: Ambulatory visits and vaccination status in a cohort of young Swiss children. Vaccine 2013; 31:5375-80. [DOI: 10.1016/j.vaccine.2013.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/04/2013] [Accepted: 09/13/2013] [Indexed: 11/15/2022]
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Schwartz JL. "Model" patients and the consequences of provider responses to vaccine hesitancy. Hum Vaccin Immunother 2013; 9:2663-5. [PMID: 24018350 DOI: 10.4161/hv.26371] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The manner in which providers respond to parental concerns about the recommended childhood vaccination schedule is an area of increasing interest in pediatrics and medical ethics. Like many aspects of vaccination policy and practice, evaluating the reactions of providers to parental vaccine hesitancy--including the potential dismissal of such families from their practices--requires an appreciation of the twin character of vaccination as both a public health program as well as an individual preventive intervention. Accordingly, the ethics of vaccination combine many aspects of traditional medical ethics, such as respect for patient autonomy, the primacy of informed consent, and concern for the doctor-patient relationship, with the relatively newer discourse of public health ethics, one that directs particular attention to the health of populations and the pursuit of social justice. When parents are hesitant about vaccination for their children, providers may face a significant challenge reconciling their commitment to the health of those children, their respect for the perspectives of parents, and their interest in the health of their other patients and their communities. The tensions and potential conflicts among these considerations help to explain why provider responses to vaccine hesitancy have emerged as a frequent topic of discussion among practitioners, public health advocates, and ethicists alike.
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Affiliation(s)
- Jason L Schwartz
- University Center for Human Values; Princeton University; Princeton, NJ USA
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Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger JA. Vaccine hesitancy: an overview. Hum Vaccin Immunother 2013; 9:1763-73. [PMID: 23584253 PMCID: PMC3906279 DOI: 10.4161/hv.24657] [Citation(s) in RCA: 1130] [Impact Index Per Article: 102.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 04/04/2013] [Accepted: 04/11/2013] [Indexed: 01/27/2023] Open
Abstract
Despite being recognized as one of the most successful public health measures, vaccination is perceived as unsafe and unnecessary by a growing number of individuals. Lack of confidence in vaccines is now considered a threat to the success of vaccination programs. Vaccine hesitancy is believed to be responsible for decreasing vaccine coverage and an increasing risk of vaccine-preventable disease outbreaks and epidemics. This review provides an overview of the phenomenon of vaccine hesitancy. First, we will characterize vaccine hesitancy and suggest the possible causes of the apparent increase in vaccine hesitancy in the developed world. Then we will look at determinants of individual decision-making about vaccination.
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Affiliation(s)
- Eve Dubé
- Centre de recherche du CHU de Québec; Québec, QC Canada
- Institut national de santé publique du Québec (INSPQ); Québec, QC Canada
- Université Laval; Québec City, QC Canada
| | | | - Maryse Guay
- Institut national de santé publique du Québec (INSPQ); Québec, QC Canada
- Université de Sherbrooke; Longueuil, QC Canada
- Centre de recherche du CSSS Champlain—Charles-LeMoyne; Longueuil, QC Canada
- Direction de santé publique de la Montérégie; Québec, QC Canada
| | | | - Réal Roy
- University of Victoria; Saanich, BC Canada
| | - Julie A. Bettinger
- University of British Columbia; Vancouver, BC Canada
- Vaccine Evaluation Center; Women’s Health Research Institute; BC Women’s and Children's Hospital; Vancouver, BC Canada
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Hagood EA, Herlihy SM. Addressing heterogeneous parental concerns about vaccination with a multiple-source model: a parent and educator perspective. Hum Vaccin Immunother 2013; 9:1790-4. [PMID: 23732902 PMCID: PMC3906283 DOI: 10.4161/hv.24888] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 04/22/2013] [Accepted: 05/01/2013] [Indexed: 11/19/2022] Open
Abstract
Previous models of vaccine education have not addressed differences in levels and motives of vaccine concerns in parents. These differences may require changes in education approaches based on type of parental concern. Addressing vaccine concerns will require a multi-modal approach involving more than just a pediatrician or primary health care provider, as well as more than one educational approach.
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Affiliation(s)
- E Allison Hagood
- Department of Psychology; Arapahoe Community College; Littleton, CO USA
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Wheeler M, Buttenheim AM. Parental vaccine concerns, information source, and choice of alternative immunization schedules. Hum Vaccin Immunother 2013; 9:1782-9. [PMID: 23900266 DOI: 10.4161/hv.25959] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Alternative immunization schedules increase the time a child is unvaccinated and require greater resources from providers. Understanding what drives interest in alternative immunization schedules can potentially inform the design of effective, targeted messages that help to reduce time spent counseling and decrease requests for alternative immunization schedules. This study used the Theory of Planned Behavior to explore associations between sources of vaccine information, parental vaccine concerns, peer norms for vaccine behavior and intentions to follow an alternative immunization schedule. We performed logistic regression using medical record data from a private pediatric practice in a large northeastern city. Routine data were recorded in the EMR by the pediatrician during an initial vaccine counseling conversation with the parent(s). Parents who received vaccine information from doctors were less likely to have immunization concerns while parents who got vaccine information from friends and family or from books were more likely to report specific vaccine concerns. Our multivariate analysis shows that number of reported vaccine concerns and concerns about the utility or necessity of vaccines are strongly associated with alternative immunization intentions. We also find a direct relationship between sources of information about vaccines and alternative immunization intentions. Our results suggest that vaccine concerns and non-physician information sources play an important role in alternative immunization intentions while communication from physicians may play an important role in addressing vaccine concerns and promoting adherence to the ACIP immunization schedule.
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Affiliation(s)
- Marissa Wheeler
- University of Pennsylvania School of Nursing; Philadelphia, PA USA
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Buttenheim AM, Cherng ST, Asch DA. Provider dismissal policies and clustering of vaccine-hesitant families: an agent-based modeling approach. Hum Vaccin Immunother 2013; 9:1819-24. [PMID: 23831786 DOI: 10.4161/hv.25635] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Many pediatric practices have adopted vaccine policies that require parents who refuse to vaccinate according to the ACIP schedule to find another health care provider. Such policies may inadvertently cluster unvaccinated patients into practices that tolerate non vaccination or alternative schedules, turning them into risky pockets of low herd immunity. The objective of this study was to assess the effect of provider zero-tolerance vaccination policies on the clustering of intentionally unvaccinated children. We developed an agent-based model of parental vaccine hesitancy, provider non-vaccination tolerance, and selection of patients into pediatric practices. We ran 84 experiments across a range of parental hesitancy and provider tolerance scenarios. When the model is initialized, all providers accommodate refusals and intentionally unvaccinated children are evenly distributed across providers. As provider tolerance decreases, hesitant children become more clustered in a smaller number of practices and eventually are not able to find a practice that will accept them. Each of these effects becomes more pronounced as the level of hesitancy in the population rises. Heterogeneity in practice tolerance to vaccine-hesitant parents has the unintended result of concentrating susceptible individuals within a small number of tolerant practices, while providing little if any compensatory protection to adherent individuals. These externalities suggest an agenda for stricter policy regulation of individual practice decisions.
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Affiliation(s)
- Alison M Buttenheim
- Department of Family and Community Health; University of Pennsylvania School of Nursing; Philadelphia, PA USA; The Leonard Davis Institute of Health Economics; University of Pennsylvania; Philadelphia, PA USA
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Schulz PJ, Nakamoto K. Health literacy and patient empowerment in health communication: the importance of separating conjoined twins. PATIENT EDUCATION AND COUNSELING 2013; 90:4-11. [PMID: 23063359 DOI: 10.1016/j.pec.2012.09.006] [Citation(s) in RCA: 208] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 08/06/2012] [Accepted: 09/20/2012] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Patient empowerment and health literacy have both been studied empirically, but they have hardly ever been explicitly linked. METHODS Pertinent literature from the development of both concepts was studied, drawing not only on health care literature, but also on management research. RESULTS This article argues that it is important to recognize that the concepts are distinct, both conceptually and empirically. At the same time, the impacts of health literacy and patient empowerment are deeply intertwined. High literacy does not necessarily entail empowerment and vice versa, and mismatches of the two can have deleterious consequences. High levels of health literacy without a corresponding high degree of patient empowerment creates an unnecessary dependence of patients on health professionals, while a high degree of empowerment without a corresponding degree of health literacy poses the risk of dangerous health choices. CONCLUSION We discuss the importance of carefully conceptualizing both approaches, the implications for their measurement and the design of health interventions. PRACTICE IMPLICATIONS Communication programs must include the empowerment that motivates consumers to engage and the literacy that enables them to make informed and reasoned choices.
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Affiliation(s)
- Peter J Schulz
- Institute of Communication and Health, Università della Svizzera italiana, Lugano, Switzerland.
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Ołpiński M. Anti-Vaccination Movement and Parental Refusals of Immunization of Children in USA. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.pepo.2012.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Affiliation(s)
- Stan L Block
- University of Louisville, and University of Kentucky, Lexington, KY, USA.
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