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Lorini C, Del Riccio M, Zanobini P, Biasio RL, Bonanni P, Giorgetti D, Ferro VA, Guazzini A, Maghrebi O, Lastrucci V, Rigon L, Okan O, Sørensen K, Bonaccorsi G. Vaccination as a social practice: towards a definition of personal, community, population, and organizational vaccine literacy. BMC Public Health 2023; 23:1501. [PMID: 37553624 PMCID: PMC10408168 DOI: 10.1186/s12889-023-16437-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/02/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND A comprehensive and agreed-upon definition of vaccine literacy (VL) could support the understanding of vaccination and help policy-makers and individuals make informed decisions about vaccines. METHODS To shed some light on this debate and provide clarity, a scoping review was conducted to collect, summarize, and analyse available definitions of VL. Based on the findings of the scoping review, a new and comprehensive definition was proposed by a panel of experts. RESULTS Fifty-three articles were included, and two of them appeared to be the milestones around which the other definitions were grouped. The new definition proposed by the panel of experts included not only the personal perspective, but also the community, population, and organizational perspectives. Moreover, due to the increasing complexity of the social context with respect to the ability to navigate, understand, and use information and services, the definition of organizational vaccine literacy and the attributes of a vaccine literate healthcare organization have been proposed. CONCLUSION The new definition can contribute to the overall paradigm of health literacy and its distinct component of vaccine literacy, possibly improving the implementation of public health strategies to allow vaccination to be understood as a social practice by the entire community. This study describes the conceptual foundations, the competencies, and the civic orientation to be considered when developing measurement tools devoted to assessing VL at the different levels and in different contexts.
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Affiliation(s)
- Chiara Lorini
- Department of Health Sciences, University of Florence, Viale Giovanni Battista Morgagni 48, 50134, Florence, Italy.
- Health Literacy Laboratory (HeLiLab), University of Florence, Viale Giovanni Battista Morgagni 48, 50134, Florence, Italy.
| | - Marco Del Riccio
- Department of Health Sciences, University of Florence, Viale Giovanni Battista Morgagni 48, 50134, Florence, Italy
| | - Patrizio Zanobini
- Department of Health Sciences, University of Florence, Viale Giovanni Battista Morgagni 48, 50134, Florence, Italy
- Health Literacy Laboratory (HeLiLab), University of Florence, Viale Giovanni Battista Morgagni 48, 50134, Florence, Italy
| | | | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Viale Giovanni Battista Morgagni 48, 50134, Florence, Italy
| | - Duccio Giorgetti
- Medical School of Specialization in Hygiene and Preventive Medicine, University of Florence, Largo Giovanni Alessandro Brambilla 3, 50134, Florence, Italy
| | - Valerio Allodola Ferro
- Department of Law, Economics and Human Sciences, Mediterranea University of Reggio Calabria, Via Dell'Università 25, 89124, Reggio Calabria, Italy
| | - Andrea Guazzini
- Department of Education, Literatures, Intercultural Studies, Languages and Psychology, University of Florence, Via Di San Salvi 12, 50135, Florence, Italy
| | - Olfa Maghrebi
- Department of Education, Literatures, Intercultural Studies, Languages and Psychology, University of Florence, Via Di San Salvi 12, 50135, Florence, Italy
| | - Vieri Lastrucci
- Epidemiology Unit, Meyer's Children University Hospital, Viale Gaetano Pieraccini, 24, 50139, Florence, Italy
| | - Lisa Rigon
- Medical School of Specialization in Hygiene and Preventive Medicine, University of Florence, Largo Giovanni Alessandro Brambilla 3, 50134, Florence, Italy
| | - Orkan Okan
- Department of Sport and Health Sciences, Technical University of Munich, 80992, Munich, Germany
| | - Kristine Sørensen
- Global Health Literacy Academy, Viengevej 100, 8240, Risskov, Denmark
| | - Guglielmo Bonaccorsi
- Department of Health Sciences, University of Florence, Viale Giovanni Battista Morgagni 48, 50134, Florence, Italy
- Health Literacy Laboratory (HeLiLab), University of Florence, Viale Giovanni Battista Morgagni 48, 50134, Florence, Italy
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Liu TL, Hsiao RC, Chen YM, Lin PC, Yen CF. Sources of Information about COVID-19 Vaccines for Children and Its Associations with Parental Motivation to Have Their Children Vaccinated in Taiwan. Vaccines (Basel) 2023; 11:1337. [PMID: 37631905 PMCID: PMC10459469 DOI: 10.3390/vaccines11081337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/29/2023] Open
Abstract
Pediatric COVID-19 vaccines have been developed to reduce the risk of contracting COVID-19 and subsequent hospitalization in children. Few studies have examined whether different sources of information regarding pediatric COVID-19 vaccines and parents' trust in the information have different effects on parental motivation to have their child vaccinated. No study has examined parental demographic factors related to the sources of information and the trust of parents in these sources. Understanding the sources of information on pediatric COVID-19 vaccines, parents' trust in the information, and related factors can contribute to the development of strategies for promoting the knowledge and acceptance of pediatric vaccination among parents. This study examined the sources of information regarding pediatric COVID-19 vaccines used by parents, their level of trust in these information sources, the demographic factors that influence this trust, and the associations of such information sources with parental motivation to get their child vaccinated against COVID-19. In total, 550 parents (123 men and 427 women) completed a questionnaire that was used to collect information regarding the information sources and to measure the parents' trust in these information sources. Parental motivation to get their child vaccinated was measured using the Motors of COVID-19 Vaccination Acceptance Scale for Parents. Multivariate linear regression analysis was performed to examine two associations, namely the associations of the parents' sources of information and their trust in these sources with their motivation to have their child vaccinated and the associations of the parents' demographic factors with their sources of information and their trust in these sources. For the parents, traditional mass media and medical staff in healthcare settings were the most common sources of information regarding pediatric COVID-19 vaccines. The parents rated medical staff in healthcare settings as the most trustworthy source of information. Obtaining information from acquaintances through social media and obtaining information from medical staff in healthcare settings were significantly associated with parental motivation to get their child vaccinated against COVID-19. Trust in the information provided by medical staff in healthcare settings and coworkers was significantly associated with the motivation of parents to vaccinate their children against COVID-19. Compared with fathers, mothers were more likely to obtain information from medical staff in healthcare settings and from acquaintances through social media. Parents with a higher education level were more likely to obtain information from medical staff in healthcare settings. Compared with the fathers, the mothers were more trusting of information obtained from coworkers. Health professionals should consider the sources of information used by parents and related factors when establishing strategies to increase parental motivation to get their children vaccinated against COVID-19.
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Affiliation(s)
- Tai-Ling Liu
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Psychiatry, School of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Ray C. Hsiao
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
- Department of Psychiatry, Seattle Children’s, Seattle, WA 98105, USA
| | - Yu-Min Chen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
| | - Po-Chun Lin
- Department of Psychiatry, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan
- Department of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Psychiatry, School of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- College of Professional Studies, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
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Dasch S, Wachinger J, Bärnighausen T, Chen S, McMahon SA. Deliberation, context, emotion and trust - understanding the dynamics of adults' COVID-19 vaccination decisions in Germany. BMC Public Health 2023; 23:136. [PMID: 36658504 PMCID: PMC9850339 DOI: 10.1186/s12889-022-14587-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 11/10/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Willingness to vaccinate against coronavirus disease 2019 (COVID-19), which is vital to successful vaccination campaigns, is wavering and suboptimal. In Germany, quantitative research highlighted concerns regarding the safety and efficacy of COVID-19 vaccines as barriers to uptake, but qualitative insights regarding individuals' decisions about COVID-19 vaccines and how personal perceptions reflect or refute existing behavioral theories are lacking. METHODS To identify how individuals make COVID-19 vaccination decisions within real-life contexts, we conducted 33 semi-structured, in-depth qualitative interviews with individuals in Germany between March and April 2021 using maximum variation sampling, focusing on perceptions of COVID-19 vaccines. Analysis, informed by a framework approach, began in the field via debriefings and was amplified upon the conclusion of data collection. RESULTS Four interconnected themes (deliberation, context, emotion, trust) shaped respondents' decisions about vaccination. Personal deliberation regarding benefits and risks of vaccines and perceptions of the broader social and political context sparked a spectrum of emotions that underpinned vaccination decisions. Trust in science and researchers emerged as a powerful protective factor facilitating the decision to get vaccinated even amidst a rapidly changing context and disconcerting information. CONCLUSIONS Our findings add to ongoing debates about the breadth of vaccination decisions by highlighting how respondents are influenced by their perceptions of the political context and the emotional heft of their decisions. The role of cognitive evaluation, context, and emotions mirrors other decision-making frameworks, particularly the Risk as Feelings Theory. We extend on the elements of this theory by highlighting trust as a protective factor when making decisions particularly in highly uncertain contexts. Success of vaccination campaigns, more important than ever as new variants of COVID-19 emerge, is interwoven with an ability to bolster trust in science. Communicating public-health decisions and information about vaccines transparently without instilling fear offers promising chances to strengthen public trust in COVID-19 vaccines. TRIAL REGISTRATION German Clinical Trials Register ( DRKS00024505 ).
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Affiliation(s)
- Selina Dasch
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany.
| | - Jonas Wachinger
- grid.5253.10000 0001 0328 4908Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Till Bärnighausen
- grid.5253.10000 0001 0328 4908Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany ,grid.38142.3c000000041936754XDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA ,grid.506261.60000 0001 0706 7839Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Simiao Chen
- grid.5253.10000 0001 0328 4908Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany ,grid.506261.60000 0001 0706 7839Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shannon A. McMahon
- grid.5253.10000 0001 0328 4908Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany ,grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Fadda M, Bezani K, Amati R, Fiordelli M, Crivelli L, Albanese E, Suggs LS, Caiata-Zufferey M. Decision-making on COVID-19 vaccination: A qualitative study among health care and social workers caring for vulnerable individuals. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100181. [PMID: 36267682 PMCID: PMC9561372 DOI: 10.1016/j.ssmqr.2022.100181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 01/12/2023]
Abstract
In January 2021, the Swiss government introduced the first COVID-19 vaccines and prioritized allocation to at-risk individuals and professionals working with them. Despite this opportunity, vaccine uptake among staff employed in retirement homes and institutes for people with disabilities was suboptimal. This study aimed to capture real-time decision-making about COVID-19 vaccine among staff employed in nursing homes and institutes for people with disabilities in Southern Switzerland. We conducted semi-structured phone-interviews with 25 staff employed in retirement homes and institutes for people with disabilities between February and May 2021, i.e., when participants had to decide whether they wanted to adhere to the priority vaccination programme. Among participants, 21 either signed up for the COVID-19 vaccination or were fully or partly vaccinated at the time of the interview. For most participants, the vaccination choice was a challenging process: information appeared to be lacking and conflicting; numerous moral principles were at stake and contradictory; the way vaccination was organized clashed with the health values to which respondents had been previously exposed; finally, the fear of discrimination for those who decided not to get vaccinated loomed over the vaccination choice. Participants decided for or against vaccination based on principles, traditions, emotions, and a reflexive assessment of the personal vs. collective benefit of the vaccination, the latter being the most common within the investigated sample. This study shows that deciding to get vaccinated against COVID-19 is a nuanced process and that individuals cannot simply be categorized as "novax" or "provax" based on their vaccination decision.
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Affiliation(s)
- Marta Fadda
- Institute of Public Health, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland,Corresponding author
| | - Kleona Bezani
- Institute of Public Health, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland
| | - Rebecca Amati
- Institute of Public Health, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland
| | - Maddalena Fiordelli
- Institute of Public Health, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland
| | - Luca Crivelli
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Via Violino 11, 6928, Manno, Switzerland
| | - Emiliano Albanese
- Institute of Public Health, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland
| | - L. Suzanne Suggs
- Institute of Public Health, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland
| | - Maria Caiata-Zufferey
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Via Violino 11, 6928, Manno, Switzerland
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Valdecantos RL, Palladino R, Lo Vecchio A, Montella E, Triassi M, Nardone A. Organisational and Structural Drivers of Childhood Immunisation in the European Region: A Systematic Review. Vaccines (Basel) 2022; 10:1390. [PMID: 36146467 PMCID: PMC9505321 DOI: 10.3390/vaccines10091390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022] Open
Abstract
Despite the implementation of widespread vaccination programs, the European Health Systems continue to experience care challenges attributable to organizational and structural issues. This study aimed to review the available data on aspects within the organizational and structural domains that might impact vaccination coverage. We searched a comprehensive range of databases from 1 January 2007 to 6 July 2021 for studies that reported quantitative or qualitative research on interventions to raise childhood vaccine coverage. Outcome assessments comprised organizational and structural factors that contribute to vaccine concern among pediatric parents, as well as data reported influencing the willingness to vaccinate. To analyze the risk of bias, the Ottawa, JBI's (Joanna Briggs Institute) critical appraisal tool, and Amstar quality assessment were used accordingly. The inclusion criteria were met by 205 studies across 21 articles. The majority of the studies were conducted in the United Kingdom (6), the European Union (3), and Italy (3). A range of interventions studied in primary healthcare settings has been revealed to improve vaccination coverage rates including parental engagement and personalization, mandatory vaccination policies, program redesign, supply chain design, administering multiple/combination vaccines, improved vaccination timing and intervals, parental education and reminders, surveillance tools and Supplemental Immunisation Activity (SIA), and information model.
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Affiliation(s)
- Ronan Lemwel Valdecantos
- Department of Public Health, University “Federico II” of Naples, 80138 Napoli, Italy
- Global Health Workforce Network (GHWN) Youth Hub, World Health Organization, 1211 Geneva, Switzerland
| | - Raffaele Palladino
- Department of Public Health, University “Federico II” of Naples, 80138 Napoli, Italy
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University “Federico II” of Naples, 80138 Napoli, Italy
- Department of Primary Care and Public Health, Imperial College, London SW7 2BX, UK
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Section of Pediatrics, University “Federico II” of Naples, 80138 Napoli, Italy
| | - Emma Montella
- Department of Public Health, University “Federico II” of Naples, 80138 Napoli, Italy
| | - Maria Triassi
- Department of Public Health, University “Federico II” of Naples, 80138 Napoli, Italy
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University “Federico II” of Naples, 80138 Napoli, Italy
| | - Antonio Nardone
- Department of Public Health, University “Federico II” of Naples, 80138 Napoli, Italy
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Fields EJ, Hopfer S, Warren JR, BeLue R, Lebed J, Hecht ML. Motivators and Barriers to HPV Vaccination: A Qualitative Study of Underserved Women Attending Planned Parenthood. Vaccines (Basel) 2022; 10:vaccines10071126. [PMID: 35891290 PMCID: PMC9317585 DOI: 10.3390/vaccines10071126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 12/10/2022] Open
Abstract
Human papilloma virus (HPV) is the most common sexually transmitted infection in the United States. Disease-associated strains of HPV can cause genital warts and six cancer types. HPV-associated cervical cancer disproportionately impacts medically underserved women including Black and Latina women with respect to incidence, prevalence, and mortality rates. Although safe and effective vaccines are available, HPV vaccination rates remain low among low-income individuals and women of color. The current study examined individual and structural motivators and barriers to HPV vaccination among medically underserved women utilizing a Planned Parenthood health center in Southeast Pennsylvania. Guided by narrative engagement theory (NET), qualitative interviews (N = 24) were used to elicit HPV vaccine decision stories from both vaccinated and unvaccinated women. Using a phronetic iterative data analysis approach, we identified three motivators to vaccinate against HPV: (1) receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) feeling empowered to take control of one’s health (an individual determinant), and (3) knowing someone infected with HPV (an individual determinant). Among unvaccinated participants, barriers to HPV vaccination included: (1) not receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) low perceived risk for acquiring HPV or that HPV is not severe (an individual determinant), and (3) lack of maternal support to vaccinate (a structural determinant). Healthcare providers are optimally positioned to fill the gap in prior missed vaccine opportunities and empower women by recommending HPV vaccination.
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Affiliation(s)
- Emilia J. Fields
- Department of Health, Society, and Behavior, Program in Public Health, University of California-Irvine, Irvine, CA 92697, USA;
| | - Suellen Hopfer
- Department of Health, Society, and Behavior, Program in Public Health, University of California-Irvine, Irvine, CA 92697, USA;
- Correspondence: ; Tel.: +1-(949)-824-6996
| | - Jennifer R. Warren
- Department of Communication, Women and Gender Studies, African and African American Studies, George Mason University, Fairfax, VA 22030, USA;
| | - Rhonda BeLue
- Department of Public Health, University of Texas San Antonio, San Antonio, TX 78249, USA;
| | - Joel Lebed
- Planned Parenthood Southeastern Pennsylvania, Philadelphia, PA 19107, USA;
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Motivation for Vaccination against COVID-19 in Persons Aged between 18 and 60 Years at a Population-Based Vaccination Site in Manresa (Spain). Vaccines (Basel) 2022; 10:vaccines10040597. [PMID: 35455345 PMCID: PMC9027286 DOI: 10.3390/vaccines10040597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 02/04/2023] Open
Abstract
Our purpose was to identify the reasons why members of the population, aged 18–60 years, are vaccinated against COVID-19 at the mass vaccination point in Bages, Spain. This is 1 of 42 provisional spaces outside of health centres which have been set up in Catalonia in the context of the COVID-19 pandemic, and where people from all over Catalonia could go to be vaccinated by appointment. Methodology: We performed a cross-sectional study of users attending mass vaccination points in Bages during the months of July, August, and September 2021. Results: A total of 1361 questionnaires were statistically analysed. The most common reasons for vaccination were fear of infecting family (49.52%) and fear of self-infection (39.45%), followed by socialising (31.00%) and travel (30.56%). However, by applying a logistic regression model to each reason for vaccination, it was possible to estimate the associations regarding age, sex, marital status, educational level, production sector, mass vaccination point, previous COVID-19 infection, and COVID-19 infection of a family member. Relevance: The data generated will inform decisions and formulations of appropriate campaigns that will promote vaccination in specific population groups.
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Cooper S, Schmidt BM, Sambala EZ, Swartz A, Colvin CJ, Leon N, Wiysonge CS. Factors that influence parents' and informal caregivers' views and practices regarding routine childhood vaccination: a qualitative evidence synthesis. Cochrane Database Syst Rev 2021; 10:CD013265. [PMID: 34706066 PMCID: PMC8550333 DOI: 10.1002/14651858.cd013265.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Childhood vaccination is one of the most effective ways to prevent serious illnesses and deaths in children. However, worldwide, many children do not receive all recommended vaccinations, for several potential reasons. Vaccines might be unavailable, or parents may experience difficulties in accessing vaccination services; for instance, because of poor quality health services, distance from a health facility, or lack of money. Some parents may not accept available vaccines and vaccination services. Our understanding of what influences parents' views and practices around childhood vaccination, and why some parents may not accept vaccines for their children, is still limited. This synthesis links to Cochrane Reviews of the effectiveness of interventions to improve coverage or uptake of childhood vaccination. OBJECTIVES - Explore parents' and informal caregivers' views and practices regarding routine childhood vaccination, and the factors influencing acceptance, hesitancy, or nonacceptance of routine childhood vaccination. - Develop a conceptual understanding of what and how different factors reduce parental acceptance of routine childhood vaccination. - Explore how the findings of this review can enhance our understanding of the related Cochrane Reviews of intervention effectiveness. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, and three other databases for eligible studies from 1974 to June 2020. SELECTION CRITERIA We included studies that: utilised qualitative methods for data collection and analysis; focused on parents' or caregivers' views, practices, acceptance, hesitancy, or refusal of routine vaccination for children aged up to six years; and were from any setting globally where childhood vaccination is provided. DATA COLLECTION AND ANALYSIS We used a pre-specified sampling frame to sample from eligible studies, aiming to capture studies that were conceptually rich, relevant to the review's phenomenon of interest, from diverse geographical settings, and from a range of income-level settings. We extracted contextual and methodological data from each sampled study. We used a meta-ethnographic approach to analyse and synthesise the evidence. We assessed methodological limitations using a list of criteria used in previous Cochrane Reviews and originally based on the Critical Appraisal Skills Programme quality assessment tool for qualitative studies. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We integrated the findings of this review with those from relevant Cochrane Reviews of intervention effectiveness. We did this by mapping whether the underlying theories or components of trial interventions included in those reviews related to or targeted the overarching factors influencing parental views and practices regarding routine childhood vaccination identified by this review. MAIN RESULTS We included 145 studies in the review and sampled 27 of these for our analysis. Six studies were conducted in Africa, seven in the Americas, four in South-East Asia, nine in Europe, and one in the Western Pacific. Studies included urban and rural settings, and high-, middle-, and low-income settings. Many complex factors were found to influence parents' vaccination views and practices, which we divided into four themes. Firstly, parents' vaccination ideas and practices may be influenced by their broader ideas and practices surrounding health and illness generally, and specifically with regards to their children, and their perceptions of the role of vaccination within this context. Secondly, many parents' vaccination ideas and practices were influenced by the vaccination ideas and practices of the people they mix with socially. At the same time, shared vaccination ideas and practices helped some parents establish social relationships, which in turn strengthened their views and practices around vaccination. Thirdly, parents' vaccination ideas and practices may be influenced by wider political issues and concerns, and particularly their trust (or distrust) in those associated with vaccination programmes. Finally, parents' vaccination ideas and practices may be influenced by their access to and experiences of vaccination services and their frontline healthcare workers. We developed two concepts for understanding possible pathways to reduced acceptance of childhood vaccination. The first concept, 'neoliberal logic', suggests that many parents, particularly from high-income countries, understood health and healthcare decisions as matters of individual risk, choice, and responsibility. Some parents experienced this understanding as in conflict with vaccination programmes, which emphasise generalised risk and population health. This perceived conflict led some parents to be less accepting of vaccination for their children. The second concept, 'social exclusion', suggests that some parents, particularly from low- and middle-income countries, were less accepting of childhood vaccination due to their experiences of social exclusion. Social exclusion may damage trustful relationships between government and the public, generate feelings of isolation and resentment, and give rise to demotivation in the face of public services that are poor quality and difficult to access. These factors in turn led some parents who were socially excluded to distrust vaccination, to refuse vaccination as a form of resistance or a way to bring about change, or to avoid vaccination due to the time, costs, and distress it creates. Many of the overarching factors our review identified as influencing parents' vaccination views and practices were underrepresented in the interventions tested in the four related Cochrane Reviews of intervention effectiveness. AUTHORS' CONCLUSIONS Our review has revealed that parents' views and practices regarding childhood vaccination are complex and dynamic social processes that reflect multiple webs of influence, meaning, and logic. We have provided a theorised understanding of the social processes contributing to vaccination acceptance (or not), thereby complementing but also extending more individualistic models of vaccination acceptance. Successful development of interventions to promote acceptance and uptake of childhood vaccination will require an understanding of, and then tailoring to, the specific factors influencing vaccination views and practices of the group(s) in the target setting. The themes and concepts developed through our review could serve as a basis for gaining this understanding, and subsequent development of interventions that are potentially more aligned with the norms, expectations, and concerns of target users.
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Affiliation(s)
- Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Bey-Marrié Schmidt
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Evanson Z Sambala
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Alison Swartz
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christopher J Colvin
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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9
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Chen YL, Lin YJ, Chang YP, Chou WJ, Yen CF. Differences in Sources of Information, Risk Perception, and Cognitive Appraisals between People with Various Latent Classes of Motivation to Get Vaccinated against COVID-19 and Previous Seasonal Influenza Vaccination: Facebook Survey Study with Latent Profile Analysis in Taiwan. Vaccines (Basel) 2021; 9:1203. [PMID: 34696311 PMCID: PMC8538554 DOI: 10.3390/vaccines9101203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 12/23/2022] Open
Abstract
The present study aimed (1) to identify distinct latent classes of motivation to get vaccinated against coronavirus disease 2019 (COVID-19) and previous seasonal influenza vaccination among people in Taiwan and (2) to examine the roles of sources of information, risk perception, and cognitive appraisals of vaccination against COVID-19 in these classes. We recruited 1047 participants through a Facebook advertisement. The participants' motivation to get vaccinated against COVID-19, previous seasonal influenza vaccination, sources of information about COVID-19 vaccination, risk perception of COVID-19, and cognitive appraisals of vaccination against COVID-19 were determined. We examined the participants' motivation for COVID-19 vaccination and previous seasonal influenza vaccination through latent profile analysis. Four latent classes of motivation were identified: participants with high motivation for COVID-19 vaccination and high seasonal influenza vaccination, those with high motivation for COVID-19 vaccination but low seasonal influenza vaccination, those with low motivation for COVID-19 vaccination but high seasonal influenza vaccination, and those with low motivation for COVID-19 vaccination and low seasonal influenza vaccination. Compared with participants in the latent class of high motivation for COVID-19 vaccination and high seasonal influenza vaccination, those in the other three latent classes had lower levels of positive appraisals of COVID-19 vaccination; participants in the latent class of low motivation for COVID-19 vaccination and low seasonal influenza vaccination had lower risk perception of COVID-19 and were also less likely to obtain information about COVID-19 vaccination from the internet, friends, and family members. The various motivations and behaviors for vaccination, sources of information, risk perception, and cognitive appraisals of vaccination against COVID-19 should be considered in intervention programs aiming to increase people's motivation to get vaccinated against COVID-19.
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Affiliation(s)
- Yi-Lung Chen
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan;
- Department of Psychology, Asia University, Taichung 41354, Taiwan
| | - Yen-Ju Lin
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
| | - Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, New York, NY 14214-8013, USA;
| | - Wen-Jiun Chou
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung 83301, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- College of Professional Studies, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
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10
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Fadda M, Suggs LS, Albanese E. Willingness to vaccinate against Covid-19: A qualitative study involving older adults from Southern Switzerland. Vaccine X 2021; 8:100108. [PMID: 34308329 PMCID: PMC8279929 DOI: 10.1016/j.jvacx.2021.100108] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 06/23/2021] [Accepted: 07/09/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The Covid-19 pandemic is causing unprecedented disruption and suffering to people across the globe, with a disproportionate toll on the elderly. The development and equitable distribution of a vaccine seems to be the most promising and sustainable route ahead. The goal of this study was to explore older adults' attitudes towards and beliefs regarding the Covid-19 vaccination in Southern Switzerland. METHODS We conducted a qualitative study employing telephone interviews to understand older adults' attitudes towards and beliefs about the Covid-19 vaccine. No Covid-19 vaccine had yet been approved at the moment of data collection. A convenience and snowball sample of 19 participants was recruited. Participants had to be at least 65 years old, without any hearing impairments, and be resident in the Canton of Ticino. RESULTS Most participants were women (n = 12), Swiss nationals (n = 14), retired (n = 18), resident in urban areas (n = 14), and had obtained a secondary school degree (n = 14). The average age was 75 (SD = 6.04; range = 64-85). We found that the majority of participants were in favor of the vaccination and highlighted its positive consequences, such as the abandonment of current freedom-limiting protective measures. Those participants who were against or unsure about the vaccination had concerns regarding the novelty of the vaccine and its impact on its safety and efficacy, stated they would prefer other protective measures rather than the vaccination, and identified contextual and individual drivers of their concerns. CONCLUSIONS Independently from the outbreak's trajectory, efforts to foster vaccination acceptance should focus on the benefit of relapsing freedom-limiting protective measures. Vaccination strategies should be grounded in an evidence-based, participatory approach, ongoing community engagement, trust-building activities, and communication about vaccine developments and how the vaccine will be combined with other outbreak response measures.
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Affiliation(s)
- Marta Fadda
- Institute of Public Health, Università della Svizzera italiana, Switzerland
| | - L. Suzanne Suggs
- Institute of Public Health, Università della Svizzera italiana, Switzerland
| | - Emiliano Albanese
- Institute of Public Health, Università della Svizzera italiana, Switzerland
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11
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Fernández-Basanta S, Lagoa-Millarengo M, Movilla-Fernández MJ. Encountering Parents Who Are Hesitant or Reluctant to Vaccinate Their Children: A Meta-Ethnography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147584. [PMID: 34300041 PMCID: PMC8306550 DOI: 10.3390/ijerph18147584] [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: 06/10/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022]
Abstract
(1) Background: Health professionals play an important role in addressing parents who are hesitant or reluctant to immunise their children. Despite the importance of this topic, gaps remain in the literature about these experiences. This meta-ethnography aimed to synthesise the available body of qualitative work about the care experiences of community and hospital health professionals in encounters with parents hesitant or reluctant to vaccinate their children. The aim is to provide key information for the creation of strategies that address vaccine hesitancy or refusal and ensure public trust in vaccination programs, which are required in a pandemic context such as the current one. (2) Methods: Noblit and Hare’s interpretive meta-ethnography of 12 studies was followed. A line of argument synthesis based on a metaphor was developed. (3) Results: The metaphor “The stone that refuses to be sculpted”, accompanied by three themes, symbolises the care experiences of health professionals in their encounters with parents that hesitate or refuse to vaccinate their children. (4) Conclusions: The creation of clearer communication strategies, the establishment of a therapeutic alliance, health literacy and the empowerment of parents are recommended. The incorporation of health professionals in decision making and the strengthening of multidisciplinary teams interacting with such parents are also included.
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Affiliation(s)
- Sara Fernández-Basanta
- Research Group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, University of A Coruña, Naturalista López Seoane s/n, 15471 Ferrol, Spain;
- Correspondence: ; Tel.: +34-981-337400-3544
| | - Manuel Lagoa-Millarengo
- Galician Health Service (SERGAS), University Hospital Complex of Ferrol, Av. da Residencia, S/N, 15405 Ferrol, Spain;
| | - María-Jesús Movilla-Fernández
- Research Group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, University of A Coruña, Naturalista López Seoane s/n, 15471 Ferrol, Spain;
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12
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Wang PW, Ahorsu DK, Lin CY, Chen IH, Yen CF, Kuo YJ, Griffiths MD, Pakpour AH. Motivation to Have COVID-19 Vaccination Explained Using an Extended Protection Motivation Theory among University Students in China: The Role of Information Sources. Vaccines (Basel) 2021; 9:380. [PMID: 33924604 PMCID: PMC8070343 DOI: 10.3390/vaccines9040380] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The aims of the present study were to examine the prediction of the threat and coping appraisal utilizing an extended protection motivation theory (PMT) for the motivation to have COVID-19 vaccination and the influence of various information sources on coping appraisal among university students in China. METHODS The sample comprised 3145 students from 43 universities in China who completed an online survey including PMT constructs as well as constructs added to PMT. The PMT constructs comprised motivation to have COVID-19 vaccination, threat appraisal, and coping appraisal. The extended PMT constructs comprised knowledge about mechanisms and information sources of COVID-19 vaccination. RESULTS Perceived severity of COVID-19 was positively associated with motivation to have COVID-19 vaccination. Receiving information concerning COVID-19 vaccination from medical personnel was associated with greater self-efficacy, response efficacy, and knowledge, whereas receiving information concerning COVID-19 vaccination from coworkers/colleagues was associated with less response efficacy and knowledge. Receiving online information concerning COVID-19 vaccination was associated with greater response cost of vaccination efficacy and less knowledge. CONCLUSIONS This study supported the prediction of perceived severity in the PMT for motivation to have COVID-19 vaccination among university students in China. Vaccination information sources have different effects on students' coping appraisal of COVID-19 vaccination.
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Affiliation(s)
- Peng-Wei Wang
- Department of Psychiatry, School of Medicine College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Daniel Kwasi Ahorsu
- Department of Rehabilitation Sciences, Faculty of Health & Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China;
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan;
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - I-Hua Chen
- School of Education Science, Minnan Normal University, Zhangzhou 363000, China
- Key Laboratory of Applied Cognition & Personality, Fujian Province University, Zhangzhou 363000, China
- International College, Krirk University, Bangkok 10220, Thailand
| | - Cheng-Fang Yen
- Department of Psychiatry, School of Medicine College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan;
- Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Mark D. Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham NG1 4FQ, UK;
| | - Amir H. Pakpour
- Department of Nursing, School of Health and Welfare, Jönköping University, 55318 Jönköping, Sweden;
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13
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What Affects Maternal Response to Measles Vaccinations? Examining the Health Beliefs Model (HBM). SCI 2021. [DOI: 10.3390/sci3020020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Renewed measles outbreaks in recent years indicate that despite the routine availability of vaccines for a disease that is considered contagious, dangerous and deadly, many anti-vaccinationists do not vaccinate their children, which consequently endangers public health. This study aimed to investigate the factors that influence mothers to vaccinate their children, and whether the Health Belief Model (HBM) could predict compliance or non-compliance. Methods: This was a quantitative correlational research, using a 40-item questionnaire administered to 181 mothers in Israel. Results: The findings indicated two main factors that affected mothers’ intention to vaccinate their children against measles: first, their perception of the vaccine’s advantages, and second, their perception of the severity of the disease. It was also found that the HBM variables significantly affected the intention to administer vaccines. Conclusion: Consequently, raising public awareness of the vaccine’s advantages and importance to preventing mass infection, as well as attempts by the health system and practitioners to understand the motivations of anti-vaccinationists (including health beliefs and cultural sensitivities) could significantly increase the percentage of vaccinated children, and eradicate the measles epidemic.
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14
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Wilder-Smith AB, Qureshi K. Resurgence of Measles in Europe: A Systematic Review on Parental Attitudes and Beliefs of Measles Vaccine. J Epidemiol Glob Health 2021; 10:46-58. [PMID: 32175710 PMCID: PMC7310814 DOI: 10.2991/jegh.k.191117.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/11/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Europe has experienced a major resurgence of measles in recent years, despite the availability and free access to a safe, effective, and affordable vaccination measles, mumps and rubella vaccine (MMR). The main driver for this is suboptimal vaccine coverage. The three objectives of this study are to synthesize and critically assess parental attitudes and beliefs toward MMR uptake, to develop strategies and policy recommendations to effectively improve MMR vaccine uptake accordingly, and ultimately to identify areas for further research. METHODS A systematic review was conducted using primary studies from PubMed, Medline, Embase, and Scopus published between 2011 and April 2019. Inclusion criteria comprised primary studies in English conducted in Europe and studying parental attitudes and behavior regarding MMR uptake. Data were extracted using an inductive grounded theory approach. RESULTS In all, 20 high-quality studies were identified. Vaccine hesitancy or refusal were mainly due to concerns about vaccine safety, effectiveness, perception of measles risk and burden, mistrust in experts, and accessibility. Factors for MMR uptake included a sense of responsibility toward child and community health, peer judgement, trust in experts and vaccine, and measles severity. Anthroposophical and Gypsy, Roma, and Traveler populations presented unique barriers such as accessibility. CONCLUSION A multi-interventional, evidence-based approach is vital to improve confidence, competence, and convenience of measles vaccination uptake. Healthcare professionals need an understanding of individual contextual attitudes and barriers to MMR uptake to tailor effective communication. Effective surveillance is needed to identify under-vaccinated populations for vaccination outreach programs to improve accessibility and uptake.
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Affiliation(s)
- Annika B Wilder-Smith
- School of Social and Political Science, Usher Institute of Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
| | - Kaveri Qureshi
- School of Social and Political Science, Global Health Policy Unit, University of Edinburgh, Crystal Macmillan Building, Edinburgh EH8 9LD, UK
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15
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Camerini AL, Diviani N, Fadda M, Schulz PJ. Using protection motivation theory to predict intention to adhere to official MMR vaccination recommendations in Switzerland. SSM Popul Health 2019; 7:005-5. [PMID: 30581956 PMCID: PMC6293080 DOI: 10.1016/j.ssmph.2018.11.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/09/2018] [Accepted: 11/11/2018] [Indexed: 12/04/2022] Open
Abstract
Switzerland has not yet reached the measles vaccination coverage of 95 percent that is recommended by the World Health Organization to achieve herd immunity. Within the overall objective of informing effective ways to promote the combined Measles, Mumps, Rubella (MMR) vaccination in Switzerland, the aim of this study was to identify predictors of parents' intention to adhere to official MMR vaccination recommendations. Between October 2012 and January 2013, we surveyed 554 parents of middle school students aged 13 to 15 in Ticino, Switzerland. Guided by Protection Motivation Theory (PMT), the survey covered predictors related to threat and coping appraisal with regards to measles and the MMR vaccine, MMR-related social attitudes and social norms, past experience with the disease and the vaccine, and information sources in the MMR vaccine context. Data were analyzed using Structural Equation Modelling. Among central PMT concepts describing people's threat and coping appraisal, only response (vaccination) efficacy showed to be directly related to parents' intention to adhere to MMR vaccination recommendations (B = .39, p < .001). In addition, social attitudes (B = .38, p < .001) were a direct predictor. Furthermore, social attitudes, social norms, knowing somebody who experienced MMR vaccination side effects, and having sought MMR information from public health institutions, all indirectly predicted parents' intention to adhere to MMR recommendations by activating different threat and coping appraisal mechanisms. To conclude, future communication measures from public health institutions should highlight the altruistic aspect (herd immunity) of the immunization practice as well as present evidence on the high effectiveness of the vaccination in reducing the risk at both the individual and collective levels of getting infected with measles.
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Affiliation(s)
- Anne-Linda Camerini
- Institute of Communication and Health, Università della Svizzera italiana, Switzerland
| | - Nicola Diviani
- Department of Health Sciences and Health Policy, University of Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Marta Fadda
- Institute of Communication and Health, Università della Svizzera italiana, Switzerland
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Peter J. Schulz
- Institute of Communication and Health, Università della Svizzera italiana, Switzerland
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16
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BECHINI A, MOSCADELLI A, PIERALLI F, SARTOR G, SERAVALLI V, PANATTO D, AMICIZIA D, BONANNI P, BOCCALINI S. Impact assessment of an education course on vaccinations in a population of pregnant women: a pilot study. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E5-E11. [PMID: 31041404 PMCID: PMC6477562 DOI: 10.15167/2421-4248/jpmh2019.60.1.1093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/20/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Although the benefits of vaccinations have been extensively demonstrated, vaccination coverage remains unsatisfactory as result of many people's poor knowledge and negative perception of vaccination.We evaluated the impact of an education course on vaccinations in a population of pregnant women. METHODS A total of 214 pregnant women were invited to participate in this project, which was undertaken at the Obstetrics and Gynaecology Department of Careggi University Hospital in Florence (Italy). Anonymous questionnaires were administered to women before and after the intervention.A descriptive and statistical analysis was carried out in order to compare the responses obtained before and after the intervention. RESULTS Adherence to the initiative was good (98%): initially, the respondents were not hostile to vaccinations, though many (43%) were poorly or insufficiently informed. The educational intervention had a positive impact. After the intervention, the number of women who rated their level of knowledge of vaccinations as poor or insufficient had decreased by 30% and the number of "hesitant" respondents had decreased with respect to all aspects of the study, especially the decision to be vaccinated during pregnancy. CONCLUSIONS Hesitancy stems from a lack of accurate information. Healthcare professionals need to improve their communication skills. Appropriate education during pregnancy, when women are more receptive, may have a highly positive impact. These observations need to be considered in the planning of courses to prepare pregnant women for delivery also in other maternal-foetal centres in Italy.
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Affiliation(s)
- A. BECHINI
- Department of Health Sciences, University of Florence, Italy
| | - A. MOSCADELLI
- Department of Health Sciences, University of Florence, Italy
| | - F. PIERALLI
- Department of Health Sciences, University of Florence, Italy
| | - G. SARTOR
- Department of Health Sciences, University of Florence, Italy
| | - V. SERAVALLI
- Department of Health Sciences, University of Florence, Italy
| | - D. PANATTO
- Department of Health Sciences, University of Genoa, Italy
| | - D. AMICIZIA
- Department of Health Sciences, University of Genoa, Italy
| | - P. BONANNI
- Department of Health Sciences, University of Florence, Italy
| | - S. BOCCALINI
- Department of Health Sciences, University of Florence, Italy
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17
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Swaney SE, Burns S. Exploring reasons for vaccine-hesitancy among higher-SES parents in Perth, Western Australia. Health Promot J Austr 2018; 30:143-152. [PMID: 30091836 DOI: 10.1002/hpja.190] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/09/2018] [Accepted: 07/29/2018] [Indexed: 11/07/2022] Open
Abstract
ISSUES ADDRESSED The increasing prevalence among higher-socioeconomic (higher-SES) parents in Perth, Western Australia (WA), to be vaccine-hesitant (VH) is placing herd immunity at risk. METHODS Eighteen one-on-one interviews were conducted; (n = 11) parents who earned >$125 000 pa and expressed ever having concerns surrounding vaccination; (n = 7) health care professionals (HCPs), who provided clinical services. Using grounded theory methodology, data were analysed by constant coding and comparison until themes emerged and an explanatory model was developed. RESULTS Four main areas leading to vaccine-hesitancy emerged from the data: We are Educated; We Control our Health; Safe from Disease, At Risk from Vaccines; and What We Want. Parents believed themselves capable of making good vaccination decisions based on their higher education levels and self-sourced vaccination information, yet frequently sought reassurance. Healthism concepts were adopted and parents believed lifestyle factors could control for vaccine-preventable diseases (VPD). Risk perception of disease was low and influenced by the remote geographic location of Perth, whilst perceived negative consequences of vaccination were high. A reduced concept of the social responsibility for vaccination and understanding of herd immunity emerged. Parents called for vaccine contents to be listed and requested more information on why vaccination was necessary. CONCLUSION Four areas of VH emerged and reflected parents' belief that higher educational and socioeconomic status, previous successes in life and where they live would result in positive health outcomes and reduce the risk of contracting VPDs. SO WHAT?: This study provides new research into the perceptions among higher-SES VH parents who live in Perth, WA. It provides a model that fills a significant gap in information that could be used effectively for future health promotion interventions.
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Affiliation(s)
| | - Sharyn Burns
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, Western Australia, Australia
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18
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Castro-Sánchez E, Vila-Candel R, Soriano-Vidal FJ, Navarro-Illana E, Díez-Domingo J. Influence of health literacy on acceptance of influenza and pertussis vaccinations: a cross-sectional study among Spanish pregnant women. BMJ Open 2018; 8:e022132. [PMID: 29982220 PMCID: PMC6042548 DOI: 10.1136/bmjopen-2018-022132] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Immunisations against influenza and Bordetella pertussis infection are recommended to pregnant women in Valencia (Spain), yet vaccination rates remain low. Health literacy (HL) appears as a crucial factor in vaccination decision-making. We explored the relation between HL of pregnant women and decisions to receive influenza and pertussis immunisations. SETTING University hospital in Valencia (Spain). PARTICIPANTS 119 women who gave birth at a hospital in Valencia (Spain) between November 2015 and May 2016. Women in the immediate postpartum period (more than 27 weeks of gestation), between November 2015 and May 2016 were included in the study. Women with impairments, language barriers or illiteracy which prevented completion of the questionnaires, or those who were under 18 years were excluded from enrolment. PRIMARY AND SECONDARY OUTCOME MEASURES HL level; influenza and pertussis immunisation rate; reasons for rejection of vaccination. RESULTS 119 participants were included (mean age 32.3±5.5 years, 52% primiparous, 95% full-term deliveries). A higher education level was associated with Short Assessment of Health Literacy for Spanish Adults _50 (adjusted R2=0.22, p=0.014) and Newest Vital Sign (adjusted R2=0.258, p=0.001) scores. Depending on the scale, 56%-85% of participants had adequate HL. 52% (62/119) and 94% (112/119) of women received influenza and pertussis immunisation, respectively. Women rejecting influenza vaccine had a higher HL level (measured by SALHSA_50 tool) than those accepting it (Kruskal-Wallis test p=0.022). 24% of women who declined influenza vaccination felt the vaccine was unnecessary, and 23% claimed to have insufficient information. CONCLUSIONS Influenza vaccination rate was suboptimal in our study. Women with high HL were more likely to decline immunisation. Information from professionals needs to match patients' HL levels to reduce negative perceptions of vaccination.
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Affiliation(s)
- Enrique Castro-Sánchez
- NIHR Health Protection Research Unit (HPRU) in Healthcare Associated Infections (HCAI) and Antimicrobial Resistance (AMR), Imperial College London, London, UK
| | - Rafael Vila-Candel
- Department of Obstetrics and Gynaecology, Hospital Universitario de la Ribera, Valencia, Spain
- Faculty of Nursing, Universidad Católica de Valencia ‘San Vicente Mártir’, Valencia, Spain
| | - Francisco J Soriano-Vidal
- Faculty of Nursing, Universidad Católica de Valencia ‘San Vicente Mártir’, Valencia, Spain
- Xàtiva-Ontinyent Health Department, Xàtiva, Spain
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
- Department of Nursing, University of Alicante. San Vicente del Raspeig, Alicante, Spain
| | - Esther Navarro-Illana
- Faculty of Nursing, Universidad Católica de Valencia ‘San Vicente Mártir’, Valencia, Spain
| | - Javier Díez-Domingo
- Faculty of Nursing, Universidad Católica de Valencia ‘San Vicente Mártir’, Valencia, Spain
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
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Renouard A, Mazabraud Y. Context-based learning for Inhibition of alternative conceptions: the next step forward in science education. NPJ SCIENCE OF LEARNING 2018; 3:10. [PMID: 30631471 PMCID: PMC6220291 DOI: 10.1038/s41539-018-0026-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 04/30/2018] [Accepted: 05/10/2018] [Indexed: 06/09/2023]
Abstract
The scientific literacy level of the whole population has long been focusing the researchers' attention because of its direct impact on many aspects of our lives. As a matter of fact, studies in cognition have both been inspired by educational issues as well as by misconceptions of scientific ideas often based on irrational beliefs, old theories, unscientific reasoning, or unassimilated conceptual instruction. As a result, individual conceptions are now accurately described in many scientific fields, which has led to improvements in science teaching and learning. However, the community (scientists, academics, high school and primary school teachers, and educators) has not yet succeeded in solving all the issues, so some pre-existing misconceptions still persist in the population. In this paper, we argue that cognition studies must now focus on the origin of individuals' conceptions and on their modes of acquisition and propagation. The goal is to provide educational tools for acting upstream, during early scientific instruction, before the very acquisition of scientific conceptions.
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Affiliation(s)
- Alexandra Renouard
- Université de Strasbourg, CNRS, IPGS, UMR 7516, 5 rue René Descartes, 67100 Strasbourg, France
| | - Yves Mazabraud
- Université des Antilles, Géosciences Montpellier UMR 5243, Fouillole, 97159 Pointe à Pitre, France
- Université des Antilles, Ecole Supérieure du Professorat et de l’Education de Guadeloupe, CRREF EA 4538, Morne Ferret, 97178 Abymes, France
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Orr D, Baram-Tsabari A. Science and Politics in the Polio Vaccination Debate on Facebook: A Mixed-Methods Approach to Public Engagement in a Science-Based Dialogue. JOURNAL OF MICROBIOLOGY & BIOLOGY EDUCATION 2018; 19:jmbe-19-34. [PMID: 29904532 PMCID: PMC5969418 DOI: 10.1128/jmbe.v19i1.1500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/15/2017] [Indexed: 05/26/2023]
Abstract
This study examines the ways in which the public discusses and debates the scientific issue of vaccinations in the online social media environment of Facebook. We apply a mixed-methods approach, where a qualitative analysis is combined with a quantitative analysis of the characteristics of the debate on polio vaccinations in a Facebook group dedicated to parental and professional dialogue. The qualitative analysis suggested that dialogue became more political than scientific overall, yet the quantitative analysis showed that the discussants did not abandon the scientific nature of the issue at hand.
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Affiliation(s)
- Daniela Orr
- Corresponding author. Mailing address: Faculty of Education in Science and Technology, Technion – Israel Institute of Technology, Technion City, Haifa 3200003, Israel. Phone: +972-52-8382567. Fax: +972-4-829-5634. E-mail:
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Náfrádi L, Nakamoto K, Csabai M, Papp-Zipernovszky O, Schulz PJ. An empirical test of the Health Empowerment Model: Does patient empowerment moderate the effect of health literacy on health status? PATIENT EDUCATION AND COUNSELING 2018; 101:511-517. [PMID: 28899712 DOI: 10.1016/j.pec.2017.09.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The Health Empowerment Model (Schulz & Nakamoto, 2013) advocates that the effects of health literacy and empowerment are intertwined on health outcomes. This study aims to test this assumption in the context of health status as a patient outcome. METHODS A cross-sectional study was conducted with a sample of 302 participants between June and December 2015. The participants' health literacy (using the NVS and S-TOFHLA tests), empowerment and self-reported health status were assessed. RESULTS The participants having a high level of patient empowerment and concurrent adequate health literacy (the so-called 'effective self-managers') reported better health status compared to patients who had either lower health literacy and/or lower empowerment scores (P<0.05). Moreover, the meaningfulness (b=0.053, t(297)=2.29, P=0.02) and competence (b=0.07, t(297)=2.47, P=0.01) sub-dimensions of patient empowerment moderated the effect of the NVS on current health status. CONCLUSION The study provides evidence for the independence of health literacy and empowerment and partial evidence for their interaction predicting health status. PRACTICE IMPLICATIONS Our findings highlight that health literacy and patient empowerment (in particular its competence and meaningfulness sub-facets) are crucial patient-related variables, to be taken into consideration simultaneously, during screening and health promotion campaigns fostering health status in the general population.
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Affiliation(s)
- Lilla Náfrádi
- Institute of Communication and Health, Università della Svizzera italiana, Lugano, Switzerland.
| | - Kent Nakamoto
- Institute of Communication and Health, Università della Svizzera italiana, Lugano, Switzerland
| | - Márta Csabai
- Institute of Psychology, University of Szeged, Szeged, Hungary
| | | | - Peter J Schulz
- Institute of Communication and Health, Università della Svizzera italiana, Lugano, Switzerland
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Wang X, Zhou X, Leesa L, Mantwill S. The Effect of Vaccine Literacy on Parental Trust and Intention to Vaccinate after a Major Vaccine Scandal. JOURNAL OF HEALTH COMMUNICATION 2018; 23:413-421. [PMID: 29589807 DOI: 10.1080/10810730.2018.1455771] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Health literacy, and more specifically vaccine literacy, might be an important factor in reducing the negative effects of exposure to misleading reports on vaccination. This study explores the association between vaccine literacy and vaccination-related outcomes after misleading reports on a scandal concerning locally produced childhood vaccines had emerged in 2016 in China. Data for this study came from a cross-sectional survey, which was conducted in April 2016 in Hangzhou, China. Data were collected in kindergartens and community health centers among parents of children up to 6 years of age. Data were analyzed for 1864 participants. Binary logistic regression models showed that, after controlling for socio-demographics and children's age, parents who had better vaccine literacy (<0.05) were more likely to trust and choose domestically produced vaccines, which account for about 95% of the total vaccinations in China. This study provides evidence on a still largely understudied relationship between vaccine literacy and vaccination-related outcomes. Findings might suggest that higher literacy levels could reduce some of the negative effects of being exposed to misleading information on vaccination, eventually leading to less vaccination hesitancy.
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Affiliation(s)
- Xiaomin Wang
- a Institute for Social Medicine , Zhejiang University , Hangzhou , Zhejiang , China
- b Department of Social and Behavioral Sciences , Harvard T.H. Chan School of Public Health , Boston , Massachusetts , USA
- c Center for Community-Based Research , Dana-Farber Cancer Institute , Boston , Massachusetts , USA
| | - Xudong Zhou
- a Institute for Social Medicine , Zhejiang University , Hangzhou , Zhejiang , China
| | - Lin Leesa
- b Department of Social and Behavioral Sciences , Harvard T.H. Chan School of Public Health , Boston , Massachusetts , USA
- c Center for Community-Based Research , Dana-Farber Cancer Institute , Boston , Massachusetts , USA
- d Division of Policy Translation and Leadership Development , Harvard T.H. Chan School of Public Health , Boston , Massachusetts , USA
| | - Sarah Mantwill
- e Department of Health Sciences and Health Policy , University of Lucerne , Lucerne , Switzerland
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Marta F, Elisa G, Luisa R, Marino F, Sabrina S, Alessandro Z, Peter J S. Validation of a scale to measure parental psychological empowerment in the vaccination decision. J Public Health Res 2017; 6:955. [PMID: 29071257 PMCID: PMC5641652 DOI: 10.4081/jphr.2017.955] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/28/2017] [Indexed: 12/04/2022] Open
Abstract
Background and aims. Parents’ empowerment is advocated to promote and preserve an informed and autonomous decision regarding their children’ immunization. The scope of this study is to develop and evaluate the psychometric properties of an instrument to measure parents’ psychological empowerment in their children’s vaccination decision and propose a context-specific definition of this construct. Materials and methods. Grounding in previous qualitative data, we generated an initial pool of items which was later content and face validated by a panel of experts. A pretest allowed us to reduce the initial pool to 9 items. Convergent and discriminant validity measures included the General Self-Efficacy Scale, a Psychological Empowerment Scale, and the Control Preference Scale. Vaccination-related outcomes such as attitude and intention were also included. Results. Principal Component Analysis revealed a 2-factor structure, with each factor composed of 2 items. The first factor concerns the perceived influence of one’s personal and family experience with vaccination, while the second factor represents the desire not to ask other parents about their experience with vaccination and their lack of interest in other parents’ vaccination opinion. Conclusions In light of its association with positive immunization-related outcomes, public health efforts should be directed to reinforce parents’ empowerment. Significance for public health Suboptimal vaccination coverage is associated with increased risk of disease outbreak. Increasing parental acceptance of childhood vaccinations will help public health systems to reach the recommended threshold to eliminate a number of preventable diseases. This study contributes to our knowledge of the antecedents of parental immunization decision, showing that parents who excessively rely on their peers and are less self-determined have lower levels of vaccination knowledge and decreased intention to vaccinate their children. The results of this study can be used to design effective public health communication campaigns aimed at increasing vaccination acceptance.
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Affiliation(s)
- Fadda Marta
- Institute of Communication and Health, Faculty of Communication Sciences, University of Lugano, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Galimberti Elisa
- Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Romanò Luisa
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - Faccini Marino
- Agency for the Protection of Health of the Province of Milan, Italy
| | - Senatore Sabrina
- Agency for the Protection of Health of the Province of Milan, Italy
| | - Zanetti Alessandro
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - Schulz Peter J
- Institute of Communication and Health, Faculty of Communication Sciences, University of Lugano, Switzerland
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Marta F, Elisa G, Luisa R, Marino F, Sabrina S, Alessandro Z, Peter J S. Validation of a scale to measure parental psychological empowerment in the vaccination decision. J Public Health Res 2017; 6:955. [PMID: 29071257 DOI: 10.4081/2fjphr.2017.955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/28/2017] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND AND AIMS Parents' empowerment is advocated to promote and preserve an informed and autonomous decision regarding their children' immunization. The scope of this study is to develop and evaluate the psychometric properties of an instrument to measure parents' psychological empowerment in their children's vaccination decision and propose a context-specific definition of this construct. MATERIALS AND METHODS Grounding in previous qualitative data, we generated an initial pool of items which was later content and face validated by a panel of experts. A pretest allowed us to reduce the initial pool to 9 items. Convergent and discriminant validity measures included the General Self-Efficacy Scale, a Psychological Empowerment Scale, and the Control Preference Scale. Vaccination-related outcomes such as attitude and intention were also included. RESULTS Principal Component Analysis revealed a 2-factor structure, with each factor composed of 2 items. The first factor concerns the perceived influence of one's personal and family experience with vaccination, while the second factor represents the desire not to ask other parents about their experience with vaccination and their lack of interest in other parents' vaccination opinion. CONCLUSIONS In light of its association with positive immunization-related outcomes, public health efforts should be directed to reinforce parents' empowerment.
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Affiliation(s)
- Fadda Marta
- Institute of Communication and Health, Faculty of Communication Sciences, University of Lugano, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Galimberti Elisa
- Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Romanò Luisa
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - Faccini Marino
- Agency for the Protection of Health of the Province of Milan, Italy
| | - Senatore Sabrina
- Agency for the Protection of Health of the Province of Milan, Italy
| | - Zanetti Alessandro
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - Schulz Peter J
- Institute of Communication and Health, Faculty of Communication Sciences, University of Lugano, Switzerland
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Ames HMR, Glenton C, Lewin S. Parents' and informal caregivers' views and experiences of communication about routine childhood vaccination: a synthesis of qualitative evidence. Cochrane Database Syst Rev 2017; 2:CD011787. [PMID: 28169420 PMCID: PMC5461870 DOI: 10.1002/14651858.cd011787.pub2] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Childhood vaccination is an effective way to prevent serious childhood illnesses, but many children do not receive all the recommended vaccines. There are various reasons for this; some parents lack access because of poor quality health services, long distances or lack of money. Other parents may not trust vaccines or the healthcare workers who provide them, or they may not see the need for vaccination due to a lack of information or misinformation about how vaccinations work and the diseases they can prevent.Communication with parents about childhood vaccinations is one way of addressing these issues. Communication can take place at healthcare facilities, at home or in the community. Communication can be two-way, for example face-to-face discussions between parents and healthcare providers, or one-way, for instance via text messages, posters or radio programmes. Some types of communication enable parents to actively discuss vaccines and their benefits and harms, as well as diseases they can prevent. Other communication types simply give information about vaccination issues or when and where vaccines are available. People involved in vaccine programmes need to understand how parents experience different types of communication about vaccination and how this influences their decision to vaccinate. OBJECTIVES The specific objectives of the review were to identify, appraise and synthesise qualitative studies exploring: parents' and informal caregivers' views and experiences regarding communication about childhood vaccinations and the manner in which it is communicated; and the influence that vaccination communication has on parents' and informal caregivers' decisions regarding childhood vaccination. SEARCH METHODS We searched MEDLINE (OvidSP), MEDLINE In-process and Other Non-Index Citations (Ovid SP), Embase (Ovid), CINAHL (EbscoHOST), and Anthropology Plus (EbscoHost) databases for eligible studies from inception to 30 August 2016. We developed search strategies for each database, using guidelines developed by the Cochrane Qualitative Research Methods Group for searching for qualitative evidence as well as modified versions of the search developed for three related reviews of effectiveness. There were no date or geographic restrictions for the search. SELECTION CRITERIA We included studies that utilised qualitative methods for data collection and analysis; focused on the views and experiences of parents and informal caregivers regarding information about vaccination for children aged up to six years; and were from any setting globally where information about childhood vaccinations was communicated or distributed. DATA COLLECTION AND ANALYSIS We used maximum variation purposive sampling for data synthesis, using a three-step sampling frame. We conducted a thematic analysis using a constant comparison strategy for data extraction and synthesis. We assessed our confidence in the findings using the GRADE-CERQual approach. High confidence suggests that it is highly likely that the review finding is a reasonable representation of the phenomenon of interest, while very low confidence indicates that it is not clear whether the review finding is a reasonable representation of it. Using a matrix model, we then integrated our findings with those from other Cochrane reviews that assessed the effects of different communication strategies on parents' knowledge, attitudes and behaviour about childhood vaccination. MAIN RESULTS We included 38 studies, mostly from high-income countries, many of which explored mothers' perceptions of vaccine communication. Some focused on the MMR (measles, mumps, rubella) vaccine.In general, parents wanted more information than they were getting (high confidence in the evidence). Lack of information led to worry and regret about vaccination decisions among some parents (moderate confidence).Parents wanted balanced information about vaccination benefits and harms (high confidence), presented clearly and simply (moderate confidence) and tailored to their situation (low confidence in the evidence). Parents wanted vaccination information to be available at a wider variety of locations, including outside health services (low confidence) and in good time before each vaccination appointment (moderate confidence).Parents viewed health workers as an important source of information and had specific expectations of their interactions with them (high confidence). Poor communication and negative relationships with health workers sometimes impacted on vaccination decisions (moderate confidence).Parents generally found it difficult to know which vaccination information source to trust and challenging to find information they felt was unbiased and balanced (high confidence).The amount of information parents wanted and the sources they felt could be trusted appeared to be linked to acceptance of vaccination, with parents who were more hesitant wanting more information (low to moderate confidence).Our synthesis and comparison of the qualitative evidence shows that most of the trial interventions addressed at least one or two key aspects of communication, including the provision of information prior to the vaccination appointment and tailoring information to parents' needs. None of the interventions appeared to respond to negative media stories or address parental perceptions of health worker motives. AUTHORS' CONCLUSIONS We have high or moderate confidence in the evidence contributing to several review findings. Further research, especially in rural and low- to middle-income country settings, could strengthen evidence for the findings where we had low or very low confidence. Planners should consider the timing for making vaccination information available to parents, the settings where information is available, the provision of impartial and clear information tailored to parental needs, and parents' perceptions of health workers and the information provided.
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Affiliation(s)
- Heather MR Ames
- Norwegian Institute of Public HealthGlobal Health UnitPilestredet Park 7OsloNorway0130
- University of OsloInstitute of Health and SocietyOsloNorway
| | - Claire Glenton
- Norwegian Institute of Public HealthGlobal Health UnitPilestredet Park 7OsloNorway0130
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
- Medical Research Council of South AfricaHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
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Seeber L, Conrad T, Hoppe C, Obermeier P, Chen X, Karsch K, Muehlhans S, Tief F, Boettcher S, Diedrich S, Schweiger B, Rath B. Educating parents about the vaccination status of their children: A user-centered mobile application. Prev Med Rep 2017; 5:241-250. [PMID: 28127527 PMCID: PMC5257187 DOI: 10.1016/j.pmedr.2017.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/06/2017] [Accepted: 01/08/2017] [Indexed: 01/05/2023] Open
Abstract
Parents are often uncertain about the vaccination status of their children. In times of vaccine hesitancy, vaccination programs could benefit from active patient participation. The Vaccination App (VAccApp) was developed by the Vienna Vaccine Safety Initiative, enabling parents to learn about the vaccination status of their children, including 25 different routine, special indication and travel vaccines listed in the WHO Immunization Certificate of Vaccination (WHO-ICV). Between 2012 and 2014, the VAccApp was validated in a hospital-based quality management program in Berlin, Germany, in collaboration with the Robert Koch Institute. Parents of 178 children were asked to transfer the immunization data of their children from the WHO-ICV into the VAccApp. The respective WHO-ICV was photocopied for independent, professional data entry (gold standard). Demonstrating the status quo in vaccine information reporting, a Recall Group of 278 parents underwent structured interviews for verbal immunization histories, without the respective WHO-ICV. Only 9% of the Recall Group were able to provide a complete vaccination status; on average 39% of the questions were answered correctly. Using the WHO-ICV with the help of the VAccApp resulted in 62% of parents providing a complete vaccination status; on average 95% of the questions were answered correctly. After using the VAccApp, parents were more likely to remember key aspects of the vaccination history. User-friendly mobile applications empower parents to take a closer look at the vaccination record, thereby taking an active role in providing accurate vaccination histories. Parents may become motivated to ask informed questions and to keep vaccinations up-to-date.
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Key Words
- ED, emergency department
- Electronic health records
- Immunization
- Mobile health
- Patient education
- Patient empowerment
- QM, quality management
- RSV, respiratory syncytial virus
- SOP, standard operating procedure
- VAccApp, Vaccination App, a mobile application for vaccination histories
- VPD, vaccine-preventable disease
- Vaccination history
- ViVI, Vienna Vaccine Safety Initiative
- WHO, World Health Organization
- WHO-ICV, International Certificate of Vaccination, issued by the World Health Organization
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Affiliation(s)
- Lea Seeber
- Department of Pediatrics, Charité University Medical Center, Augustenburger Platz 1, 13353 Berlin, Germany; Vienna Vaccine Safety Initiative, Berlin, Germany
| | - Tim Conrad
- Department of Mathematics and Computer Sciences, Freie University, Arnimallee 14, 14195 Berlin, Germany
| | - Christian Hoppe
- Department of Pediatrics, Charité University Medical Center, Augustenburger Platz 1, 13353 Berlin, Germany; Vienna Vaccine Safety Initiative, Berlin, Germany; Department of Mathematics and Computer Sciences, Freie University, Arnimallee 14, 14195 Berlin, Germany
| | - Patrick Obermeier
- Department of Pediatrics, Charité University Medical Center, Augustenburger Platz 1, 13353 Berlin, Germany; Vienna Vaccine Safety Initiative, Berlin, Germany
| | - Xi Chen
- Department of Pediatrics, Charité University Medical Center, Augustenburger Platz 1, 13353 Berlin, Germany; Vienna Vaccine Safety Initiative, Berlin, Germany
| | - Katharina Karsch
- Department of Pediatrics, Charité University Medical Center, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Susann Muehlhans
- Department of Pediatrics, Charité University Medical Center, Augustenburger Platz 1, 13353 Berlin, Germany; Vienna Vaccine Safety Initiative, Berlin, Germany
| | - Franziska Tief
- Department of Pediatrics, Charité University Medical Center, Augustenburger Platz 1, 13353 Berlin, Germany; Vienna Vaccine Safety Initiative, Berlin, Germany
| | - Sindy Boettcher
- National Reference Center for Poliomyelitis and Enteroviruses, Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany
| | - Sabine Diedrich
- National Reference Center for Poliomyelitis and Enteroviruses, Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany
| | - Brunhilde Schweiger
- National Reference Center for Influenza, Robert Koch Institute, Seestr. 10, 13353 Berlin, Germany
| | - Barbara Rath
- Department of Pediatrics, Charité University Medical Center, Augustenburger Platz 1, 13353 Berlin, Germany; Vienna Vaccine Safety Initiative, Berlin, Germany; The University of Nottingham School of Medicine, Hucknall Road, Nottingham NG51PB, UK
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Kaljee LM, Kilgore P, Prentiss T, Lamerato L, Moreno D, Arshad S, Zervos M. "You need to be an advocate for yourself": Factors associated with decision-making regarding influenza and pneumococcal vaccine use among US older adults from within a large metropolitan health system. Hum Vaccin Immunother 2016; 13:206-212. [PMID: 27625007 DOI: 10.1080/21645515.2016.1228503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
In the United States, influenza and pneumonia account significantly to emergency room use and hospitalization of adults >65 y. The Centers for Disease Control and Prevention recommends use of the annual influenza vaccine and 2 pneumococcal vaccines for older adults to decrease risks of morbidity and mortality. However, actual vaccine up-take is estimated at 61.3% for pneumococcal vaccines and 65% for influenza vaccine in the 2013-2014 season. Vaccine up-take is affected by multiple socio-cultural and economic factors including general healthcare access and utilization, social networks and norms, communication with health providers and health information sources, as well as perceptions related to vaccines and targeted diseases. In this study, 8 focus group discussions (total N = 48) were conducted with adults 65+ years living in urban and suburban communities in the Detroit Metropolitan Area. The research objective was to increase understanding of barriers and facilitators to vaccine up-take in this age cohort within the context of general healthcare availability and accessibility, social networks, information sources, and personal perceptions of diseases and vaccines. The data suggest the need to integrate broader health care service experiences, concepts of knowledge of one's own well-being and vulnerabilities, and self-advocacy as factors associated with older adults' vaccine-use decisions. These data also support recognition of multiple levels of vaccine acceptance which can be disease specific. Implications include potential for increasing vaccine up-take through general improvement in health care delivery and services, as well as specific vaccine-focused patient and provider education programs.
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Affiliation(s)
- Linda M Kaljee
- a Global Health Initiative, Henry Ford Health System , Detroit , MI , USA
| | - Paul Kilgore
- b Eugene Applebaum School of Pharmacy and Health Sciences, Wayne State University , Detroit , MI , USA
| | - Tyler Prentiss
- a Global Health Initiative, Henry Ford Health System , Detroit , MI , USA
| | - Lois Lamerato
- c Henry Ford Health System, Public Health Sciences and Research , Detroit , MI , USA
| | - Daniela Moreno
- d Division of Infectious Disease, Henry Ford Health System , Detroit , MI , USA
| | - Samia Arshad
- d Division of Infectious Disease, Henry Ford Health System , Detroit , MI , USA
| | - Marcus Zervos
- d Division of Infectious Disease, Henry Ford Health System , Detroit , MI , USA
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Fadda M, Galimberti E, Carraro V, Schulz PJ. What are parents' perspectives on psychological empowerment in the MMR vaccination decision? A focus group study. BMJ Open 2016; 6:e010773. [PMID: 27084284 PMCID: PMC4838687 DOI: 10.1136/bmjopen-2015-010773] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Most developed countries do not have compulsory immunisation requirements, but instead issue recommendations. Although parents are expected to make an informed, autonomous (ie, empowered) decision regarding their children's vaccinations, there is no evidence about how parents' interpret this demand nor on the latitude of their decision-making. The goal of this study is to gain insights from parents residing in a low measles-mumps-rubella (MMR) uptake area on what constitutes feelings of empowerment in the decision they have to make on their child's MMR vaccination. DESIGN A qualitative study employing focus group interviews. SETTING 11 vaccination centres and hospitals in the Province of Trento, Italy. PARTICIPANTS 24 mothers and 4 fathers of children for whom the MMR vaccination decision was still pending participated in 6 focus groups. RESULTS Autonomy and competence were salient themes in relation to empowerment, and were further connected with beliefs regarding legal responsibility and ethics of freedom concerning the decision, parents' relationship with the paediatrician (trust), feelings of relevance of the decision and related stress, and seeking, avoidance, or fear of vaccination-related information. Competence was interpreted as medical knowledge and information-seeking skills, but it was also related to the extent parents perceived the paediatrician to be competent. CONCLUSIONS Since parents' interpretation of empowerment goes beyond mere perceptions of being informed and autonomous and differs across individuals, it is important that this construct be correctly interpreted and implemented by best practice, for instance by explicitly adopting a relational conception of autonomy. Knowing whether parents want to make an empowered decision and what their information and autonomy needs are might help health professionals adapt their communication about immunisation, and promote parental perception of making an informed, autonomous decision.
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Affiliation(s)
- Marta Fadda
- Faculty of Communication Sciences, Institute of Communication and Health, Università della Svizzera Italiana, Lugano, Switzerland
| | - Elisa Galimberti
- Faculty of Communication Sciences, Institute of Communication and Health, Università della Svizzera Italiana, Lugano, Switzerland
| | - Valter Carraro
- Department of Hygiene and Public Health, Azienda Autonoma Sanitaria della Provincia di Trento, Trento, Italy
| | - Peter J Schulz
- Faculty of Communication Sciences, Institute of Communication and Health, Università della Svizzera Italiana, Lugano, Switzerland
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