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Pringle W, Greyson D, Graham JE, Dubé È, Mitchell H, Russell ML, MacDonald SE, Bettinger JA. "I try to take all the time needed, even if i do not have it!": Knowledge, attitudes, practices of perinatal care providers in canada about vaccination. Vaccine X 2024; 18:100490. [PMID: 38699156 PMCID: PMC11063514 DOI: 10.1016/j.jvacx.2024.100490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024] Open
Abstract
Objective Successful clinical conversations about vaccination in pregnancy (pertussis, COVID-19, and influenza) are key to improving low uptake rates of both vaccination in pregnancy and infancy. The purpose of this study was to understand Canadian perinatal care providers' knowledge, attitudes, and practices around vaccination in pregnancy. Methods Qualitative interviews with 49 perinatal care providers (nurse practitioner, general practitioner, registered nurse, registered midwife, obstetrician-gynecologist, and family physicians) in 6 of 13 provinces and territories were deductively coded using directed content analysis [1] and analyzed according to key themes. Results Participants detailed their professional training and experiences, patient community demographics, knowledge of vaccines, views and beliefs about vaccination in pregnancy, and attitudes about vaccine counselling. Providers generally described having a good range of information sources to keep vaccine knowledge up to date. Some providers lacked the necessary logistical setups to administer vaccines within their practice. Responses suggest diverging approaches to vaccine counselling. With merely hesitant patients, some opted to dig in and have more in-depth discussions, while others felt the likelihood of persuading an outright vaccine-refusing patient to vaccinate was too low to be worthwhile. Conclusion Provider knowledge, attitudes, and practices around vaccination varied by professional background. To support perinatal providers' knowledge and practices, clinical guidelines should detail the importance of vaccination relative to other care priorities, emphasize the positive impact of engaging hesitant patients in vaccine counselling.
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Affiliation(s)
- Wendy Pringle
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, 950 W 28th Ave, Vancouver, British Columbia V5Z 4H4, Canada
| | - Devon Greyson
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, 950 W 28th Ave, Vancouver, British Columbia V5Z 4H4, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Janice E. Graham
- Department of Pediatrics, Dalhousie University, 5849 University Ave, C-309, Halifax, Nova Scotia B3H 4H7, Canada
| | - Ève Dubé
- Quebec National Institute of Public Health, 945, av Wolfe, Quebec City, Quebec G1V 5B3, Canada
| | - Hana Mitchell
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, 950 W 28th Ave, Vancouver, British Columbia V5Z 4H4, Canada
| | - Margaret L. Russell
- Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
| | - Shannon E. MacDonald
- Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, Alberta T6G 1C9, Canada
| | - Julie A. Bettinger
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, 950 W 28th Ave, Vancouver, British Columbia V5Z 4H4, Canada
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Jinarong T, Chootong R, Vichitkunakorn P, Songwathana P. Muslim parents' beliefs and factors influencing complete immunization of children aged 0-5 years in a Thai rural community: a qualitative study. BMC Public Health 2023; 23:1348. [PMID: 37442996 PMCID: PMC10339562 DOI: 10.1186/s12889-023-15273-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/14/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE Vaccine-preventable diseases have decreased globally. However, measles and diphtheria outbreaks still occur in Southern Thailand, where Muslims are predominant with a documented low vaccine coverage. The purpose of this study was to investigate Muslim parents' beliefs and factors influencing them to complete immunization of children aged 0-5 years in Y.L. province, Thailand. METHOD A descriptive qualitative study was conducted, using focus group discussion with 26 participants. They are parents whose children had complete or incomplete vaccination and community/religious leaders. Data were analyzed using content-analysis and triangulation method was used to ensure trustworthiness. RESULTS Four major themes emerged from the analysis: (1) positive vaccine beliefs, which included knowledge and awareness of vaccination, trust in vaccine efficacy, and religious beliefs; (2) positive factors influencing positive beliefs and vaccine acceptance, which were accessibility of reliable sources, and imitation of leaders and health-community-network; (3) negative vaccine beliefs, including bias in vaccine efficacy and safety, personal beliefs about sources of vaccines, and religious misconceptions regarding the value of vaccines and Halal concerns; and (4) negative factors influencing negative beliefs and refusal of vaccination, which were perception of disadvantages of vaccines spread by word-of-mouth, trust in person over empirical evidence, religious views based on self-interpretation, and lack of public information on Halal vaccines. CONCLUSION Both positive and negative factors influencing complete immunization were found in this study. To enhance vaccine acceptance, health care providers should understand Muslim cultural beliefs by offering parents a chance to express their attitudes and encourage vaccination via religious leaders and community role models.
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Affiliation(s)
- Taqwa Jinarong
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, 90110, Songkhla, Thailand
| | - Rattanaporn Chootong
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, 90110, Songkhla, Thailand.
| | - Polathep Vichitkunakorn
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, 90110, Songkhla, Thailand
| | - Praneed Songwathana
- Faculty of Nursing, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, 90110, Songkhla, Thailand
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Zhou F, Lindley MC, Lee JT, Jatlaoui TC. Association Between Influenza Vaccination During Pregnancy and Infant Influenza Vaccination. Obstet Gynecol 2023; 141:563-569. [PMID: 36728080 PMCID: PMC11259230 DOI: 10.1097/aog.0000000000005101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/22/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the association between influenza vaccination during pregnancy and infant influenza vaccination. METHODS We conducted a retrospective analysis of individuals aged 15-49 years who were continually privately insured from August 2017 to May 2019 and had singleton live births between September 2017 and February 2018 and their infants. Influenza vaccination coverage was assessed for pregnant people during the 2017-2018 influenza season and for their infants during the 2018-2019 season using the 2017-2019 MarketScan data. Multivariate log-binomial regressions were conducted to examine the association between influenza vaccination during pregnancy and infant influenza vaccination. RESULTS Of the 34,919 pregnant people in this analysis, 14,168 (40.6%) received influenza vaccination during pregnancy. Of the infants born to people vaccinated during pregnancy, 90.0% received at least one dose of influenza vaccine during the 2018-2019 season and 75.5% received at least two doses. Of the infants born to those not vaccinated during pregnancy, 66.3% received at least one dose of influenza vaccine and 51.8% received at least two doses. At-least-one-dose coverage was 35.7% higher (adjusted risk ratio [aRR] 1.34, 95% CI 1.33-1.36) and at-least-two-dose coverage was 45.8% higher (aRR 1.43, 95% CI 1.41-1.46) for infants born to people who received influenza vaccination during pregnancy compared with infants born to people who did not. CONCLUSION Our results show a positive and statistically significant relationship between influenza vaccination during pregnancy and infant influenza vaccination status in their first season eligible for vaccination. Interventions to increase influenza vaccination coverage among pregnant people may also increase infant influenza vaccination coverage, offering greater protection against serious complications of influenza in both vulnerable populations.
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Affiliation(s)
- Fangjun Zhou
- Immunization Service Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Saitoh A, Takaku M, Saitoh A. High rates of vaccine hesitancy among pregnant women during the coronavirus disease 2019 (COVID-19) pandemic in Japan. Hum Vaccin Immunother 2022; 18:2064686. [PMID: 35476032 PMCID: PMC9897641 DOI: 10.1080/21645515.2022.2064686] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This study aimed to 1) determine the prevalence and contents of vaccine hesitancy among pregnant women during the coronavirus disease 2019 (COVID-19) pandemic and 2) evaluate its association with maternal sociodemographic factors. A cross-sectional survey was conducted between August and December 2020 among pregnant women between 28 and 32 weeks of gestation who received antenatal care at four clinics and hospitals in Niigata City, Japan. Vaccine hesitancy was assessed using the Parent Attitudes about Childhood Vaccines survey, and associations between vaccine hesitancy and sociodemographic factors were analyzed. In total, 113/200 (56.5%) subjects responded to the survey. Overall, 46/113 (40.7%) pregnant women were resistant or hesitant to receive the vaccine. Women with vaccine hesitancy were more likely to fear adverse reactions (concern 79.6%, not concerned 15.9%, and not sure 4.4%), safety (concerned 69.0%, not concerned 23.9%, and not sure 7.1%), and efficacy (concerned 47.8%, not concerned 35.4%, and not sure 16.8%) compared to those without vaccine hesitancy (P < .01, < .01, and <.01, respectively). In the multivariate logistic regression analyses, primipara women had higher rates of vaccine hesitancy than multipara pregnant women (odds ratio: 2.38, P = .04). In conclusion, the prevalence of vaccine hesitancy among pregnant Japanese women, especially primipara women, was higher than that in other countries during the COVID-19 pandemic. Their major concerns were adverse reactions, safety, and the efficacy of childhood vaccines. Further strategies are needed to provide appropriate vaccine information to prevent vaccine-preventable diseases in both infants and children.
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Affiliation(s)
- Aya Saitoh
- Department of Fundamental Nursing, School of Health Sciences, Faculty of Medicine, Graduate School of Health Sciences, Niigata University, Niigata, Japan,CONTACT Aya Saitoh Department of Fundamental Nursing, School of Health Sciences, Faculty of Medicine, Graduate School ofHealth Sciences, Niigata University, 2-746 Asahimachi-dori, Chuo-ku, Niigata 951-8518, Japan
| | - Mayumi Takaku
- Department of Fundamental Nursing, School of Health Sciences, Faculty of Medicine, Graduate School of Health Sciences, Niigata University, Niigata, Japan
| | - Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Dudley MZ, Omer SB, O'Leary ST, Limaye RJ, Ellingson MK, Spina CI, Brewer SE, Bednarczyk RA, Chamberlain AT, Malik F, Frew PM, Church-Balin C, Riley LE, Ault KA, Orenstein WA, Halsey NA, Salmon DA. MomsTalkShots, tailored educational app, improves vaccine attitudes: a randomized controlled trial. BMC Public Health 2022; 22:2134. [PMID: 36411403 PMCID: PMC9676851 DOI: 10.1186/s12889-022-14498-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/13/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Many pregnant women and parents have concerns about vaccines. This analysis examined the impact of MomsTalkShots, an individually tailored educational application, on vaccine attitudes of pregnant women and mothers. METHODS MomsTalkShots was the patient-level component of a multi-level intervention to improve maternal and infant vaccine uptake that also included provider- and practice-level interventions. The impact of these interventions was studied using a two-by-two factorial design, randomizing at both the patient- and the practice-level. Study staff recruited pregnant women from a diverse set of prenatal care practices in Colorado and Georgia between June 2017 and July 2018. All participants (n = 2087) received a baseline survey of maternal and infant vaccine intentions and attitudes, and two follow-up surveys at least 1 month and 1 year after their infant's birth, respectively. Half of participants (n = 1041) were randomly assigned to receive educational videos through MomsTalkShots, algorithmically tailored to their vaccine intentions, attitudes, and demographics. Since the practice/provider intervention did not appear impactful, this analysis focused on MomsTalkShots regardless of the practice/provider intervention. RESULTS By 1 month post-birth, MomsTalkShots increased perceived risk of maternal influenza disease (61% among MomsTalkShots recipients vs 55% among controls; Odds Ratio: 1.61, 95% Confidence Interval: 1.23-2.09), confidence in influenza vaccine efficacy (73% vs 63%; OR: 1.97, 95%CI: 1.47-2.65), and perceived vaccine knowledge (55% vs 48%; OR: 1.39, 95%CI: 1.13-1.72). Among those intending not to vaccinate at baseline, MomsTalkShots increased perceived risk of maternal influenza disease (38% vs 32%; OR: 2.07, 95%CI: 1.15-3.71) and confidence in influenza vaccine efficacy (44% vs 28%; OR: 2.62, 95%CI: 1.46-4.69). By 1 year post-birth, MomsTalkShots increased perceived vaccine knowledge (62% vs 50%; OR: 1.74, 95%CI: 1.36-2.24) and trust in vaccine information from obstetricians and pediatricians (64% vs 55%; OR: 1.53, 95%CI: 1.17-2.00). Among those uncertain about vaccinating at baseline, MomsTalkShots increased perceived vaccine knowledge (47% vs 12%; OR: 6.89, 95%CI: 1.52-31.25) and reduced infant vaccine safety concerns (71% vs 91%; OR: 0.24, 95%CI: 0.06-0.98). CONCLUSIONS MomsTalkShots improved pregnant women's and mothers' knowledge and perceptions of maternal and infant vaccines and the diseases they prevent, and offers a scalable tool to address vaccine hesitancy. TRIAL REGISTRATION Registered at Clinicaltrials.gov on 13/09/2016 (registration number: NCT02898688).
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Affiliation(s)
- Matthew Z Dudley
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, W5041, Baltimore, MD, 21205, USA.
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Saad B Omer
- Yale Institute for Global Health, Yale School of Medicine, New Haven, USA
- Department of Infectious Diseases, Yale School of Medicine, New Haven, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, USA
| | - Sean T O'Leary
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N Revere Ct. Mailstop F443, Aurora, CO, 80045, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO, 80045, USA
| | - Rupali J Limaye
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, W5041, Baltimore, MD, 21205, USA
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Present address: Merck & Co., Inc., (at Emory University and the University of Nevada - not Merck - when work was performed), NJ, Kenilworth, USA
| | - Mallory K Ellingson
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA
| | - Christine I Spina
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N Revere Ct. Mailstop F443, Aurora, CO, 80045, USA
| | - Sarah E Brewer
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N Revere Ct. Mailstop F443, Aurora, CO, 80045, USA
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
- Emory Vaccine Center, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA
| | - Allison T Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
| | - Fauzia Malik
- Department of Health Policy and Management, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-0834, USA
| | - Paula M Frew
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, 2015 Uppergate Dr, Atlanta, GA, 30322, USA
- School of Public Health; School of Medicine; Population Health & Health Equity Initiative, Office of Research and Economic Development, University of Nevada, 4505 S. Maryland Pkwy, Las Vegas, NV, 89154, USA
- Present address: Merck & Co., Inc., (at Emory University and the University of Nevada - not Merck - when work was performed), NJ, Kenilworth, USA
| | - Cathy Church-Balin
- Center for Communication Programs, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Laura E Riley
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA
| | - Kevin A Ault
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Walter A Orenstein
- Emory Vaccine Center, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, 2015 Uppergate Dr, Atlanta, GA, 30322, USA
- Department of Pediatrics, School of Medicine, Emory University, 2015 Uppergate Dr, Atlanta, GA, 30322, USA
| | - Neal A Halsey
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, W5041, Baltimore, MD, 21205, USA
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, W5041, Baltimore, MD, 21205, USA
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Okruszek Ł, Piejka A, Banasik-Jemielniak N, Jemielniak D. Climate change, vaccines, GMO: The N400 effect as a marker of attitudes toward scientific issues. PLoS One 2022; 17:e0273346. [PMID: 36201440 PMCID: PMC9536546 DOI: 10.1371/journal.pone.0273346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 08/05/2022] [Indexed: 11/05/2022] Open
Abstract
While the psychological predictors of antiscience beliefs have been extensively studied, neural underpinnings of the antiscience beliefs have received relatively little interest. The aim of the current study is to investigate whether attitudes towards the scientific issues are reflected in the N400 potential. Thirty-one individuals were asked to judge whether six different issues presented as primes (vaccines, medicines, nuclear energy, solar energy, genetically-modified organisms (GMO), natural farming) are well-described by ten positive and ten negative target words. EEG was recorded during the task. Furthermore, participants were asked to rate their own expertise in each of the six topics. Both positive and negative target words related to GMO elicited larger N400, than targets associated with vaccines and natural farming. The results of the current study show that N400 may be an indicator of the ambiguous attitude toward scientific issues.
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Affiliation(s)
- Łukasz Okruszek
- Social Neuroscience Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
- * E-mail:
| | - Aleksandra Piejka
- Social Neuroscience Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | | | - Dariusz Jemielniak
- Management in Networked and Digital Societies (MINDS) Department, Kozminski University, Warsaw, Poland
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Pringle W, Greyson D, Graham JE, Dubé È, Mitchell H, Trottier MÈ, Berman R, Russell ML, MacDonald SE, Bettinger JA. Suitable but requiring support: How the midwifery model of care offers opportunities to counsel the vaccine hesitant pregnant population. Vaccine 2022; 40:5594-5600. [PMID: 35989134 DOI: 10.1016/j.vaccine.2022.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 06/02/2022] [Accepted: 07/27/2022] [Indexed: 11/28/2022]
Abstract
Uptake of vaccination during pregnancy in Canada is lower than comparator countries. A recommendation from a trusted perinatal healthcare provider is a key opportunity to promote vaccine uptake and improve confidence. This study aims to identify barriers and opportunities to vaccination in midwifery care. Seventeen semi-structured telephone interviews with practicing midwives, educators and public health professionals with immunization training experiences were conducted. Documents pertaining to the midwifery profession (approx. 50) were reviewed. Inductive thematic analysis identified logistical, interprofessional, and information barriers preventing Canadian midwives from administering vaccines and counseling clients about vaccination, as well as opportunities to address each barrier. Key interventions at the level of logistics, training, and client information materials would help address barriers to the integration of midwives into the provision and recommendation of vaccines in perinatal care across Canada.
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Affiliation(s)
- Wendy Pringle
- Vaccine Evaluation Center, University of British Columbia, 950 W 28th Ave, Vancouver, British Columbia V5Z 4H4, Canada.
| | - Devon Greyson
- Department of Communication, University of Massachusetts Amherst, Integrative Learning Center, 650 N Pleasant St, Amherst, Massachusetts 01003, USA; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada.
| | - Janice E Graham
- Department of Pediatrics, Dalhousie University, 5849 University Ave, C-309, P.O. Box 15000, Halifax, Nova Scotia B3H 4H7, Canada.
| | - Ève Dubé
- Quebec National Institute of Public Health, 945, av Wolfe, Quebec City, Quebec G1V 5B3, Canada.
| | - Hana Mitchell
- Vaccine Evaluation Center, University of British Columbia, 950 W 28th Ave, Vancouver, British Columbia V5Z 4H4, Canada; Department of Pediatrics, UBC Faculty of Medicine, Rm 2D19, 4480 Oak Street, BC Children's Hospital, Vancouver, BC V6H 3V4, Canada.
| | - Marie-Ève Trottier
- Quebec National Institute of Public Health, 945, av Wolfe, Quebec City, Quebec G1V 5B3, Canada.
| | - Robyn Berman
- Ottawa Birth and Wellness Centre, 2260 Walkley Rd, Ottawa, Ontario K1G 6A8, Canada.
| | - Margaret L Russell
- Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada.
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, Alberta T6G 1C9, Canada.
| | - Julie A Bettinger
- Vaccine Evaluation Center, University of British Columbia, 950 W 28th Ave, Vancouver, British Columbia V5Z 4H4, Canada; Department of Pediatrics, UBC Faculty of Medicine, Rm 2D19, 4480 Oak Street, BC Children's Hospital, Vancouver, BC V6H 3V4, Canada.
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8
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Yarnall JN, Seashore C, Phillipi CA, Hatch JE, King B, Hart C, Lohr JA. Timing of Vaccine Decision-Making Among First-Time Parents. Acad Pediatr 2022; 22:551-558. [PMID: 34748968 DOI: 10.1016/j.acap.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/04/2021] [Accepted: 10/19/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Decreased childhood vaccination can lead to local outbreaks of vaccine-preventable disease. In a pilot study from our group, 72% of parents of newborns reported initiating their vaccine decision-making for that child prior to conception. Since a sound understanding of the timing of parental vaccine decision-making is needed to direct educational efforts, we surveyed a national cohort of first-time parents to extend our preliminary findings. METHODS From March 2019 to March 2020, first-time parents of newborns in mother-baby units of the Better Outcomes through Research for Newborns (BORN) network completed the Vaccine Preference Development Survey (VPDS). The VPDS measures intent to vaccinate, timing of vaccine decision-making, and sources of influence. Univariate and multivariate analyses explored associations between intent to vaccinate and timing of vaccine decision-making with demographic variables. RESULTS Twenty-three sites provided surveys through site-specific nonrandom systemic sampling; 91% (1393/1524) of surveys were used in the analysis. Most parents planned to fully vaccinate (1191/1380, 86.3%) and started vaccine decision-making prior to conception (850/1378, 61.7%). Maternal age, race and ethnicity, relationship status, and education were all significantly associated with planning to fully vaccinate and preconception decision-making (P < .001). Preconception decision-making correlated strongly with intent to fully vaccinate (P < .001). Parents influenced by personal education, medical professionals, and family/friends were more likely to endorse preconception decision-making; those strongly influenced by internet/social media were less likely to allow all vaccines or start decision-making prior to conception. CONCLUSIONS Vaccine decision-making occurs preconception for most new parents. Initiating vaccine discussions during the birth hospitalization may be too late.
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Affiliation(s)
- J Nathan Yarnall
- Emory University School of Medicine (JN Yarnall), Atlanta, Ga; Children's Healthcare of Atlanta (JN Yarnall), Atlanta, Ga.
| | - Carl Seashore
- University of North Carolina School of Medicine (C Seashore, JE Hatch, C Hart, and JA Lohr), Chapel Hill, NC; UNC Health - Children's (C Seashore, C Hart), Chapel Hill, NC
| | | | - Joseph E Hatch
- University of North Carolina School of Medicine (C Seashore, JE Hatch, C Hart, and JA Lohr), Chapel Hill, NC
| | - Beth King
- Academic Pediatric Association (B King), McLean, Va
| | - Chayla Hart
- University of North Carolina School of Medicine (C Seashore, JE Hatch, C Hart, and JA Lohr), Chapel Hill, NC; UNC Health - Children's (C Seashore, C Hart), Chapel Hill, NC
| | - Jacob A Lohr
- University of North Carolina School of Medicine (C Seashore, JE Hatch, C Hart, and JA Lohr), Chapel Hill, NC
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Rubincam C, Greyson D, Haselden C, Saunders R, Bettinger JA. Is the pre-natal period a missed opportunity for communicating with parents about immunizations? Evidence from a longitudinal qualitative study in Victoria, British Columbia. BMC Public Health 2022; 22:237. [PMID: 35123432 PMCID: PMC8817524 DOI: 10.1186/s12889-022-12658-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 01/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background Growing evidence shows that many parents begin the decision-making process about infant vaccination during pregnancy and these decisions – once established – may be resistant to change. Despite this, many interventions targeting vaccination are focused on communicating with parents after their baby is born. This suggests that the prenatal period may constitute a missed opportunity for communicating with expectant parents about infant vaccination. Methods Using a longitudinal qualitative design, we conducted two interviews (prepartum and postpartum) with women (n = 19) to explore the optimal timing of vaccination information. The data were analyzed thematically, and examined across all sets of pre- and post-partum interviews as well as within each individual participant to draw out salient themes. Results Most participants formed their intentions to vaccinate before the baby was born and indicated that they would welcome information about vaccination from their maternity care providers. However, few individuals recalled their maternity care providers initiating vaccination-related conversations with them. Conclusion The prenatal period is an important time to begin conversations with expectant parents about vaccinating their infants, particularly if these conversations are initiated by trusted maternity care providers. More information is needed on how maternity care providers can be better supported to have these conversations with their patients.
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10
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Abdel-Qader DH, Hayajneh W, Albassam A, Obeidat NM, Belbeisi AM, Al Mazrouei N, Al-Shaikh AF, Nusair KE, Al Meslamani AZ, El-Shara AA, El Sharu H, Mohammed Ebaed SB, Mohamed Ibrahim O. Pharmacists-physicians collaborative intervention to reduce vaccine hesitancy and resistance: A randomized controlled trial. Vaccine X 2022; 10:100135. [PMID: 34977553 PMCID: PMC8712432 DOI: 10.1016/j.jvacx.2021.100135] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Given their negative influence on community health, vaccine hesitancy and resistance are emerging challenges that require healthcare intervention. Therefore, this study aimed to assess the impact of physician-pharmacist collaborative health coaching on rates of hesitancy and resistance for a COVID-19 vaccine. Methods After an initial assessment of rates of hesitancy and resistance for a COVID-19 vaccine was conducted, hesitant and resistant participants were approached, recruited, and randomized into an active and control group. Pharmacists-physicians collaborative coaching intervention was delivered to active group subjects over two months through Facebook live sessions. The outcome measures were assessed in both groups before coaching, directly after coaching, and a month after coaching. Results The proportions of hesitancy and resistance for a COVID-19 vaccine among subjects in the active group were significantly reduced from 64.3% and 35.7% before coaching to 20.1% and 7.8% directly after coaching, respectively. These proportions were further reduced to 11.1% and 3.3% a month after coaching, respectively. Furthermore, the mean scores for knowledge on, and attitude towards COVID-19 vaccine were significantly increased from 4.6 ± 1.8 and 4.1 ± 1.7 before coaching to 7.5 ± 3.1 and 8.9 ± 3.8 directly after coaching, respectively. However, the change in mean score of beliefs about COVID-19 vaccines among active group subjects was not significant. Conclusion High rates of hesitancy and resistance for a COVID-19 vaccine were found in Jordan. These rates can be significantly reduced through online pharmacists-physicians collaborative coaching, which can also improve knowledge of and attitude towards COVID-19 vaccines.
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Affiliation(s)
| | | | - Abdullah Albassam
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait
| | | | | | - Nadia Al Mazrouei
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, United Arab Emirates
| | | | | | - Ahmad Z Al Meslamani
- College of Pharmacy, Al Ain University of Science and Technology, Abu Dhabi, United Arab Emirates
| | | | - Husam El Sharu
- Indiana University Center for Health Innovation and Implementation Science, Indianapolis, IN, USA
| | | | - Osama Mohamed Ibrahim
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Egypt.,Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, United Arab Emirates
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11
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Thompson P. Incomplete Vaccinations: Considering What Comes Before the Model. J Pediatric Infect Dis Soc 2021:piab070. [PMID: 34343325 DOI: 10.1093/jpids/piab070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/22/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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12
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van Zoonen K, Ruijs WLM, De Melker HE, Bongers MEJ, Mollema L. How to increase awareness of additional vaccinations; the case of maternal pertussis vaccination. BMC Public Health 2021; 21:1257. [PMID: 34187436 PMCID: PMC8244209 DOI: 10.1186/s12889-021-11344-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective and safe vaccines are available outside national immunization programs (NIP). Increased awareness and vaccine uptake can improve public health. Before the inclusion of maternal pertussis vaccination (MPV) in the Dutch NIP in December 2019, extra communication efforts were undertaken. Here we examine the success of these efforts, investigating women's awareness of and their decision-making process regarding MPV. METHODS Between December 2018 and January 2019, one year before the introduction of MPV in the NIP, and about three years after MPV was recommended by the Dutch Health Council, pregnant and non-pregnant women (i.e. child younger than two years) were invited to fill out an online questionnaire. Participant's decision-making processes regarding MPV were assessed with an adapted Precaution Adoption Process Model (PAPM), including stages of awareness, engagement, information-seeking, and vaccination behaviour. Furthermore, factors related to the decision-making process were examined. RESULTS In total, 942 women were included, of whom 62% were non-pregnant. Most of the pregnant and nonpregnant women were aware of MPV during pregnancy (respectively 69 and 56%). Most aware women had heard about MPV through their midwife and the Public Health Institute (PHI) website. Women unaware of MPV reported a need for information, preferably from their midwives. Most aware women felt MPV was important to them (88%) and were classified as "engaged". Of the eligible and "engaged" pregnant women, 58% were vaccinated, versus 38% of "engaged" non-pregnant women. CONCLUSIONS As the most preferred and trusted source of information, midwives are essential to increasing awareness of MPV. The PHI website is considered to be a reliable information source and is often consulted. To increase awareness, appropriate healthcare workers should be encouraged to actively inform target groups about available, additional vaccinations.
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Affiliation(s)
- K van Zoonen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - W L M Ruijs
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands
| | - H E De Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands
| | - M E J Bongers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands
| | - L Mollema
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands
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13
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Fuchs EL, Hirth JM, Guo F, Brown VG, Cofie L, Berenson AB. Infant vaccination education preferences among low-income pregnant women. Hum Vaccin Immunother 2021; 17:255-258. [PMID: 32460665 PMCID: PMC7872064 DOI: 10.1080/21645515.2020.1764272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Childhood vaccination is an important public health intervention, yet many children remain under-vaccinated. The objective of this study was to examine infant vaccination education preferences in a population of low-income pregnant women by ethnicity, nativity, and language. Pregnant women 14–44 y old (n = 335) attending a participating low-income reproductive health clinic in southeast Texas from May 26-July 21, 2017, and who completed a paper survey offered in English and Spanish were included. Participants were asked to complete questions about their demographic characteristics and preferences about infant vaccination education. To examine differences in vaccine education preferences by participant demographic characteristics, chi-squared tests, or Fisher’s exact tests and one-way analysis of variance (ANOVA) were conducted using Stata SE Version 15.1 with α = 0.05. Nearly half (47.5%) of participants considered pregnancy the best time to get information about infant vaccination and were most likely (40.6%) to indicate the nurse who gives vaccines during pregnancy as the health-care worker with whom they would like to discuss infant vaccination. There were no demographic differences in preferred timing of vaccine education delivery or provider who delivers vaccine education. Prenatal, nurse-delivered vaccine educational programs would be well accepted in this low-income population.
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Affiliation(s)
- Erika L Fuchs
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch , Galveston, TX, USA.,Sealy Institute for Vaccine Sciences, University of Texas Medical Branch , Galveston, TX, USA
| | - Jacqueline M Hirth
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch , Galveston, TX, USA
| | - Fangjian Guo
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch , Galveston, TX, USA
| | - V Gnaukita Brown
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch , Galveston, TX, USA
| | - Leslie Cofie
- College of Health and Human Performance, East Carolina University , Greenville, NC, USA
| | - Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch , Galveston, TX, USA
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14
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Communicating with Parents About Vaccines. Vaccines (Basel) 2021. [DOI: 10.1007/978-3-030-58414-6_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Abstract
Although vaccine acceptance and uptake are overall high among children in the United States, vaccine delays or refusals are a growing concern. Vaccine hesitancy is a challenge for the pediatric provider, given the diverse factors associated with hesitancy and the limited evidence on effective strategies for addressing vaccine hesitancy in the provider office. In this article, we review available evidence and approaches for vaccine communication, including the importance of using a whole-team approach, building trust, starting the conversation early, using a presumptive approach for vaccine recommendations, motivational interviewing with parents who have concerns for vaccines, and additional techniques for responding to parent questions. We also review organizational strategies to help create a culture of immunization in the practice, including evidence-based approaches for increasing vaccine uptake and efficiency. Although these communication approaches and organizational strategies are intended to reassure parents who are vaccine hesitant that all routine, universally recommended vaccines are safe and effective, they likely will take on increased significance as the development, implementation, and evaluation of coronavirus disease 2019 vaccines continue to unfold. [Pediatr Ann. 2020;49(12):e523-e531.].
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16
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Sugishita Y, Kurita J, Akagi T, Sugawara T, Ohkusa Y. Determinants of Vaccination Coverage for the Second Dose of Measles-Rubella Vaccine in Tokyo, Japan. TOHOKU J EXP MED 2020; 249:265-273. [PMID: 31852852 DOI: 10.1620/tjem.249.265] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In Japan, some measles outbreaks were initiated by a tourist from oversea and foreign workers recently. Moreover, rubella outbreak emerged since July 2018 mainly in the South Kanto, and the outbreak is currently ongoing in 2019. It is important to maintain a high measles-rubella combined vaccine (MR) coverage for measles-rubella control. Vaccination coverage for the second dose of MR (MR2) is 90.8% in Tokyo in 2016, which was the third worst among all prefectures in Japan. The purpose of this study was to clarify determinant factors of vaccination coverage for MR2 in Tokyo. Data were obtained for 49 wards and cities in Tokyo in 2016. We regressed vaccination coverage of MR2 on the times of notification by mail, the proportion of households receiving welfare payments, and the proportion of non-Japanese elementary school students. In addition to the simplest specification, five factors were included separately as explanatory variables: the proportion of public health nurses; the ratio of the number of pediatric medical facilities to the number of preschool and elementary school children; the moving-in rate; the proportion of households with a single parent; and the proportion of households with husband and wife both working. Results show that a high proportion of households receiving welfare payments, notification by two or more letters, and moving-in rate or a lower proportion of non-Japanese elementary school students improve coverage. In conclusion, the health authorities can exert efforts to reduce burden of time spent for vaccination and provide sufficient information to improve coverage.
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Affiliation(s)
- Yoshiyuki Sugishita
- Infectious Disease Control Section, Health and Safety Division, Bureau of Social Welfare and Public Health, Tokyo Metropolitan Government.,National Institute of Infectious Diseases
| | - Junko Kurita
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences
| | - Takanobu Akagi
- Infectious Disease Control Section, Health and Safety Division, Bureau of Social Welfare and Public Health, Tokyo Metropolitan Government
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17
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Dudley MZ, Limaye RJ, Omer SB, O'Leary ST, Ellingson MK, Spina CI, Brewer SE, Chamberlain AT, Bednarczyk RA, Malik F, Frew PM, Salmon DA. Characterizing the vaccine knowledge, attitudes, beliefs, and intentions of pregnant women in Georgia and Colorado. Hum Vaccin Immunother 2020; 16:1109-1117. [PMID: 32078395 PMCID: PMC7227625 DOI: 10.1080/21645515.2020.1717130] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Vaccine coverage for maternal vaccines is suboptimal; only about half of pregnant women received influenza and Tdap vaccines in 2018. We explored knowledge, attitudes, beliefs, intentions, and trust regarding maternal and infant vaccines among pregnant women. Between June 2017 and July 2018, we surveyed 2196 pregnant women recruited from geographically and socio-demographically diverse prenatal care practices in Georgia and Colorado (56% response rate). Fifty-six percent of pregnant women intended to receive both influenza and Tdap vaccines during pregnancy and 68% intended to vaccinate their baby with all recommended vaccines on time. Attitudinal constructs associated with intention to vaccinate include confidence in vaccine safety (ORs: 16–38) and efficacy (ORs: 4–19), perceived risk of vaccine-preventable diseases (ORs: 2–6), social norms (ORs: 4–10), and trust in sources of vaccine information. Women pregnant with their first child were less likely than women who had prior children to intend to vaccinate themselves and their children, more likely to be unsure about their intentions to receive both maternal and infant vaccines, and less likely to report feeling they had enough knowledge or information about vaccines and vaccine safety (p < .01). This demonstrates an opportunity for vaccine education to increase vaccine confidence and informed decision-making, especially among first-time pregnant women.
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Affiliation(s)
- Matthew Z Dudley
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rupali J Limaye
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saad B Omer
- Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA.,Yale Institute for Global Health, New Haven, CT, USA.,Yale School of Medicine, Infectious Diseases, Yale New Haven Hospital, New Haven, CT, USA
| | - Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA.,Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mallory K Ellingson
- Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Christine I Spina
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Sarah E Brewer
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA.,Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Allison T Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Robert A Bednarczyk
- Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Emory Vaccine Center, Emory University, Atlanta, GA, USA
| | - Fauzia Malik
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Paula M Frew
- School of Community Health Sciences and Office of Research and Economic Development, University of Nevada, Las Vegas, NV, USA.,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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18
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Justwan F, Baumgaertner B, Carlisle JE, Carson E, Kizer J. The effect of trust and proximity on vaccine propensity. PLoS One 2019; 14:e0220658. [PMID: 31461443 PMCID: PMC6713324 DOI: 10.1371/journal.pone.0220658] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/19/2019] [Indexed: 01/21/2023] Open
Abstract
The main goal of this paper is to study the effects of (1) trust in government medical experts and (2) proximity to a recent disease outbreak on vaccine propensity. More specifically, we explore how these variables affect attitudes with regards to measles. Using original survey data, collected in January/February 2017, we obtain three main empirical findings. First, contrary to our expectations, an individual's proximity to a recent measles outbreak has no independent effect on vaccination attitudes. Second, corroborating previous studies in the field, we find that trust in institutions such as the CDC has a positive effect on our dependent variable. Third, there is a significant interactive relationship between proximity and trust in governmental medical experts. While distance from a previous measles outbreak has no effect on vaccination attitudes for respondents with medium or high levels of trust, the variable exerts a negative effect for subjects with little confidence in government medical experts. In other words: low-trust individuals who live farther away from a recent measles outbreak harbor less favorable views about vaccination for this particular disease than low-trust respondents who live close to an affected area. This implies that citizens who are skeptical of the CDC and similar institutions base their vaccination decision-making to some degree on whether or not a given disease occurs in close vicinity to their community.
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Affiliation(s)
- Florian Justwan
- Department of Politics and Philosophy, University of Idaho, Moscow, Idaho, United States of America
| | - Bert Baumgaertner
- Department of Politics and Philosophy, University of Idaho, Moscow, Idaho, United States of America
| | - Juliet E. Carlisle
- Department of Political Science, University of Utah, Salt Lake City, Utah, United States of America
| | - Emma Carson
- Independent Researcher, Moscow, Idaho, United States of America
| | - Jordan Kizer
- Lyndon B. Johnson School of Public Affairs, University of Texas, Austin, Texas, United States of America
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19
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Scott VP, Opel DJ, Reifler J, Rikin S, Pethe K, Barrett A, Stockwell MS. Office-Based Educational Handout for Influenza Vaccination: A Randomized Controlled Trial. Pediatrics 2019; 144:peds.2018-2580. [PMID: 31292219 DOI: 10.1542/peds.2018-2580] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess the impact of a parent educational intervention about influenza disease on child vaccine receipt. METHODS A convenience sample of parents of children ≥6 months old with a visit at 2 New York City pediatric clinics between August 2016 and March 2017 were randomly assigned (1:1:1) to receive either usual care, an educational handout about influenza disease that was based on local data, or an educational handout about influenza disease that was based on national data. Parents received the handout in the waiting room before their visit. Primary outcomes were child influenza vaccine receipt on the day of the clinic visit and by the end of the season. A multivariable logistic regression was used to assess associations between intervention and vaccination, with adjustment for variables that were significantly different between arms. RESULTS Parents who received an intervention (versus usual care) had greater odds of child influenza vaccine receipt by the end of the season (74.9% vs 65.4%; adjusted odds ratio 1.68; 95% confidence interval: 1.06-2.67) but not on the day of the clinic visit. Parents who received the national data handout (versus usual care) had greater odds of child influenza vaccine receipt on the day of the clinic visit (59.0% vs 52.6%; adjusted odds ratio 1.79; 95% confidence interval: 1.04-3.08) but not by the end of the season. CONCLUSIONS Providing an educational intervention in the waiting room before a pediatric provider visit may help increase child influenza vaccine receipt.
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Affiliation(s)
- Vanessa P Scott
- Departments of Pediatrics.,NewYork-Presbyterian Hospital, New York, New York
| | - Douglas J Opel
- Department of Pediatrics, School of Medicine, University of Washington and Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, Washington; and
| | - Jason Reifler
- Department of Politics, University of Exeter, Exeter, United Kingdom
| | - Sharon Rikin
- NewYork-Presbyterian Hospital, New York, New York.,Medicine, and
| | - Kalpana Pethe
- Departments of Pediatrics.,NewYork-Presbyterian Hospital, New York, New York
| | | | - Melissa S Stockwell
- Departments of Pediatrics, .,NewYork-Presbyterian Hospital, New York, New York.,Population and Family Health, Columbia University, New York, New York
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20
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Kaufman J, Attwell K, Hauck Y, Omer SB, Danchin M. Vaccine discussions in pregnancy: interviews with midwives to inform design of an intervention to promote uptake of maternal and childhood vaccines. Hum Vaccin Immunother 2019; 15:2534-2543. [PMID: 31124728 PMCID: PMC6930050 DOI: 10.1080/21645515.2019.1607131] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/21/2019] [Accepted: 04/06/2019] [Indexed: 01/06/2023] Open
Abstract
Presumptive and Motivational Interviewing communication styles have successfully promoted childhood and adolescent vaccination to parents, but less is known about effective communication approaches during pregnancy to promote maternal vaccination and childhood vaccines. In Australian public antenatal settings, midwives provide a substantial proportion of care and are highly accessed and trusted sources of vaccine information for expectant parents. However, there are no evidence-based interventions incorporating communication strategies and resources for midwives to optimize discussions and promote acceptance of maternal and childhood vaccines. This study aimed to gather qualitative data from midwives to inform the design of a feasible and acceptable vaccine communication intervention package building on an evidence-based model utilized with US obstetricians. We explored midwives' attitudes and values regarding maternal and childhood vaccination, their perceived role in vaccine advocacy and delivery, and barriers and enablers to implementation of a potential communication intervention. We recruited 12 midwives for semi-structured interviews at two Australian tertiary public hospitals (one with antenatal vaccines onsite, one without). Interviews were analyzed using thematic template analysis. Midwives supported vaccination but expressed varied views regarding its centrality to their role. Most reported receiving minimal or no training on vaccine communication. Their communication practices focused primarily on vaccine information provision rather than persuasion, although some midwives shared personal views and actively encouraged vaccination. More vaccine and communication training and resources were requested. Findings highlight the need for communication tools that align with midwifery standards for practice to support midwives to address parents' questions and concerns about maternal and childhood vaccines.
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Affiliation(s)
- Jessica Kaufman
- Vaccine and Immunisation Research Group (VIRGo), Murdoch Children‘s Research Institute, Parkville, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Katie Attwell
- School of Social Sciences, University of Western Australia, Perth, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Telethon Kids
| | - Yvonne Hauck
- School of Nursing, Midwifery & Paramedicine, Curtin University, Perth, Australia
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Australia
| | - Saad B. Omer
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Margie Danchin
- Vaccine and Immunisation Research Group (VIRGo), Murdoch Children‘s Research Institute, Parkville, Australia
- Telethon Kids
- Department of General Medicine, The Royal Children‘s Hospital, Parkville, Australia
- Department of Paediatrics and School of Population and Global Health, University of Melbourne, Melbourne, Australia
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21
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Fuchs EL, Starkey JM, Rupp RE, Berenson AB. Prenatal vaccination of mothers and hepatitis B vaccination of their infants. Prev Med 2019; 121:68-73. [PMID: 30763628 PMCID: PMC6399050 DOI: 10.1016/j.ypmed.2019.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/02/2019] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination and influenza vaccination are recommended during pregnancy primarily to prevent influenza and pertussis in mothers and their infants. This study examines associations between prenatal Tdap vaccination and influenza vaccination of mothers and hepatitis B vaccination of their infants. A retrospective cohort study was conducted using data from electronic medical records from 15,468 deliveries to 14,925 mothers occurring April 2, 2014-December 3, 2016 at a university hospital in Texas. Hepatitis B vaccine receipt in the first 3 days of life was dichotomized. Margins post-estimation commands in Stata SE 15.1 were used to obtain predicted probabilities and risk differences after estimating odds ratios in logistic regression with robust variance estimates. Adjusted models included maternal age, race/ethnicity, Medicaid use, year of delivery, parity, and gravidity. Infants of mothers who received prenatal influenza vaccination in the 2014-2015 and 2015-2016 influenza seasons were more likely than those of mothers who did not to receive a hepatitis B vaccine in their first 3 days of life (adjusted risk difference (RD) 2.8%, 95% confidence interval (CI) 1.5-4.1% and RD 2.2%, 95% CI 0.9-3.5%, respectively). Hepatitis B vaccination was also higher among infants of Tdap-eligible mothers who received prenatal Tdap vaccination during pregnancy compared to those of mothers who did not (adjusted RD 9.1%, 95% CI 7.6-10.5%). Overall, prenatal vaccination was significantly associated with uptake of infant hepatitis B vaccine.
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Affiliation(s)
- Erika L Fuchs
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0587, USA.
| | - Jonathan M Starkey
- Institute for Translational Sciences & Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0587, USA.
| | - Richard E Rupp
- Sealy Institute for Vaccine Sciences, Department of Pediatrics, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0587, USA.
| | - Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0587, USA.
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22
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Hu Y, Chen Y, Liang H, Wang Y. Reliability and validity of a survey to identify vaccine hesitancy among parents in Changxing county, Zhejiang province. Hum Vaccin Immunother 2019; 15:1092-1099. [PMID: 30676850 DOI: 10.1080/21645515.2019.1572409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND To evaluate the validity and reliability of a survey to identify vaccine hesitancy among parents. METHODS Cross-sectional survey of parents of 19-35 month old children was conducted in Changxing County, Zhejiang Province, through a questionnaire developed for the survey of the vaccine hesitancy. Construct validity was assessed by linking parental responses to their child's immunization record. The association between mean% of days of under-immunization and the parental socio-demographics and the individual item response was explored via the univariate and multivariate analyses. Factor analysis was applied to confirm survey sub-domains and Cronbach's α to determine the internal consistency reliability of sub-domain scales. RESULTS We approached 336 households while 285 of them agreed to participate in this study. Education level and the parental 'score of vaccination hesitancy' were significantly associated with the mean% of days of under-immunization. Cronbach's coefficients for the 3 sub-domain scales created by re-grouping the questionnaire's items were 0.71, 0.83, and 0.72, respectively. CONCLUSIONS The survey represented a valid and reliable instrument to identify VHPs and it could help to screen parents to receive an intervention aimed at increasing acceptance of vaccinations.
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Affiliation(s)
- Yu Hu
- a Institute of Immunization and Prevention , Zhejiang Center for Disease Control and Prevention , Hangzhou , China
| | - Yaping Chen
- a Institute of Immunization and Prevention , Zhejiang Center for Disease Control and Prevention , Hangzhou , China
| | - Hui Liang
- a Institute of Immunization and Prevention , Zhejiang Center for Disease Control and Prevention , Hangzhou , China
| | - Ying Wang
- a Institute of Immunization and Prevention , Zhejiang Center for Disease Control and Prevention , Hangzhou , China
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Bednarczyk RA. Addressing HPV vaccine myths: practical information for healthcare providers. Hum Vaccin Immunother 2019; 15:1628-1638. [PMID: 30676241 DOI: 10.1080/21645515.2019.1565267] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Human papillomavirus (HPV) vaccine uptake consistently lags behind that of other adolescent vaccines. In 2017, uptake of a single HPV vaccine dose and HPV vaccine series completion was 66% and 49%, respectively, compared to uptake of tetanus, diphtheria, and acellular pertussis vaccine (89%) and quadrivalent meningococcal conjugate vaccine (85%). Reasons for not vaccinating adolescents again HPV are varied, and in many cases, are rooted in commonly spread myths and misperceptions about the vaccine. In this review, we address five key myths - HPV vaccination is not effective at preventing cancer; Pap smears are sufficient to prevent cervical cancer; HPV vaccination is not safe; HPV vaccination is not needed since most infections are naturally cleared by the immune system; 11-12 years of age is too young to vaccinate. For each myth, we summarize the scientific evidence refuting the myth and provide speaking prompts for healthcare professionals to communicate about HPV vaccination.
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Affiliation(s)
- Robert A Bednarczyk
- a Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta GA , USA.,b Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta GA , USA.,c Cancer Prevention and Control Program, Winship Cancer Institute, Emory University , Atlanta GA , USA.,d Emory Vaccine Center, Emory University , Atlanta GA , USA
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24
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Bianco A, Mascaro V, Zucco R, Pavia M. Parent perspectives on childhood vaccination: How to deal with vaccine hesitancy and refusal? Vaccine 2019; 37:984-990. [DOI: 10.1016/j.vaccine.2018.12.062] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 12/12/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
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O'Leary ST, Brewer SE, Pyrzanowski J, Barnard J, Sevick C, Furniss A, Dempsey AF. Timing of Information-Seeking about Infant Vaccines. J Pediatr 2018; 203:125-130.e1. [PMID: 30195554 DOI: 10.1016/j.jpeds.2018.07.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/21/2018] [Accepted: 07/11/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess among pregnant and recently delivered women the timing of thinking about and seeking information about childhood vaccines and the preferred modes of vaccine education. STUDY DESIGN An e-mail survey among women in 9 urban and rural obstetrics practices in Colorado was conducted from February to April 2014, timed so that approximately one-half had delivered and one-half were still pregnant, designed to assess the frequency of thinking about and seeking information about vaccines in relation to estimated or actual delivery date. A shortened version of the Parental Attitudes About Childhood Vaccines scale was used to assess vaccine hesitancy. RESULTS The response rate was 54% (230 of 425); 56% were pregnant, 44% had delivered, and 18% were vaccine-hesitant. Compared with pregnant women, women who had delivered more often reported thinking about vaccines for their infant (pregnant: 19% often, 42% sometimes; delivered: 29% often, 51% sometimes; P < .05) and looking for information about vaccines (pregnant: 6% often, 22% sometimes; delivered: 16% often, 34% sometimes; P < .01). Women most frequently reported seeking information about vaccines 2-4 weeks after delivery, followed by 4-6 weeks after delivery. The most preferred method for vaccine education was their child's doctor (95% acceptable; 92% likely to use) followed by their obstetrician (79% acceptable; 64% likely to use). CONCLUSIONS Within 6 weeks postdelivery appears to be when the most women seek vaccine information. A child's doctor remains the most acceptable source of vaccine education.
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Affiliation(s)
- Sean T O'Leary
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado/Children's Hospital Colorado, Aurora, CO.
| | - Sarah E Brewer
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado/Children's Hospital Colorado, Aurora, CO
| | - Jennifer Pyrzanowski
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado/Children's Hospital Colorado, Aurora, CO
| | - Juliana Barnard
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado/Children's Hospital Colorado, Aurora, CO
| | - Carter Sevick
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado/Children's Hospital Colorado, Aurora, CO
| | - Anna Furniss
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado/Children's Hospital Colorado, Aurora, CO
| | - Amanda F Dempsey
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado/Children's Hospital Colorado, Aurora, CO
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Kraśnicka J, Krajewska-Kułak E, Klimaszewska K, Cybulski M, Guzowski A, Kowalewska B, Jankowiak B, Rolka H, Doroszkiewicz H, Kułak W. Mandatory and recommended vaccinations in Poland in the views of parents. Hum Vaccin Immunother 2018; 14:2884-2893. [PMID: 30257128 DOI: 10.1080/21645515.2018.1496766] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Background: Vaccinations are currently the key element in the prevention of the spread of infectious diseases. We studied parents' opinions about mandatory and recommended preventive vaccinations in Poland. Methods: A diagnostic survey using an original questionnaire was done in a group of 300 parents. Results: A total of 3.7% of parents did not vaccinate their children. 90% were aware of the threat potentially posed by infectious diseases, and 73.7% knew that breastfeeding alone does not ensure sufficient protection against them. 28% believed that it is necessary to vaccinate a child against all diseases, 51.7% that the number of vaccinations is insufficient, and 62.7% that vaccine use is safe. 40.7% thought that unvaccinated children should not be able to attend nurseries and kindergartens, as they pose a threat to other children. Postvaccinal adverse events occurred in 21.3% of children, mainly (71.9%) an increase in body temperature above 38°C. 88.3% were informed about possible vaccine-induced complications, most often by nurses (79.7%). 88% of the respondents were aware of the possibility to switch to an alternative immunization program, 92% were informed on the possible administration of recommended vaccines, and 53% took advantage of combined vaccines. Conclusions: Views on vaccinations were mostly varied, depending on the age, sex, education, and financial situation of the respondents. Most of the parents who did not vaccinate their children believed that immunity can be acquired by infection. They were in favor of a limited number of vaccinations, were more critical of the vaccination program in Poland, considered the vaccines used in Poland to be unsafe, and blamed vaccines for multiple developmental defects and autism in children. Parents whose children experienced vaccine-induced adverse reactions were more likely to have doubts before the next vaccination.
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Affiliation(s)
- Jolanta Kraśnicka
- a Family Doctors Clinic "Pro Medica Centrum" in Białystok , Białystok , Poland
| | | | - Krystyna Klimaszewska
- b Department of Integrated Medical Care , Medical University of Bialystok , Białystok , Poland
| | - Mateusz Cybulski
- b Department of Integrated Medical Care , Medical University of Bialystok , Białystok , Poland
| | - Andrzej Guzowski
- b Department of Integrated Medical Care , Medical University of Bialystok , Białystok , Poland
| | - Beata Kowalewska
- b Department of Integrated Medical Care , Medical University of Bialystok , Białystok , Poland
| | - Barbara Jankowiak
- b Department of Integrated Medical Care , Medical University of Bialystok , Białystok , Poland
| | - Hanna Rolka
- b Department of Integrated Medical Care , Medical University of Bialystok , Białystok , Poland
| | - Halina Doroszkiewicz
- c Department of Geriatrics , Medical University of Bialystok , Białystok , Poland
| | - Wojciech Kułak
- d Department of Pediatric Rehabilitation , Medical University of Bialystok , Białystok , Poland
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Okeibunor J, Mihigo R, Anya B, Zawaira F. Five-year experience of African Vaccination Week implemented by the WHO Regional Office. JOURNAL OF IMMUNOLOGICAL SCIENCES 2018; Suppl:10-16. [PMID: 30687850 PMCID: PMC6345372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The 5th edition of the African Vaccination Week (AVW) kicked off in Lusaka, Zambia, on 23 April 2016, the same day as did the 4th World Immunization Week (WIW), and vaccination week in other WHO regions. The theme was "Save lives, prevent disabilities, vaccinate!". The aim was to draw attention to the need to attain universal immunization coverage in the African Region by closing the immunization gap, while also celebrating the important polio eradication milestone reached in the African Region. Twenty-eight (59.6%) of the 47 countries in the African Region celebrated the AVW within the regionally set dates of 24th to 30th April 2015. However, given its flexibility, the celebration continued until September in 15 other countries in the Region. Three countries, namely Comoros, Gabon, and Cape Verde did not join the celebration for the 2015 edition of the AVW. Countries used the opportunity to introduce new vaccines into their routine immunization. Populations, hitherto unreached with basic health services were reached with needed services, such as vitamin A supplementation, deworming, and catch up immunization services. The programmes promoted awareness of the benefits of vaccines and the rights of communities to demand vaccines and immunization services to save lives and prevent disabilities. The number of participating countries rose steadily from 40 in 2011 to 43 and 46 countries in 2013 and 2014 respectively. The number ranged from one intervention integrated with AVW in 17 countries to 5 interventions integrated with the AVW in three countries. In 2015, 67.4% of the participating countries integrated other interventions with AVW activities.
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Affiliation(s)
| | | | - Blanche Anya
- WHO Regional Office for Africa, Brazzaville, Congo
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Massot E, Epaulard O. Midwives' perceptions of vaccines and their role as vaccinators: The emergence of a new immunization corps. Vaccine 2018; 36:5204-5209. [PMID: 29970300 DOI: 10.1016/j.vaccine.2018.06.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/18/2018] [Accepted: 06/23/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND In France, midwives have recently been authorized to administer various vaccines to women (including pregnant women), newborns, and their family members. This is expected to enhance vaccine coverage. However, the French high level of vaccine hesitancy is also observed in some healthcare workers. We thus aimed to determine the perceptions of French midwives concerning vaccines. METHODS We distributed an anonymous online questionnaire between September and December 2017, targeting midwives who were still in training or working in the public or private sector. RESULTS A total of 917 questionnaires were analyzed (median age 26 years). Almost half of participants (44.5%) were students. On a scale of 0-100, the median perception of the usefulness, safety, and trust of vaccinations were 92, 80, and 85, respectively. The mean scores of students were significantly higher for each perception, whereas in professional midwives, age and perceptions were negatively correlated. When asked whether there were scientific, philosophical, or religious arguments not to vaccinate, 83.2%, 69.8%, and 77.8% of participants disagreed, respectively. The vast majority (91.6%) was very or mostly favorable to the pertussis vaccine after delivery, but only around half (51.5%) to the influenza vaccine during pregnancy; those favorable to the pertussis vaccine were younger. A high proportion of participants (88.3%) considered that midwives were in a good position to vaccinate, with this proportion being even higher among students. CONCLUSIONS These results suggest that the recent authorization regarding vaccine administration will result in better vaccine coverage of pregnant women and their families by midwives. The better perceptions of younger participants are also encouraging. However, the level of trust in vaccinations (only 80.1%) and the low number of participants favorable to the influenza vaccine during pregnancy suggest that initial and continuous training should be reinforced.
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Affiliation(s)
- Estelle Massot
- Midwifery School, University Grenoble-Alpes, Grenoble, France
| | - Olivier Epaulard
- Department of Infectious Diseases - Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France; Fédération d'Infectiologie Multidisciplinaire de l'Arc Alpin - Université Grenoble-Alpes, Grenoble, France.
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Corben P, Leask J. Vaccination hesitancy in the antenatal period: a cross-sectional survey. BMC Public Health 2018; 18:566. [PMID: 29716556 PMCID: PMC5930425 DOI: 10.1186/s12889-018-5389-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/28/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Recent reports of childhood vaccination coverage in Australia have shown steadily improving vaccination coverage and narrowing differences between highest and lowest coverage regions, yet the NSW North Coast consistently has the lowest coverage rates nationally. Better understanding of parents' vaccination attitudes and actions within this region may guide strategies to improve uptake. The antenatal period is when many parents explore and consolidate vaccination attitudes and so is pivotal for study. METHODS Women attending public antenatal clinics at six NSW North Coast hospitals completed a 10-min cross-sectional survey capturing stage of decision-making and decisional-conflict as well as vaccination hesitancy, attitudes, intentions and actions. Unscored responses were analysed for individual items. Decisional conflict subscales were scored using published algorithms. For consented children, immunisation status was assessed at 8 months using the Australian Immunisation Register. For Likert scale items, odds ratios and Fisher's exact, chi-squared and Chasson's tests assessed differences between subgroups. Wilcoxon rank-sum tests assessed differences between subgroups for items on scales of 0-to-10 and decisional conflict sub-scale scores. RESULTS First-time mothers were 3 times more likely than others (OR = 3.40, 95% CI 1.34-8.60) to identify as unsure, somewhat or very hesitant. Most respondents (92.2%) wanted their new baby to receive all recommended vaccinations. Many had high or moderate levels of concern about vaccine side effects (25.4%), safety (23.6%) and effectiveness (23.1%). Increased hesitancy was associated with decreased confidence in the schedule (p < 0.001), decreased trust in child's doctor (p < 0.0001), decreased perceived protection from disease (p < 0.05) and increased decisional conflict on all measured subscales (p < 0.0001). First-time mothers had higher decisional conflict on values clarity, support and uncertainty sub-scales. By 8 months of age, 83.2% of infants were fully vaccinated. Those with none or a few minor concerns were over 8 times more likely than others to vaccinate on schedule (OR = 8.7, 1.3-56.7). CONCLUSIONS Importantly this study provides further strong justification to talk with women about vaccination during pregnancy and particularly to ensure that first-time mothers are offered assistance in making these important decisions, where indicated. Further research should focus on optimising the timing, content and delivery style of perinatal interventions.
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Affiliation(s)
- Paul Corben
- Director, North Coast Public Health, Mid North Coast Local Health District, PO Box 126, Port Macquarie, NSW 2444 Australia
| | - Julie Leask
- Associate Professor, Sydney Nursing School and, Principal Research Fellow, School of Public Health, University of Sydney, 88 Mallett Street (MO2), Sydney, NSW 2050 Australia
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Cunningham RM, Minard CG, Guffey D, Swaim LS, Opel DJ, Boom JA. Prevalence of Vaccine Hesitancy Among Expectant Mothers in Houston, Texas. Acad Pediatr 2018; 18:154-160. [PMID: 28826731 DOI: 10.1016/j.acap.2017.08.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 07/26/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Nonmedical exemptions continue to rise because of increasing proportions of vaccine-hesitant parents. The proportion of expectant parents who are vaccine-hesitant is currently unknown. We assessed the prevalence of vaccine hesitancy among expectant parents receiving care at an obstetrics clinic in Houston, Texas. METHODS We conducted a cross-sectional survey of expectant parents between 12 and 31 weeks gestation who received care at Texas Children's Pavilion for Women between July 2014 and September 2015. Using convenience sampling, participants completed a questionnaire that included questions on demographic items, self-assessed pregnancy risk, receipt of annual influenza vaccine, and the 15-item Parents Attitudes About Childhood Vaccines survey, a validated tool to identify vaccine-hesitant parents. We used multivariable logistic regression to determine the association of demographic characteristics, pregnancy risk, and influenza vaccine receipt with vaccine hesitancy after controlling for variables significant in univariable analyses. RESULTS Six hundred ten expectant mothers and 38 expectant fathers completed the Parents Attitudes About Childhood Vaccines survey. Overall, 50 of 610 expectant mothers (8.2%; 95% confidence interval [CI], 6.1%-10.7%) were vaccine-hesitant. Expectant mothers were primarily non-Hispanic white, 30 years old or older, and married. The odds of being vaccine-hesitant were 2.2 times greater (95% CI, 1.2-4.1) among expectant mothers with a college level of education or less compared with those with more than a 4-year degree. The odds of being vaccine-hesitant were 7.4 times greater (95% CI, 3.9-14.0) among expectant mothers who do not receive an annual influenza vaccine compared with those who do. CONCLUSIONS Our findings suggest the need to identify and address vaccine hesitancy among expectant parents before birth.
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Affiliation(s)
| | | | | | - Laurie S Swaim
- Baylor College of Medicine, Houston; Texas Children's Pavilion for Women, Houston
| | - Douglas J Opel
- Seattle Children's Research Institute, Seattle, Wash; University of Washington School of Medicine, Seattle, Wash
| | - Julie A Boom
- Texas Children's Hospital, Houston; Baylor College of Medicine, Houston
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Attwell K, Wiley KE, Waddington C, Leask J, Snelling T. Midwives' attitudes, beliefs and concerns about childhood vaccination: A review of the global literature. Vaccine 2018; 36:6531-6539. [PMID: 29483029 DOI: 10.1016/j.vaccine.2018.02.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 12/20/2017] [Accepted: 02/02/2018] [Indexed: 11/24/2022]
Abstract
Vaccine hesitancy in industrialised countries is an area of concern. Health professionals play a significant role in parental vaccination decisions, however, to date the role of midwives has not been widely explored. This review sought to describe the attitudes and communication practices of midwives in developed countries towards childhood vaccines. Medline, Cinahl, PsychInfo, Embase and the grey literature were searched. Inclusion criteria were qualitative and quantitative studies reporting midwives' beliefs, attitudes and communication practices toward childhood vaccination. The search returned 366 articles, of which 359 were excluded by abstract. Two additional articles were identified from the grey literature and references, resulting in nine studies from five countries included in the review. Across the studies, the majority of midwives supported vaccination, although a spectrum of beliefs and concerns emerged. A minority expressed reservations about the scientific justification for vaccination, which focussed on what is not yet known rather than mistrust of current evidence. Most midwives felt that vaccines were safe; a minority were unsure, or believed they were unsafe. The majority of midwives agreed that childhood vaccines are necessary. Among those who expressed doubt, a commonly held opinion was that vaccine preventable diseases such as measles are relatively benign and didn't warrant vaccination against them. Finally, the midwifery model of care was shown to focus on providing individualised care, with parental choice being placed at a premium. The midwifery model care appears to differ in approach from others, possibly due to a difference in the underpinning philosophies. Research is needed to understand how midwives see vaccination, and why there appears to be a spectrum of views on the subject. This information will inform the development of resources tailored to the midwifery model of care, supporting midwives in advocating for childhood vaccination.
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Affiliation(s)
- K Attwell
- School of Social Science, University of Western Australia, 35 Stirling Hwy, Crawley, Australia; Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Western Australia, Australia.
| | - K E Wiley
- School of Public Health, Edward Ford Building A27, University of Sydney, Australia; National Centre for Immunisation Research & Surveillance, cnr Hawkesbury Rd & Hainsworth St, Westmead 2415, Australia
| | - C Waddington
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Western Australia, Australia
| | - J Leask
- School of Public Health, Edward Ford Building A27, University of Sydney, Australia
| | - T Snelling
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Western Australia, Australia; Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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Steigerung von elterlichem Gesundheitswissen durch schriftliches Informationsmaterial unter Berücksichtigung des familiären sozioökonomischen Status. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:385-393. [DOI: 10.1007/s00103-018-2705-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Frew PM, Randall LA, Malik F, Limaye RJ, Wilson A, O'Leary ST, Salmon D, Donnelly M, Ault K, Dudley MZ, Fenimore VL, Omer SB. Clinician perspectives on strategies to improve patient maternal immunization acceptability in obstetrics and gynecology practice settings. Hum Vaccin Immunother 2018; 14:1548-1557. [PMID: 29313458 DOI: 10.1080/21645515.2018.1425116] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Pregnancy is an ideal time to communicate with women about vaccines for themselves and their infants, yet maternal immunization rates remain suboptimal. This study aimed to identify clinic, provider, and staff-related attributes and facilitators to be utilized for a comprehensive vaccine intervention in ob-gyn clinical settings. We conducted in-depth interviews with 24 providers, both healthcare providers (e.g., physicians, nurse practitioners, midwives) and practice managers, from urban and suburban ob-gyn practices in Georgia and Colorado about their immunization attitudes, practices, and patient experiences. Qualitative analyses included Pearson correlation tests to evaluate patterns and relationships within the data to determine themes. Six major themes emerged: 1) strong provider "buy in" for maternal immunization; 2) the supporting role of clinical/interpersonal cues for vaccine promotion; 3) varying provider-patient communication approaches and its influence on maternal and pediatric uptake; 4) an urgent need for a designated office immunization champion; 5) reimbursement and practice implementation challenges; and 6) region differences in attitudes and values toward maternal immunization. Although providers expressed strong support for maternal immunization practices and offered environmental cues for vaccine promotion, practices often lacked a designated, structured role for an immunization champion equipped to manage delicate conversations with patients. The findings reflect needs for immunization champion identification, training, and support, along with best practices guidelines to improve coordination of vaccine promotion and delivery efforts in ob-gyn provider offices. Additionally, provider training on communication approaches to enhance acceptance and uptake of maternal vaccines is warranted.
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Affiliation(s)
- Paula M Frew
- a Emory University School of Medicine , Department of Medicine, Division of Infectious Diseases , Atlanta , GA , USA.,b Emory University Rollins School of Public Health , Hubert Department of Global Health , Atlanta , GA , USA
| | - Laura A Randall
- a Emory University School of Medicine , Department of Medicine, Division of Infectious Diseases , Atlanta , GA , USA
| | - Fauzia Malik
- b Emory University Rollins School of Public Health , Hubert Department of Global Health , Atlanta , GA , USA
| | - Rupali J Limaye
- c Johns Hopkins Bloomberg School of Public Health , Department of International Health, Division of Global Disease Epidemiology and Control , Baltimore , MD , USA
| | - Andrew Wilson
- b Emory University Rollins School of Public Health , Hubert Department of Global Health , Atlanta , GA , USA
| | - Sean T O'Leary
- d University of Colorado Denver , Department of Pediatrics, Division of Infectious Diseases , Denver , CO , USA
| | - Daniel Salmon
- c Johns Hopkins Bloomberg School of Public Health , Department of International Health, Division of Global Disease Epidemiology and Control , Baltimore , MD , USA
| | - Meghan Donnelly
- e University of Colorado School of Medicine , Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Denver , CO , USA
| | - Kevin Ault
- f University of Kansas Medical Center , Department of Obstetrics and Gynecology , Kansas City , KS , USA
| | - Matthew Z Dudley
- c Johns Hopkins Bloomberg School of Public Health , Department of International Health, Division of Global Disease Epidemiology and Control , Baltimore , MD , USA
| | - Vincent L Fenimore
- a Emory University School of Medicine , Department of Medicine, Division of Infectious Diseases , Atlanta , GA , USA
| | - Saad B Omer
- b Emory University Rollins School of Public Health , Hubert Department of Global Health , Atlanta , GA , USA.,g Emory University Rollins School of Public Health , Department of Epidemiology , Atlanta , GA , USA.,h Emory University School of Medicine , Department of Medicine, Division of Pediatrics , Atlanta , GA , USA
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Abstract
OBJECTIVES Evidence-based pain-limiting strategies for pediatric immunizations remain underutilized, with barriers identified to date mostly pertaining to health care providers and systems of care. The present study sought to quantify and investigate parent attitudes toward pain management as another potential barrier to the routine use of pain-mitigating strategies during immunizations. MATERIALS AND METHODS Questionnaires measuring parent attitudes, willingness to pay, and perceived barriers for using pain management for immunizations were completed by 259 parent/guardians of children ages 0 to 5 years attending appointments at an urban primary care clinic in the Midwestern United States. RESULTS Parent attitudes toward pain management for immunization were relatively normally distributed and varied from strongly positive to negative, with 33% of parents disagreeing that they were concerned about the pain their child may experience and 50% agreeing that there are no lasting negative effects from immunization pain. Negative parent attitudes were associated with willingness to spend less in money or time for pain management and with greater perceived significance of cost, time, and other barriers for using pain-mitigating strategies. DISCUSSION Some parents perceive limited value in trying to reduce pain during immunizations such that they may be hesitant to invest much time or effort in interventions. Greater success of translating evidence-based pain management into practice therefore may require accounting for differences in parent attitudes by tailoring educational efforts and pain management options accordingly.
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Pihl GT, Johannessen H, Ammentorp J, Jensen JS, Kofoed PE. "Lay epidemiology": an important factor in Danish parents' decision of whether to allow their child to receive a BCG vaccination. A qualitative exploration of parental perspective. BMC Pediatr 2017; 17:194. [PMID: 29162054 PMCID: PMC5698925 DOI: 10.1186/s12887-017-0944-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 11/08/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Vaccination is used worldwide to prevent infectious diseases. However, vaccination programmes in western countries face challenges in sustaining high coverage rates. The aim of this study was to explore how parents in Denmark make a decision about whether to allow their child to receive a Bacille Calmette Guerin vaccine at birth for the purpose of achieving non-specific effects on the immune system. METHODS A total of five focus groups were conducted with expectant mothers and fathers. Written information about the vaccine and information about the hypothesis of non-specific effects of the vaccine were delivered in order to discuss considerations and determinants of parents' decisions. RESULTS Heritable factors and the possibility of stimulating the immune system of the child to achieve less atopic diseases and fewer infections were identified as arguments in favour of receiving the BCG vaccine. Arguments against receiving BCG mainly focused on concerns about its described and non-described side effects. Both arguments for and arguments against the vaccine were seen as parents attempt to make an individual risk evaluation for their child. Attitudes and beliefs in the local network were identified as important for parents' decisions. DISCUSSION It is discussed how "lay epidemiology" characterizes parents' risk evaluation as an individual addition to the population-based risk declaration. It is furthermore discussed how health professionals should engage with both the empirical element and the value element of "Lay epidemiology". CONCLUSION "Lay epidemiology" forms the basis for the parental decision of whether to allow their child to receive a BCG vaccination. Attitudes and beliefs about the causes and distribution of illnesses in the family or local network influence parents' risk evaluations. It would be ideal for parents if health professionals focused their communication about the BCG vaccine on individual risk evaluations.
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Affiliation(s)
- Gitte Thybo Pihl
- Department of Paediatrics, Lillebaelt Hospital, Skovvangen 2-8, DK-6000 Kolding, Denmark
- Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 3. sal, DK-5000 Odense C, Denmark
| | - Helle Johannessen
- Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 3. sal, DK-5000 Odense C, Denmark
| | - Jette Ammentorp
- Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 3. sal, DK-5000 Odense C, Denmark
- Health Services Research Unit, Lillebaelt Hospital, Kabbeltoft 25, DK-7100 Vejle, Denmark
| | - Jane Schmidt Jensen
- Health Services Research Unit, Lillebaelt Hospital, Kabbeltoft 25, DK-7100 Vejle, Denmark
| | - Poul-Erik Kofoed
- Department of Paediatrics, Lillebaelt Hospital, Skovvangen 2-8, DK-6000 Kolding, Denmark
- Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 3. sal, DK-5000 Odense C, Denmark
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Olszewska M, Smykla B, Gdańska M, Kiełbasa G, Ficinski M, Szymońska I, Starzec K, Kwinta P. The analysis of parental attitude towards active immunoprophylaxis and its influence on the implementation of an Immunization Schedule among children in Poland. CHILDRENS HEALTH CARE 2017. [DOI: 10.1080/02739615.2017.1354293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Marta Olszewska
- Students’ Scientific Group at Chair of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Barbara Smykla
- Students’ Scientific Group at Chair of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Marta Gdańska
- Students’ Scientific Group at Chair of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Grzegorz Kiełbasa
- Students’ Scientific Group at Chair of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Matthew Ficinski
- Students’ Scientific Group at Chair of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Izabela Szymońska
- Chair of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Starzec
- Chair of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Przemko Kwinta
- Chair of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
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Illness Representations of Pertussis and Predictors of Child Vaccination Among Mothers in a Strict Vaccination Exemption State. Matern Child Health J 2017; 22:137-146. [PMID: 28884450 DOI: 10.1007/s10995-017-2363-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Vaccine preventable diseases are making a comeback in the US. However, research is lacking on illness representations of vaccine preventable diseases and their application in improving childhood immunization. Objective We utilized the common sense model of self-regulation to examine illness representations of pertussis and their associations with child's receipt of any vaccine, up-to-date vaccination status, and mothers' intentions to follow the recommended vaccination schedule in the future. Methods We developed vaccine worry and vaccine hassles scales to assess mothers' worries and hassles for child vaccination, and used an open ended question to assess mother's illness representations of pertussis. We surveyed mothers with children <3 years old (N = 160) in the Appalachian state of West Virginia, which only allows medical vaccine exemptions. Results Some children (5.0%) had received no vaccination, 15.0% were not up-to-date with the recommended vaccination schedule, and 13.8% mothers reported no intention to follow the recommended schedule in future (future intention). Illness representations included identity (17.8%), timeline (61.8%), consequences (58.6%), cause (35.0%), and cure/control (56.7%). Higher vaccine worry was associated with child receiving no vaccine. Not using daycare, higher vaccine worry, and difficulty breathing (identity) were associated with child not being up-to-date. Higher vaccine worry, cough (identity), and belief that vaccines are ineffective (cure/control) were associated with no future intention. Conclusions Vaccination interventions need to address mothers' worry regarding vaccine safety. 'Common Sense' beliefs regarding vaccines need to be reconciled with scientific data about vaccine safety and effectiveness, even among those with high socio-economic status in a strict vaccination state.
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Danchin MH, Costa-Pinto J, Attwell K, Willaby H, Wiley K, Hoq M, Leask J, Perrett KP, O'Keefe J, Giles ML, Marshall H. Vaccine decision-making begins in pregnancy: Correlation between vaccine concerns, intentions and maternal vaccination with subsequent childhood vaccine uptake. Vaccine 2017; 36:6473-6479. [PMID: 28811050 DOI: 10.1016/j.vaccine.2017.08.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/09/2017] [Accepted: 08/02/2017] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Maternal and childhood vaccine decision-making begins prenatally. Amongst pregnant Australian women we aimed to ascertain vaccine information received, maternal immunisation uptake and attitudes and concerns regarding childhood vaccination. We also aimed to determine any correlation between a) intentions and concerns regarding childhood vaccination, (b) concerns about pregnancy vaccination, (c) socioeconomic status (SES) and (d) uptake of influenza and pertussis vaccines during pregnancy and routine vaccines during childhood. METHODS Women attending public antenatal clinics were recruited in three Australian states. Surveys were completed on iPads. Follow-up phone surveys were done three to six months post delivery, and infant vaccination status obtained via the Australian Childhood Immunisation Register (ACIR). RESULTS Between October 2015 and March 2016, 975 (82%) of 1184 mothers consented and 406 (42%) agreed to a follow up survey, post delivery. First-time mothers (445; 49%) had significantly more vaccine concerns in pregnancy and only 73% had made a decision about childhood vaccination compared to 89% of mothers with existing children (p-value<0.001). 66% of mothers reported receiving enough information during pregnancy on childhood vaccination. In the post delivery survey, 46% and 82% of mothers reported receiving pregnancy influenza and pertussis vaccines respectively. The mother's degree of vaccine hesitancy and two attitudinal factors were correlated with vaccine uptake post delivery. There was no association between reported maternal vaccine uptake or SES and childhood vaccine uptake. CONCLUSION First time mothers are more vaccine hesitant and undecided about childhood vaccination, and only two thirds of all mothers believed they received enough information during pregnancy. New interventions to improve both education and communication on childhood and maternal vaccines, delivered by midwives and obstetricians in the Australian public hospital system, may reduce vaccine hesitancy for all mothers in pregnancy and post delivery, particularly first-time mothers.
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Affiliation(s)
- M H Danchin
- Vaccine and Immunisation Research Group, Murdoch Childrens Research Institute, Australia; Department of General Medicine, The Royal Children's Hospital, Australia; School of Population and Global Health, The University of Melbourne, Australia.
| | - J Costa-Pinto
- Department of General Medicine, The Royal Children's Hospital, Australia
| | - K Attwell
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia; Sir Walter Murdoch School of Public Policy and International Affairs, Murdoch University, Australia
| | - H Willaby
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Australia
| | - K Wiley
- National Centre for Immunisation Research and Surveillance, Australia
| | - M Hoq
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Australia
| | - J Leask
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Australia; National Centre for Immunisation Research and Surveillance, Australia
| | - K P Perrett
- Vaccine and Immunisation Research Group, Murdoch Childrens Research Institute, Australia; Department of General Medicine, The Royal Children's Hospital, Australia; School of Population and Global Health, The University of Melbourne, Australia
| | - Jacinta O'Keefe
- Vaccine and Immunisation Research Group, Murdoch Childrens Research Institute, Australia
| | - M L Giles
- The Alfred Hospital, Royal Women's Hospital and Monash Health and Monash University, Australia
| | - H Marshall
- Women's and Children's Hospital and Robinson Research Institute, The University of Adelaide, South Australia, Australia
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Saitoh A, Saitoh A, Sato I, Shinozaki T, Kamiya H, Nagata S. Effect of stepwise perinatal immunization education: A cluster-randomized controlled trial. Vaccine 2017; 35:1645-1651. [PMID: 28222999 DOI: 10.1016/j.vaccine.2017.01.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/20/2017] [Accepted: 01/27/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Perinatal immunization education is important for improving the immunization outcomes of infants; however, the content of educational materials used at each perinatal period has not been carefully evaluated. We hypothesized that stepwise education offered at different perinatal periods would improve infant immunization status and enhance maternal immunization knowledge. METHODS In this cluster-randomized controlled trial, pregnant women were recruited from nine obstetric sites in Niigata, Japan. The intervention group received a stepwise, interactive education intervention (prenatally, postnatally, and 1month after birth). The control group received a leaflet containing general information on immunization. Infant immunization status was evaluated at 6months of age, and maternal immunization knowledge was evaluated by a written survey after each intervention. RESULTS Among 188 study participants, 151 (80.3%) replied to the final post-intervention survey. At 6months of age, the percentage of children who completed three doses of inactivated polio, diphtheria, tetanus toxoid, and acellular pertussis (DTaP-IPV) vaccine was higher in the intervention group than in the control (p=0.04); however, no differences between groups were observed for the Haemophilus influenzae type b (Hib) (p=0.67) or 13-valent pneumococcal conjugate (PCV13) vaccines (p=0.20). The duration to the completion of the third dose of the DTaP-IPV, Hib, and PCV13 vaccines was shorter in the intervention group than in the control (p=0.03, p<0.01, and p<0.01, respectively). Furthermore, maternal knowledge scores exhibited significantly greater improvement in the intervention group over time compared with those of the control group (p=0.02). CONCLUSIONS Stepwise perinatal immunization education improved immunization schedule adherence for required vaccines and improved maternal immunization knowledge.
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Affiliation(s)
- Aya Saitoh
- Department of Community Health Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | | | - Tomohiro Shinozaki
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hajime Kamiya
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Satoko Nagata
- Department of Community Health Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Frew PM, Chung Y, Fisher AK, Schamel J, Basket MM. Parental experiences with vaccine information statements: Implications for timing, delivery, and parent-provider immunization communication. Vaccine 2016; 34:5840-5844. [PMID: 27789148 DOI: 10.1016/j.vaccine.2016.10.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We examined Vaccine Information Statements (VIS) dissemination practices and parental use and perceptions. METHODS We conducted a national online panel survey of 2603 US parents of children aged <7. Primary outcomes included reported VIS receipt, delivery timing, reading experiences, and perceived utility. RESULTS Most parents received a VIS (77.2%; [95% CI: 74.5-79.7%]), 59.7% [56.6-62.7%] before vaccination but 14.5% [12.5-16.8%] reported receiving it after their child's immunization; 15.1% [13.0-17.6%] were unsure of receipt status or timing; another 10.7% [9.0-12.6%] reported non-receipt of a VIS. Less than half who received a VIS before vaccination completed it before vaccination (46.2% [42.4, 50.0%]), but most who read at least some found the information useful (95.7% [93.8-97.0%]). Parents who delayed or refused at least one recommended non-influenza vaccine reported fewer opportunities to ask providers VIS questions. CONCLUSIONS Most parents report receiving VIS before vaccination as per federal guidelines. Continued effort is needed to enhance VIS distribution practice and parent-provider VIS content communication.
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Affiliation(s)
- Paula M Frew
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, United States; Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, United States; Emory University, Rollins School of Public Health, Hubert Department of Global Health, United States; U.S. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, United States.
| | - Yunmi Chung
- Oak Ridge Institute for Science and Education (ORISE), United States
| | - Allison Kennedy Fisher
- U.S. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, United States
| | - Jay Schamel
- Oak Ridge Institute for Science and Education (ORISE), United States
| | - Michelle M Basket
- U.S. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, United States
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Gilkey MB, Calo WA, Marciniak MW, Brewer NT. Parents who refuse or delay HPV vaccine: Differences in vaccination behavior, beliefs, and clinical communication preferences. Hum Vaccin Immunother 2016; 13:680-686. [PMID: 27763818 DOI: 10.1080/21645515.2016.1247134] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND We sought to estimate the national prevalence of HPV vaccine refusal and delay in a nationally-representative sample of parents of adolescents. We also compared parents who refused versus delayed HPV vaccine in terms of their vaccination beliefs and clinical communication preferences. METHODS In 2014 to 2015, we conducted an online survey of 1,484 US parents who reported on an 11- to 17-year-old child in their household. We used weighted multinomial logistic regression to assess correlates of HPV vaccine refusal and delay. RESULTS Overall, 28% of parents reported that they had ever "refused or decided not to get" HPV vaccine for their child, and an additional 8% of parents reported that they had "delayed or put off getting" HPV vaccine. Compared to no refusal/delay, refusal was associated with lower confidence in adolescent vaccination (relative risk ratio [RRR] = 0.66, 95% confidence interval [CI], 0.48-0.91), lower perceived HPV vaccine effectiveness (RRR = 0.68, 95% CI, 0.50-0.91), and higher perceived harms (RRR = 3.49, 95% CI, 2.65-4.60). In contrast, delay was associated with needing more information (RRR = 1.76, 95% CI, 1.08-2.85). Most parents rated physicians and information sheets as helpful for making decisions about HPV vaccination, although parents who reported refusal endorsed these resources less often. CONCLUSIONS Our findings suggest that HPV vaccine refusal is common among parents of adolescents and may have increased relative to previous estimates. Because the vaccination beliefs and communication preferences of parents who refuse appear to differ from those who delay, targeted communication strategies may be needed to effectively address HPV vaccine hesitancy.
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Affiliation(s)
- Melissa B Gilkey
- a Department of Population Medicine , Harvard Medical School & Harvard Pilgrim Health Care Institute , Boston , MA , USA
| | - William A Calo
- b Department of Health Policy and Management , University of North Carolina , Chapel Hill , NC , USA
| | - Macary W Marciniak
- c Eshelman School of Pharmacy , University of North Carolina , Chapel Hill , NC , USA
| | - Noel T Brewer
- d Department of Health Behavior & Lineberger Comprehensive Cancer Center , University of North Carolina , Chapel Hill , NC , USA
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Abstract
Immunizations have led to a significant decrease in rates of vaccine-preventable diseases and have made a significant impact on the health of children. However, some parents express concerns about vaccine safety and the necessity of vaccines. The concerns of parents range from hesitancy about some immunizations to refusal of all vaccines. This clinical report provides information about addressing parental concerns about vaccination.
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Self-reported prenatal influenza vaccination and early childhood vaccine series completion. Prev Med 2016; 88:8-12. [PMID: 27002252 DOI: 10.1016/j.ypmed.2016.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/11/2016] [Accepted: 03/16/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND No studies have examined associations between prenatal vaccination and childhood vaccination. Mothers who refuse influenza vaccinations during pregnancy report similar attitudes and beliefs to those who refuse vaccinations for their children. The objective of this study was to examine the association between self-reported prenatal influenza vaccination and early childhood vaccination. METHODS A retrospective cohort study was conducted with existing surveillance data from 4022 mothers who responded to the 2009-2011 Minnesota Pregnancy Risk Assessment Monitoring System survey and child vaccination records from the Minnesota Immunization Information Connection database. The childhood vaccine series outcome included the following vaccines: diphtheria, tetanus, and pertussis; poliovirus; measles, mumps, and rubella; Haemophilus influenzae type b (Hib); hepatitis B; varicella; and pneumococcal conjugate. To evaluate the association between self-reported prenatal influenza vaccination and early childhood vaccination, unadjusted and adjusted logistic regression was used to estimate log odds for childhood vaccination status, while margins post-estimation commands were used to obtain predicted probabilities and risk differences. RESULTS Vaccine series completion was 10.86% higher (95% confidence interval (CI) 7.33%-14.40%, adjusted and weighted model) in children of mothers who had a prenatal influenza vaccine compared to those who did not. For individual vaccines in the recommended series, risk differences ranged from 7.83% (95% CI 5.37%, 10.30%) for the Hib vaccine to 10.06% (95% CI 7.29%, 12.83%) for the hepatitis B vaccine. CONCLUSION Self-reported prenatal influenza vaccination was associated with increased early childhood vaccination. More research is needed to confirm these results and identify potential intervention strategies.
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Kempe A, O’Leary ST, Shoup JA, Stokley S, Lockhart S, Furniss A, Dickinson LM, Barnard J, Daley MF. Parental Choice of Recall Method for HPV Vaccination: A Pragmatic Trial. Pediatrics 2016; 137:e20152857. [PMID: 26921286 PMCID: PMC5884084 DOI: 10.1542/peds.2015-2857] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Completion rates for the human papillomavirus vaccine (HPV) series among adolescents remain low. Effectiveness of recall with parents choosing the method (preference-based recall) for increasing HPV series completion is unstudied. Within a cluster-randomized trial, we examined effectiveness of preference-based recall compared with usual care for increasing series completion and the association of recall choices with completion. METHODS All Kaiser Permanente Colorado pediatric practices (n = 7) were randomized to intervention (n = 4) or control (n = 3) by using covariate-constrained randomization. From January to June 2013, parents at intervention practices whose adolescents received HPV 1 were asked the recall method they preferred for subsequent doses and if they also wanted their child reminded. Completion rates were assessed 1 year after HPV 1. RESULTS At intervention practices, 374 (43%) of 867 patients were enrolled; 39% preferred text, 18% e-mail, 9% auto-dialer, and 34% 2-methods; 19% chose to have adolescent also recalled. Intervention adolescents were more likely to complete (63% vs 38%) than were controls (adjusted risk ratio 1.47 [1.38-1.57]) and less likely to be late in completing the series (45% vs 57%, P = .02). Rates of completion were similar between different recall methods, but significantly higher for those preferring e-mail and phone compared withother methods (90% vs 60%. P = .008). Completion rates were similar for adolescents who also received recalls (62%) versus those who did not (63%). CONCLUSIONS Preference-based recall was effective in increasing HPV series completion rates, with point estimates substantially higher than for most published studies of reminder/recall.
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Affiliation(s)
- Allison Kempe
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Departments of Pediatrics, and
| | - Sean T. O’Leary
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado,Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Shannon Stokley
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven Lockhart
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Anna Furniss
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - L. Miriam Dickinson
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado,Department of Family Medicine, University of Colorado, Aurora, Colorado
| | - Juliana Barnard
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Matthew F. Daley
- Department of Pediatrics, University of Colorado, Aurora, Colorado,Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
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Assessing the State of Vaccine Confidence in the United States: Recommendations from the National Vaccine Advisory Committee: Approved by the National Vaccine Advisory Committee on June 9, 2015 [corrected]. Public Health Rep 2016; 130:573-95. [PMID: 26556929 DOI: 10.1177/003335491513000606] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kelley CA, Velazco CS, Delaney TV, Bensimhon A, Huang KN, Jarvis PR, Jolin JS, Schaberg KB, Burke M, Finley C, Carney JK. Factors contributing to suboptimal rates of childhood vaccinations in Vermont. J Child Health Care 2015; 19:558-68. [PMID: 24821076 DOI: 10.1177/1367493514530955] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Childhood immunizations are invaluable in preventing contagious diseases. Nonetheless, vaccines have become increasingly controversial with growing numbers of caregivers refusing to vaccinate their children. The percentage of fully vaccinated children in Vermont is one of the lowest nationally. This study set out to determine Vermont caregivers' attitudes toward immunizations to better explain why the percentage of fully vaccinated children has fallen in Vermont. A survey regarding caregivers' health care knowledge about children, their vaccination concerns, and their children's vaccination status was sent to participants in the Vermont Women, Infants and Children's Program from two districts. In total, 83% (n = 379) of respondents reported their children received all recommended vaccinations for their age. Respondents who considered themselves highly knowledgeable regarding their children's health care and confident about the safety of vaccinations were significantly associated with reporting their children as being current on vaccinations and with their intent to continue vaccinations. Respondents indicated highest concern regarding the safety and number of vaccinations administered during one visit. Primary care providers were indicated as important resources for addressing concerns about vaccinations and health care knowledge of children. The results help to understand low vaccination rates in Vermont and can be used for targeting health campaigns to improve vaccination rates.
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Affiliation(s)
- Catherine A Kelley
- University of Vermont College of Medicine, USAVermont Department of Health, USAUniversity of Vermont College of Medicine, USA
| | - Cristine S Velazco
- University of Vermont College of Medicine, USAVermont Department of Health, USAUniversity of Vermont College of Medicine, USA
| | - Thomas V Delaney
- University of Vermont College of Medicine, USAVermont Department of Health, USAUniversity of Vermont College of Medicine, USA
| | - Adam Bensimhon
- University of Vermont College of Medicine, USAVermont Department of Health, USAUniversity of Vermont College of Medicine, USA
| | - Kuang-Ning Huang
- University of Vermont College of Medicine, USAVermont Department of Health, USAUniversity of Vermont College of Medicine, USA
| | - Paul R Jarvis
- University of Vermont College of Medicine, USAVermont Department of Health, USAUniversity of Vermont College of Medicine, USA
| | - Jonathan S Jolin
- University of Vermont College of Medicine, USAVermont Department of Health, USAUniversity of Vermont College of Medicine, USA
| | - Kurt B Schaberg
- University of Vermont College of Medicine, USAVermont Department of Health, USAUniversity of Vermont College of Medicine, USA
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Abstract
While health care providers are often cited as parents’ most trusted source for information and advice about vaccination, parents differ in their level of receptiveness to pro-vaccination conversations. The purpose of this research was to identify points in individual parents’ decision-making processes when parents are particularly open to receiving information and advice from their children’s health care providers. Interview data were collected from 20 mothers and 5 couples. Analysis of these data suggested 3 primary circumstances when parents were particularly open to receiving information and advice: during parents’ initial decision-making, as parents continued to assess vaccination options, and during particular circumstances that prompted parents to reconsider previously made vaccination choices. These results provide a mechanism for providers to identify parents who may be particularly receptive to pro-vaccination conversations. By prioritizing conversations with parents at one of these points, health care providers’ efforts at promoting vaccination may be more effective.
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Saitoh A, Saitoh A, Sato I, Shinozaki T, Nagata S. Current practices and needs regarding perinatal childhood immunization education for Japanese mothers. Vaccine 2015; 33:6128-33. [DOI: 10.1016/j.vaccine.2015.08.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/17/2015] [Accepted: 08/19/2015] [Indexed: 10/23/2022]
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Forbes TA, McMinn A, Crawford N, Leask J, Danchin M. Vaccination uptake by vaccine-hesitant parents attending a specialist immunization clinic in Australia. Hum Vaccin Immunother 2015; 11:2895-903. [PMID: 26366978 DOI: 10.1080/21645515.2015.1070997] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Vaccine hesitancy (VH) is an issue of global concern. The quality of communication between healthcare providers and parents can influence parental immunization acceptance. We aimed to describe immunization uptake following specialist immunization clinic (SIC) consultation for Australian children of VH parents as a cohort, and according to pre-clinic parental position on immunization. At a single tertiary pediatric SIC (RCH, Melbourne) a retrospective descriptive study classified VH families according to 3 proposed parental positions on immunization at initial clinic attendance. Immunization status at follow up was ascertained via the Australian Children's Immunization Register and National HPV Program Register and compared between groups. Of the VH cohort, 13/38 (34%) families were classified as hesitant, 21 (55%) as late/selective vaccinators and 4 (11%) as vaccine refusers. Mean follow up post-SIC attendance was 14.5 months. For the overall VH cohort, the majority chose selective immunization (42%) following SIC consultation. When analyzed by pre-clinic parental position on immunization, there was a trend for hesitant families to proceed with full immunization, selective families to continue selective immunization and refusing families to remain unimmunised (p < 0.0001). The most commonly omitted vaccines were hepatitis B (66%) and Haemophilus influenzae type B (55%), followed by the meningococcal C conjugate vaccine (53%) and measles, mumps and rubella vaccine (53%). Immunization outcome appears to correlate with pre-clinic parental position on immunization for the majority of families attending a SIC in Australia, with selective immunization the most common outcome. Tailored communication approaches based on parental position on immunization may optimise clinic resources and engagement of families, but require prospective research evaluation.
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Affiliation(s)
- Thomas A Forbes
- a Department of Nephrology ; Royal Children's Hospital ; Parkville , Victoria , Australia
| | - Alissa McMinn
- b SAEFVIC and Vaccine and Immunisation Research Group; Murdoch Children's Research Institute ; Parkville , VIC Australia
| | - Nigel Crawford
- b SAEFVIC and Vaccine and Immunisation Research Group; Murdoch Children's Research Institute ; Parkville , VIC Australia.,c Department of General Medicine ; Royal Children's Hospital ; Parkville , Victoria , Australia.,d Murdoch Childrens Research Institute; Parkville, Victoria, Australia ; Department of Pediatrics and School of Population and Global Health; University of Melbourne ; Parkville , VIC Australia
| | - Julie Leask
- e School of Public health; University of Sydney ; New South Wales , Australia
| | - Margie Danchin
- b SAEFVIC and Vaccine and Immunisation Research Group; Murdoch Children's Research Institute ; Parkville , VIC Australia.,c Department of General Medicine ; Royal Children's Hospital ; Parkville , Victoria , Australia.,d Murdoch Childrens Research Institute; Parkville, Victoria, Australia ; Department of Pediatrics and School of Population and Global Health; University of Melbourne ; Parkville , VIC Australia
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Abstract
The recent United States measles epidemic has sparked another contentious national discussion about childhood vaccination. A growing number of parents are expressing concerns about the safety of vaccines, often fueled by misinformation from the internet, books, and other nonmedical sources. Many of these concerned parents are choosing to refuse or delay childhood vaccines, placing their children and surrounding communities at risk for serious diseases that are nearly 100% preventable with vaccination. Between 10% and 15% of parents are asking physicians to space out the timing of vaccines, which often poses an ethical dilemma for physicians. This trend reflects a tension between personal liberty and public health, as parents fight to control the decisions that affect the health of their children and public health officials strive to maintain high immunization rates to prevent outbreaks of vaccine-preventable diseases. Interventions to address this emerging public health issue are needed. We describe a framework by which web-based interventions can be used to help parents make evidence-based decisions about childhood vaccinations.
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Affiliation(s)
- Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, United States of America
- Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado, United States of America
| | - Courtney R. Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Denver, United States of America
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, United States of America
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