Parental Knowledge, Attitudes, and Perceptions Impacting Willingness to Vaccinate Against the Human Papillomavirus in Trinidad

Background Cervical cancer remains a major cause of morbidity and mortality in young women in Trinidad and Tobago. This study aimed to determine the knowledge, attitudes, perceptions, and beliefs of Trinidadian parents toward human papillomavirus (HPV) vaccination. In addition, factors predictive of willingness to vaccinate were explored. Methodology In this cross-sectional study conducted between March and May 2019, a paper-based survey was self-administered to parents of children in the 5-12-year age group in seven geographically representative Trinidadian primary schools. Results Of the 420 questionnaires distributed, 160 were returned completed (38% response rate). General knowledge that HPV causes cervical cancer and genital warts and is spread by sexual contact was common among 81%, 71%, and 81% of parents, respectively. At least 40% of the respondents expressed uncertainty about the vaccine's long-lasting health problems and its effectiveness in preventing genital warts and cervical cancer. Half of the parents were unsure if the vaccine was harmful. The perceptions that vaccine safety data are fabricated, drug companies cover up the dangers of vaccines, vaccine efficacy data are often fabricated, people are deceived about vaccine efficacy and safety, and conspiracy beliefs were held by 15.5%, 26.1%, 13%, 21.7%, and 28.5% of parents, respectively. There was a negative correlation between knowledge and conspiracy belief scores (ρ = -0.30, p < 0.001). Overall, 45.3% of parents were willing to immunize their children against HPV. Being informed about HPV by a health professional (odds ratio (OR) = 2.9, 95% confidence interval (CI) 1.5-5.8), knowledge of the benefits (OR = 4.6, 95% CI = 2.2-9.6), and a health professional offering the option of vaccination (OR = 3.7, 95% CI = 1.7-8.0) were associated with significantly increased odds of parents willing to vaccinate their child. The agreement that vaccine safety data are often fabricated (OR = 0.31, 95% CI = 0.12-0.84), pharmaceutical companies cover up the dangers of vaccines (OR = 0.14, 95% CI = 0.06-0.37), waiting at the clinic being time-consuming (OR = 0.37, 95% CI = 0.15-0.89), and the beliefs that adolescents are too young to get a vaccine to prevent sexually transmitted disease (OR = 0.16, 95% CI = 0.11-0.83) were associated with a significantly decreased willingness to vaccinate. Conclusions While general knowledge about HPV was high, there remain several areas for parental education regarding the HPV vaccine. Misbeliefs need to be addressed and multilevel interventions are needed to improve HPV vaccine uptake in our setting.

Parent-Reported Rate of the Use of Antibiotics in Children: A Cross-Sectional Study

Background Antibiotic resistance is growing worldwide due to the magnitude of the rational and irrational use of antibiotics, particularly in children. Evidence regarding the use of antibiotics without a prescription in Saudi children is limited, and the factors that affect frequent antibiotic use in children are poorly understood. Therefore, we investigated the rate of the use of antibiotics in Saudi children reported by their parents and the factors associated with parents that affect the use of antibiotics in children. Methods A cross-sectional survey using a 27-item self-administered questionnaire was conducted among parents living in Saudi Arabia. Parents with at least one child aged 16 years or less were eligible to participate in the study. The results were analyzed via descriptive and inferential statistics. Results A total of 284 parents participated in the study. Of the participants, 81% (n = 230) had given their children at least one course of antibiotics, and 57% of their children were male (n = 164). Many parents did not have a regular general practitioner (GP) for providing care to their children (n = 201, 70%). Further, 164 (n = 71%) parents administered antibiotics without consulting a general practitioner. Neither the parent and child demographics nor the parent knowledge and behavioral variables were significantly associated with the parent's variable of interest in the administration of antibiotics. Conclusions Generally, parents reported alarmingly high rates of antibiotic use among their children. Reducing the unnecessary use of antibiotics in children is crucial for preventing antimicrobial resistance. No apparent statistically significant factor was identified as being associated with antibiotic use. The need for additional measures to limit antibiotic use in children may be warranted. Initiatives to educate parents for consulting a regular general practitioner for their children before administering antibiotics may improve the health outcomes of children.

Clinical findings from the landmark MEF2C-related disorders natural history study

Introduction

MEF2C‐related disorders are characterized by developmental and cognitive delay, limited language and walking, hypotonia, and seizures. A recent systematic review identified 117 patients with MEF2C‐related disorders across 43 studies. Despite these reports, the disorder is not easily recognized and assessments are hampered by small sample sizes. Our objective was to gather developmental and clinical information on a large number of patients.

Methods

We developed a survey based on validated instruments and subject area experts to gather information from parents of children with this condition. No personal identifiers were collected. Surveys and data were collected via REDCap and analyzed using Excel and SAS v9.4.

Results

Seventy‐three parents completed the survey, with 39.7% reporting a MEF2C variant and 54.8% reporting a deletion involving MEF2C. Limited speech (82.1%), seizures (86.3%), bruxism (87.7%), repetitive movements (94.5%), and high pain tolerance (79.5%) were some of the prominent features. Patients with MEF2C variants were similarly affected as those with deletions. Female subjects showed higher verbal abilities.

Conclusion

This is the largest natural history study to date and establishes a comprehensive review of developmental and clinical features for MEF2C‐related disorders. This data can help providers diagnose patients and form the basis for longitudinal or genotype–phenotype studies.

Parent perceptions regarding literacy instruction for students with intellectual disability

BACKGROUND

Parents offer a unique perspective as they may view literacy instruction through the lens of its direct impact on their child's daily life. Further, they are likely to provide insight into the interactions between the perceived effectiveness of instruction and their expectations for their child's success. The purposes of the current investigation were to explore perceptions of parents of children with intellectual disability (ID) related to their child's literacy instruction in schools and understand parental expectations for their child's literacy performance.

METHODS

In the current investigation, we surveyed 211 parents of children with ID in one state within the USA to identify their perceptions related to their child's literacy outcomes and instruction. The survey instrument contained 25 items including 9 multiple-choice, 12 multiple-selection, 2 open-response and 2 rank order items.

RESULTS

Data indicated significant differences across grade bands related to the type of skills students engage in learning, the importance of specific literacy skills and the challenges or barriers for students to engage in literacy instruction. The overwhelming majority of parents reported their child learning to read as very important and believe there is a difference in life outcomes between children who can read written words and those who cannot. Parents of elementary school children report barriers of disruptive behaviour, the inability of children to remain seated and distractibility more so than parents of secondary students. Parents of high school students reported a lack of instructional time more often than parents of middle and elementary school.

CONCLUSIONS

While parents across grade bands reported the importance of literacy skills for students with ID and instruction in reading comprehension, listening comprehension and vocabulary, some differences were noted. Only half the parents reported an increased focus on literacy instruction, including on essential skills (e.g. decoding), in the earlier grades. Problem behaviour and motivation served as barriers to literacy for elementary students, and a lack of instructional time served as a barrier to writing for high school students.

HPV vaccination prevalence, parental barriers and motivators to vaccinating children in Hawai'i

Objective: To determine the prevalence and barriers to human papillomavirus (HPV) vaccine uptake among 11-18 year olds in the Hawai'i's four major ethnic groups-Native Hawaiians, Filipinos, Japanese, and Caucasians. Study design: A telephone survey assessed parents' knowledge of HPV and the HPV vaccine, status of their child's HPV vaccine uptake, variables operationalizing the Health Belief Model, and barriers and motivators to uptake. Results: Across the groups, 799 parents completed the survey. About 35% of daughters and 19% of sons had received all three shots. Although ethnic differences in vaccine uptake were seen in bivariate analysis (with significantly lower uptake in Filipino youth), in multivariable logistic regression analysis, only Caucasian parents were significantly less likely to start their sons on the HPV vaccine series compared with Japanese parents (reference group). Having heard about the vaccine, believing in its effectiveness, and older age of the child were also associated with vaccine uptake. Motivators for HPV vaccination were physician's recommendation and wanting to protect one's child. The primary barrier to uptake was lack of knowledge about the vaccine. Conclusions: Findings reinforce the fact that a physician's recommendation and receipt of information about the vaccine are strong motivators for parents to vaccinate their children, regardless of ethnicity.

Diagnosing autism: Contemporaneous surveys of parent needs and paediatric practice

AIM

Concurrence between parents' information needs and clinicians' practice when diagnosing autism is unknown but may influence families' uptake of management and adjustment. We aimed to compare parents' experience and preferences with paediatrician report of (i) diagnosis delivery and (ii) information given at diagnosis and identify types and usefulness of resources accessed by families post-diagnosis.

METHODS

The design used for the study are parent and paediatrician surveys. Participants are parents of children aged 1.5-18 years, diagnosed with autism between 01 January 2010 and 30 September 2012 and their paediatricians who are members of the Australian Paediatric Research Network. Study-designed quantitative and qualitative questions about diagnosis delivery and information given at diagnosis (written and spoken vs. neither) and parent perceived importance and harms of information accessed post-diagnosis.

RESULTS

Paediatricians (53/198 (27%)) identified 1127 eligible families, of whom 404 (36%) participated. Parents were more likely to report receiving adequate time to discuss diagnosis than paediatricians (71 vs. 51%). Parents (98%) rated information about accessing allied health professionals and the meaning of diagnosis as most important, yet paediatricians offered written or spoken information about each infrequently (allied health: 22%; diagnosis: 42%). Post-diagnosis, allied health was the most important source of information (83%). Harmful resources conveyed helplessness or non-evidenced-based therapies, but few parents (14%) reported this.

CONCLUSIONS

Parents want more information than can be conveyed in a single diagnostic consultation. Developing a tailored 'autism action plan' with written materials could improve parents' understanding of and satisfaction with children's autism diagnoses.

Looking Back on Rear-Facing Car Seats: Surveying US Parents in 2011 and 2013

OBJECTIVE

We sought to determine the age at which US parents first turned their child's car seat to face forward and information sources used to make that decision at the time of the release of the 2011 guidelines for child passenger safety and 30 months later.

METHODS

We administered 2 separate cross-sectional Web-based surveys of nationally representative panels of US parents in May 2011 and November 2013. Survey participation rate was 54% in both years. Parents of children ≤4 years old responded to questions about transitioning from rear-facing to forward-facing car seats (n = 495 in 2011; n = 521 in 2013).

RESULTS

In 2011, 33% of parents of 1- to 4-year-old children who had been turned to face forward (n = 409) turned at or before 12 months and 16% turned at 2 years or older. In 2013, 24% of parents of 1- to 4-year-old children who had been turned to face forward (n = 413) turned at or before 12 months and 23% turned at 2 years or older. Car seat packaging and clinicians were the most common information sources. Demographic characteristics associated with turning to face forward at or before 12 months of age in 2011 (parent age, education, household income, rural residence) were not significantly associated with transitioning at or before 12 months in 2013.

CONCLUSIONS

Delaying the transition to a forward-facing car seat still represents an opportunity to improve passenger safety in the United States. As common sources of information, clinicians may be influential in a parent's decision to turn their child's car seat to face forward.

Chocolate frogs do not increase completion of parent survey: randomised study

Four months into a year-long, national survey assessing parents' experiences of a child's diagnosis of autism spectrum disorder, our response fraction was only 23%. We aimed to determine whether including a chocolate incentive in the postal survey would increase the response fraction. Families enrolled between 15 March and 25 May 2012 were randomised to receive a chocolate frog versus no chocolate frog. Both groups received a written reminder and replacement survey 2 weeks after the survey was posted and up to two telephone reminders thereafter. We analysed the effect of the incentive using χ(2) tests for the categorical response variable and t-tests for the continuous reminder and length of response variables at the end of (i) randomisation and (ii) the study (1 November 2012). A total of 137 families were randomised in the 6-week period. Parents who received an incentive were more likely to return a completed survey in the 6 weeks than those who did not (21% vs. 6%, P = 0.009). This effect faded by the end of the study (53% vs. 42%, P = 0.4). There were no differences between groups at either follow-up in the number of reminders that parents received or the number of days it took parents to return the survey. Including a chocolate-based incentive does not significantly increase response rate in a postal survey over and above standard reminder techniques like posting follow-up survey packs or phoning families.