Abstract
Objectives This study assessed influences on vaccination decisions among parents of young children and examined common vaccination information and advice sources. Methods Using panel samples of parents of children under 7 years, web-based surveys were conducted in 2012 (n = 2603) and 2014 (n = 2518). A vaccine decision-making typology (non-hesitant acceptors, hesitant acceptors, delayers, and refusers) was established and weighted population estimates of potential factors influencing parental vaccination decision (e.g., provider influence, source of information and advice) were computed by year and decision type. Results Delayers and refusers were more likely than acceptors to know someone whose child experienced a severe reaction to a vaccine or delayed/refused vaccine(s). High proportions of delayers (2012: 33.4%, 2014: 33.9%) and refusers (2012: 49.6%, 2014: 58.6%) reported selecting their healthcare provider based on whether the provider would allow them to delay/refuse vaccines. Providers were the most frequently reported trusted vaccine information source among all parents, though more often by acceptors than refusers (2012, 2014: p < 0.01). We found differing patterns of provider advice-seeking and internet as a reliable vaccine information source by group. Among those who had considered delay/refusal, trust in their healthcare provider’s advice was the most common reason cited for their decision reversal. Conclusions for Practice Provider trust and communication along with varying degrees of personal-network influences likely contribute to immunization decisions of parents. Vaccine hesitant parents often seek providers amenable to accommodating their vaccine beliefs. Providers may benefit from vaccine communication training as their recommendations may influence hesitant parents to immunize their children.
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References
Association of State and Territorial Health Officials. (2010). Communicating effectively about vaccines: Summary of a survey of U.S. parents and guardians Arlington, VA. Retrieved from http://www.astho.org/Programs/Immunization/Communicating-Effectively-About-Vaccines-Summary-of-a-Survey-of-U-S-Parents-and-Guardians/.
Bronfenbrenner, U. (1994). Ecological models of human development. In International encyclopedia of education (2nd ed., Vol. 3). Oxford: Elsevier.
Brunson, E. K. (2013). The impact of social networks on parents’ vaccination decisions. Pediatrics, 131(5), e1397–e1404. doi:10.1542/peds.2012-2452.
Centers for Disease Control and Prevention. (2017, February 6, 2017). Immunization Schedules for Infants and Children. Retrieved from https://www.cdc.gov/vaccines/schedules/easy-to-read/child.html.
Cherry, J. D. (2012). Epidemic pertussis in 2012—The resurgence of a vaccine-preventable disease. New England Journal of Medicine, 367(9), 785–787.
Dube, E., Vivion, M., & MacDonald, N. E. (2015). Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: Influence, impact and implications. Expert Review of Vaccines, 14(1), 99–117. doi:10.1586/14760584.2015.964212.
Frew, P. M., Fisher, A. K., Basket, M. M., Chung, Y., Schamel, J., Weiner, J. L., … Orenstein W. A. (2016). Changes in childhood immunization decisions in the United States: Results from 2012 & 2014 National Parental Surveys. Vaccine, 34(46), 5689–5696. doi:10.1016/j.vaccine.2016.08.001.
Frew, P. M., Saint-Victor, D. S., Owens, L. E., & Omer, S. B. (2014). Socioecological and message framing factors influencing maternal influenza immunization among minority women. Vaccine, 32(15), 1736–1744. doi:10.1016/j.vaccine.2014.01.030.
Frew, P. M., Zhang, S., Saint-Victor, D. S., Schade, A. C., Benedict, S., Banan, M., … Omer, S. B. (2013). Influenza vaccination acceptance among diverse pregnant women and its impact on infant immunization. Human Vaccines Immunotherapeutics, 9(12), 2591–2602. doi:10.4161/hv.26993.
GfK. (2013). KnowledgePanel Design Summary. Retrieved from http://www.knowledgenetworks.com/knpanel/docs/knowledgepanel(R)-design-summary-description.pdf.
Glanz, J. M., Wagner, N. M., Narwaney, K. J., Shoup, J. A., McClure, D. L., McCormick, E. V., & Daley, M. F. (2013). A mixed methods study of parental vaccine decision making and parent-provider trust. Academic Pediatrics, 13(5), 481–488. doi:10.1016/j.acap.2013.05.030.
Hill, H. A., Elam-Evans, L. D., Yankey, D., Singleton, J. A., & Kolasa, M. (2015). National, State, and selected local area vaccination coverage among children aged 19–35 months—United States, 2014. MMWR Morbidity and Mortality Weekly Report, 64(33), 889–896.
Jones, M., & Buttenheim, A. (2014). Potential effects of California’s new vaccine exemption law on the prevalence and clustering of exemptions. American Journal of Public Health, 104(9), e3–e6. doi:10.2105/AJPH.2014.302065.
Kempe, A., O’Leary, S. T., Kennedy, A., Crane, L. A., Allison, M. A., Beaty, B. L., … Stokley, S. (2015). Physician response to parental requests to spread out the recommended vaccine schedule. Pediatrics. doi:10.1542/peds.2014-3474.
Kennedy, A. M., & Gust, D. A. (2005). Parental vaccine beliefs and child’s school type. Journal of School Health, 75(7), 276–280. doi:10.1111/j.1746-1561.2005.00037.x.
Leask, J., Kinnersley, P., Jackson, C., Cheater, F., Bedford, H., & Rowles, G. (2012). Communicating with parents about vaccination: A framework for health professionals. BMC Pediatrics, 12, 154. doi:10.1186/1471-2431-12-154.
Lieu, T. A., Ray, G. T., Klein, N. P., Chung, C., & Kulldorff, M. (2015). Geographic clusters in underimmunization and vaccine refusal. Pediatrics, 135(2), 280–289. doi:10.1542/peds.2014-2715.
McCauley, M. M., Kennedy, A., Basket, M., & Sheedy, K. (2012). Exploring the choice to refuse or delay vaccines: A national survey of parents of 6- through 23-month-olds. Academic Pediatrics, 12(5), 375–383. doi:10.1016/j.acap.2012.06.007.
Nickerson, R. S. (1998). Confirmation bias: A ubiquitous phenomenon in many guises. Review of General Psychology, 2(2), 175.
Omer, S. B., Orenstein, W. A., & Koplan, J. P. (2013). Go big and go fast–vaccine refusal and disease eradication. New England Journal of Medicine, 368(15), 1374–1376. doi:10.1056/NEJMp1300765.
Omer, S. B., Salmon, D. A., Orenstein, W. A., deHart, M. P., & Halsey, N. (2009). Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. New England Journal of Medicine, 360(19), 1981–1988. doi:10.1056/NEJMsa0806477.
Opel, D. J., Mangione-Smith, R., Robinson, J. D., Heritage, J., DeVere, V., Salas, H. S., … Taylor, J. A. (2015). The influence of provider communication behaviors on parental vaccine acceptance and visit experience. American Journal of Public Health, 105(10), 1998–2004. doi:10.2105/ajph.2014.302425.
Oregon Health Authority. (2013). New process for claiming non-medical exemptions to school immunization requirements begins March 1, 2014.
Rao, J. N. K., & Scott, A. J. (1984). On chi-squared tests for multiway contingency tables with cell proporitions estimated from survey data. Annals of Statistics, 12(1), 46–60.
Sadaf, A., Richards, J. L., Glanz, J., Salmon, D. A., & Omer, S. B. (2013). A systematic review of interventions for reducing parental vaccine refusal and vaccine hesitancy. Vaccine, 31(40), 4293–4304. doi:10.1016/j.vaccine.2013.07.013.
Schwartz, J. L. (2013). “Model” patients and the consequences of provider responses to vaccine hesitancy. Human Vaccines & Immunotherapeutics, 9(12), 2663–2665. doi:10.4161/hv.26371.
Scott, K., & Batty, M. L. (2016). HPV vaccine uptake among canadian youth and the role of the nurse practitioner. Journal of Community Health, 41(1), 197–205. doi:10.1007/s10900-015-0069-2.
Smith, P. J., Humiston, S. G., Marcuse, E. K., Zhao, Z., Dorell, C. G., Howes, C., & Hibbs, B. (2011). Parental delay or refusal of vaccine doses, childhood vaccination coverage at 24 months of age, and the Health Belief Model. Public Health Reports, 126(Suppl 2), 135–146.
Smith, P. J., Humiston, S. G., Parnell, T., Vannice, K. S., & Salmon, D. A. (2010). The association between intentional delay of vaccine administration and timely childhood vaccination coverage. Public Health Reports (Washington, D. C.: 1974), 125(4), 534–541.
Smith, P. J., Kennedy, A. M., Wooten, K., Gust, D. A., & Pickering, L. K. (2006). Association between health care providers’ influence on parents who have concerns about vaccine safety and vaccination coverage. Pediatrics, 118(5), e1287–e1292. doi:10.1542/peds.2006-0923.
Sobo, E. J. (2015). Social cultivation of vaccine refusal and delay among Waldorf (Steiner) school parents. Medical Anthropology Quarterly. doi:10.1111/maq.12214.
Stinchfield, P. K. (2001). Ask the expert: Vaccine safety communication: The role of the pediatric nurse. Journal for Specialists in Pediatric Nursing, 6(3), 143–146.
Zipprich, J., Winter, K., Hacker, J., Xia, D., Watt, J., Harriman, K., & Centers for Disease Control and Prevention. (2015). Measles outbreak—California, December 2014-February 2015. MMWR Morbidity and Mortality Weekly Report, 64(6), 153–154.
Acknowledgements
The authors would like to acknowledge all the poll participants of this study. This research was supported in part by a grant from the Centers for Disease Control and Prevention (CDC) and an appointment to the Research Participation Program at the CDC administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and CDC. The findings and conclusions in this report are those of the authors, and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
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Chung, Y., Schamel, J., Fisher, A. et al. Influences on Immunization Decision-Making among US Parents of Young Children. Matern Child Health J 21, 2178–2187 (2017). https://doi.org/10.1007/s10995-017-2336-6
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DOI: https://doi.org/10.1007/s10995-017-2336-6