Parental perspectives on influenza immunization of children aged 6 to 23 months
ABSTRACT For the first time, in 2002, the Advisory Committee on Immunization Practices encouraged the vaccination of healthy children 6 to 23 months against influenza, whenever feasible. Participating inner-city health centers designed interventions to introduce influenza vaccination among this group of children. The study was designed to assess parents' attitudes toward the vaccine.
Following the 2002-2003 influenza vaccination season, parents were surveyed to identify barriers to and facilitators of influenza vaccination. A low-literacy level, 19-question survey was mailed to parents in three waves, 4 weeks apart. A subset of children had medical record data available to confirm vaccination status. Measures of validity were calculated. This paper focused only on the children whose parent-reported vaccination status was concordant with that reported in medical records (n = 193). Associations of responses to vaccination status were calculated in 2004, using chi-square and logistic regression procedures.
Sensitivity was 85.7% and specificity was 66% (kappa = 0.50), assessing the ability of parents to recall receipt or nonreceipt of influenza vaccine. The most important factors related to immunization of healthy infants were perceived doctor's recommendation (odds ratio [OR] = 5.5; 95% confidence interval [CI] = 2.4-12.3; p < 0.001) and belief that getting an influenza shot is a smart idea (OR = 3.5; 95% CI = 1.3-8.9; p < 0.01) for those with medical record-confirmed vaccination status.
A clear message that the doctor recommends influenza vaccination for a child is an important factor for ensuring vaccination, and may foster the idea that vaccination is "smart."
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ABSTRACT: To determine the impact of a vaccination reminder in an electronic health record supplemented with data from an immunization information system (IIS). A noninterruptive influenza vaccination reminder, based on a real-time query of hospital and city IIS, was used at 4 urban, academically affiliated clinics serving a low-income population. Using a randomized cluster-crossover design, each study site had "on" and "off" period during the fall and winter of 2011-2012. Influenza vaccination during a clinic visit was assessed for 6-month to 17-year-old patients. To assess sustainability, the reminder was active at all sites during the 2012-2013 season. In the 2011-2012 season, 8481 unique non-up-to-date children had visits. Slightly more non-up-to-date children seen when the reminder was 'on' were vaccinated than when 'off' (76.2% vs 73.8%; P = .027). Effects were seen in the winter (67.9% vs 62.2%; P = .005), not fall (76.8% vs 76.5%). The reminder also increased documentation of the reason for vaccine non-administration (68.1% vs 41.5%; P < .0001). During the 2011-2012 season, the reminder displayed for 8630 unique visits, and clinicians interacted with it in 83.1% of cases where patients required vaccination. During the 2012-2013 season, it displayed for 22 248 unique visits; clinicians interacted with it in 84.8% of cases. An IIS-linked influenza vaccination reminder increased vaccination later in the winter when fewer vaccine doses are usually given. Although the reminder did not require clinicians to interact with it, they frequently did; utilization did not wane over time. Copyright © 2015 by the American Academy of Pediatrics.Pediatrics 01/2015; 135(1):e75-82. DOI:10.1542/peds.2014-2616 · 5.30 Impact Factor
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ABSTRACT: To determine whether provision of vaccine-health-literacy-promoting information in text message vaccine reminders improves receipt and timeliness of the second dose of influenza vaccine within a season for children in need of 2 doses. During the 2012-2013 season, families of eligible 6-month through 8-year-old children were recruited at the time of their first influenza vaccination from 3 community clinics in New York City. Children (n = 660) were randomly assigned to "educational" text message, "conventional" text message, and "written reminder-only" arms. At enrollment, all arms received a written reminder with next dose due date. Conventional messages included second dose due date and clinic walk-in hours. Educational messages added information regarding the need for a timely second dose. Receipt of second dose by April 30 was assessed by using χ(2) tests. Timeliness was assessed by receipt of second dose by 2 weeks after due date (day 42) using χ(2) and over time using a Kaplan-Meier analysis. Most families were Latino and publicly insured with no significant between-arm differences between groups. Children in the educational arm were more likely to receive a second dose by April 30 (72.7%) versus conventional (66.7%) versus written reminder-only arm (57.1%; P = .003). They also had more timely receipt by day 42 (P < .001) and over time (P < .001). In this low-income, urban, minority population, embedding health literacy information improved the effectiveness of text message reminders in promoting timely delivery of a second dose of influenza vaccine, compared with conventional text messages and written reminder only. Copyright © 2015 by the American Academy of Pediatrics.Pediatrics 01/2015; 135(1):e83-91. DOI:10.1542/peds.2014-2475 · 5.30 Impact Factor
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ABSTRACT: Background: Seasonal influenza epidemic occurs every year in Guangzhou, which can affect all age groups. Young children are the most susceptible targets. Parents can decide whether to vaccinate their children or not based on their own consideration in China. The aim of this study was to identify factors that are important for parental decisions on vaccinating their children against seasonal influenza based on a modified health belief model (HBM). Methods: A cross-sectional study was conducted in Guangzhou, China. A total of 335 parents who had at least on child aged between 6 months and 3 years were recruited from women and children's hospital in Guangzhou, China. Each eligible subject was invited for a face-to-face interview based on a standardized questionnaire. Results: Uptake of seasonal influenza within the preceding 12 months among the target children who aged between 6 months and 36 months was 47.7%. Around 62.4% parents indicated as being "likely/very likely" to take their children for seasonal influenza vaccination in the next 12 months. The hierarchical logistic regression model showed that children's age (odds ratio [OR] =2.59, 95% confidence interval [CI]: 1.44-4.68), social norm (OR = 2.08, 95% CI: 1.06-4.06) and perceived control (OR = 2.96, 95% CI: 1.60-5.50) were significantly and positively associated with children's vaccination uptake within the preceding 12 months; children with a history of taking seasonal influenza vaccine (OR = 2.50, 95% CI: 1.31-4.76), perceived children's health status (OR = 3.36, 95% CI: 1.68-6.74), worry/anxious about their children influenza infection (OR = 2.31, 95% CI: 1.19-4.48) and perceived control (OR = 3.21, 95% CI: 1.65-6.22) were positively association with parental intention to vaccinate their children in the future 12 months. However, anticipated more regret about taking children for the vaccination was associated with less likely to vaccinate children within the preceding 12 months (OR = 0.21, 95% CI: 0.08-0.52). Conclusions: The modified HBM provided a good theoretical basic for understanding factors associated with parents' decisions on their children's vaccination against seasonal influenza.