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Abstract

Parents' decision to use vaccination services is complex and multi-factorial. Of particular interest are "vaccine-hesitant" parents who are in the middle of the continuum between vaccine acceptance and refusal. The objective of this qualitative longitudinal study was to better understand why mothers choose to vaccinate-or not-their newborns. Fifty-six pregnant mothers living in different areas of Quebec (Canada) were interviewed. These interviews gathered information on mothers' views about health and vaccination. Almost half of the mothers were categorized as vaccine-hesitant. A second interview was conducted with these mothers 3 to 11 months after birth to look at their actual decision and behavior concerning vaccination. Our results show the heterogeneity of factors influencing vaccine decision making. Although the majority of vaccine-hesitant mothers finally chose to follow the recommended vaccine schedule for their child, they were still ambivalent and they continued to question their decision. © The Author(s) 2015.

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... the evolution of beliefs and practices about vaccination during pregnancy and through the child's rst months of life (16,30,31). To our knowledge, none have been conducted in British Columbia. ...
... This longitudinal qualitative study (32,33) recruited English-speaking participants through maternity care providers (physicians and midwives), complementary and alternative health care providers (acupuncturists and naturopaths), and pre-natal classes offered through a regional health authority, a local college, and a parenting resource center in Victoria, British Columbia, Canada. Women choosing midwifery care as well as those under physician care were included, as some studies have shown that mothers with midwifery-assisted birth are more likely to delay vaccinations, vaccinate selectively, or not vaccinate at all (30,34,35). The model of maternity care differs for each patient in British Columbia, but in general, a woman receives maternity care from either a midwife, a specialist obstetrician/gynecologist, or a family physician with a maternity practice. ...
... These ndings build on data from earlier studies suggesting that parents who are hesitant towards vaccination are particularly receptive to counsel about vaccination from sources they perceive to be 'alternative' to traditional or allopathic medicine, including midwives (22,30,38). It further supports existing ndings that the prenatal period is an invaluable window of opportunity to disseminate vaccination information to hesitant parents at a time when they are information seeking and open to trusted sources of information (12,13,(16)(17)(18)(39)(40)(41)(42)(43)(44)(45). ...
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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.
... Dubé et al. (2018) reviewed 22 qualitative studies using the socioecological framework to depict the multiple factors that may contribute to vaccine hesitancy: experiences, emotions, ways of thinking, information sources, family and friends, perceptions of disease risk, and trust in health care systems. At the same time, other research reinforces the idea that vaccine decision-making is complex and multifaceted (Dubé et al., 2016). Each parent rationalizes vaccine hesitancy uniquely, and different interventions may be effective for addressing diverse values and beliefs underlying vaccine rejection, delay, or hesitancy. ...
... Fear of vaccine side effects. Parents in multiple studies expressed a belief that vaccines are unsafe and dangerous (Alstyne et al., 2018;Austvoll-Dahlgren & Helseth, 2010;Blaisdell et al., 2016;Dubé et al., 2016;Enkel et al., 2018;Helps et al., 2019;Meleo-Erwin et al., 2017;Senier, 2008), and that they can have permanent, longlasting adverse effects on their children's adult life (Blaisdell et al., 2016;Enkel et al., 2018;Senier, 2008;Swaney & Burns, 2019). Parents were particularly concerned about the unintended long-term side effects of vaccines that they believed were unknown to health care providers (Alstyne et al., 2018;Carrion, 2018;Harmsen et al., 2013;McCoy et al., 2019;Meleo-Erwin et al., 2017;Senier, 2008;Wilson et al., 2008). ...
... (E. Wang et al., 2015, p. 6706) In 23 studies, parents described how they perceived that the risk of adverse side effects from vaccines to be higher than the risk of acquiring vaccine-preventable disease Blaisdell et al., 2016;Dubé et al., 2016;Enkel et al., 2018;Gullion et al., 2008;Harmsen et al., 2013;Hatoková et al., 2018;Koski & Holst, 2017;McCoy et al., 2019;P. McDonald et al., 2019;Meleo-Erwin et al., 2017;Painter et al., 2019;Peretti-Watel et al., 2019;Reich, 2014Reich, , 2018Senier, 2008;Sobo et al., 2016;Swaney & Burns, 2019;Vandenberg & Kulig, 2015;E. ...
Article
Vaccines are some of the most cost-effective public health interventions for reducing disease burden and mortality. However, in recent years, health systems have faced a growing challenge with increasing number of parents who choose not to vaccinate their children. This decision has important implications for the health of communities worldwide, and despite a considerable amount of research that reinforces vaccine effectiveness and safety, there is uncertainty surrounding the factors that may encourage vaccine hesitancy in parents. In this interpretive review of 34 qualitative studies, we examine the factors that bolster vaccine hesitancy, rejection, and delay, and identify the overlaps and relationships between these factors. We depict our findings using the metaphor of a gear train where each gear represents one of seven factors: previous experiences; “natural” and “organic” living; perceptions of other parents; experiences interacting with health care providers; information sources, challenges, and preferences; distrust in health system players; and mandatory vaccine policies.
... A recurring, yet understudied, topic in vaccine hesitancy (VH) literatures involves parents' transition from seeking health-care services from biomedical doctors to providers of complementary and alternative medicine (CAM), particularly around the issue of vaccination (Dubé et al., 2016;Navin, 2015;Peretti-Watel et al., 2019). Peretti-Watel et al. (2019) describe this selection process with the metaphor of parents looking for 'a shoe that fits ' (p. ...
... Such choices are tied into more complex issues related to gendered parenting (particularly mothering), birth experiences, perceptions of parents' responsibility for children's health and development, and vaccination norms among parents' various social networks (Poltorak et al., 2005). Other logics may include favouring chemical-free, 'natural', and immunity-strengthening practices in vaccination decisions (Dubé et al., 2016;Reich, 2016b). Furthermore, researchers have demonstrated how parents' perspectives on vaccination are not set in stone and that parents may follow various 'vaccination trajectories' in their decisionmaking process (Wiley et al., 2020). ...
... In a similar study, Pedersen et al. (2016) describe how trust emerges through CAM providers' active listening, engagement with patients' bodies and material experiences of the encounter, such as how providers are dressed, the presence of potions, ointments, and decorations, or the use of music during consultations. Dubé et al. (2016)'s research with mothers in Québec, Canada showed how, in pursuit of neutral, balanced information about vaccinations, 'some vaccine-hesitant mothers considered that CAM practitioners were more credible than public health authorities because they had "nothing to gain" by dismissing vaccination while governments were perceived as having a hidden agenda' (p. 416). ...
Article
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This article examines the relationships between biomedicine, complementary and alternative medicine (CAM) and parents’ vaccination decision‐making in Switzerland. Our empirical evidence sheds light on an understudied phenomenon—parents switching from one doctor to another provider (often one offering CAM services) around issues that arise during vaccination consultations. This is important to understand since CAM is used by 25%–50% of the Swiss population and is integrated into the Swiss health‐care system when offered by biomedically trained medical doctors with additional CAM training. Qualitative data gathered from in‐depth semi‐structured interviews with parents (N = 30) and ethnographic observations of vaccination consultations (N = 16 biomedical consultations, N = 18 CAM consultations) demonstrate how there was not always a clear‐cut, direct relationship between (non)vaccination and parents’ use of CAM and/or biomedicine. Borrowing from Hirschman (Exit, voice, and loyalty: Responses to decline in firms, organizations, and states, Harvard Univ. Press, 1970), we frame our analysis by using the concepts of exit, voice and loyalty to describe parents’ provider selection and vaccination decision‐making process, although only four families in the sample described switching solely because of vaccination‐related issues. Findings add to vaccine decision‐making literature by describing and analysing the underdiscussed provider‐switching phenomenon and by demonstrating the importance of parents’ experiences of trust, affect and choice in vaccination consultations as they pursue the best health outcomes for their children.
... The content of vaccination information must be tailored to the context and the target group (Table 6) [38,63,67,79,85]. For example, the needs for vaccination information are very dependent on whether parents are slightly vaccine hesitant, moderately vaccine hesitant, or severely vaccine hesitant [31,37,85]. ...
... The content of vaccination information must be tailored to the context and the target group (Table 6) [38,63,67,79,85]. For example, the needs for vaccination information are very dependent on whether parents are slightly vaccine hesitant, moderately vaccine hesitant, or severely vaccine hesitant [31,37,85]. For parents that are lower on the vaccine-hesitancy spectrum (cautious acceptors or hesitant), the content of vaccination information that is requested is more general; parents want information about vaccine safety including balanced information about the benefits and risks of vaccination. ...
... Parents want information about the reasons behind the childhood vaccine schedule: clarification on the quantity and timing of vaccines [25,27,73,[75][76][77]85,103]. ...
Article
Full-text available
Parental vaccine hesitancy is becoming an increasingly important public health concern in the United States. In March 2020, an assessment of the latest CDC National Immunization Survey data found that more than one-third of U.S. children between the ages of 19 and 35 months were not following the recommended early childhood immunization schedule. Furthermore, a 2019 national survey found that approximately 1 in 4 parents reported serious concerns towards vaccinating their children. Vaccine hesitancy is now associated with a decrease in vaccine coverage and an increase in vaccine-preventable disease outbreaks and epidemics in the United States. Many studies have focused on understanding and defining the new socio-medical term, vaccine hesitancy; few have attempted to summarize past and current health communication interventions and strategies that have been successful or unsuccessful in tackling this growing phenomenon. This systematic literature review will attempt to aid public health professionals with a catalogue of health communication interventions and strategies to ultimately address and prevent parental vaccine hesitancy in the long term. Out of 1239 search results, a total of 75 articles were included for analysis, ranging from systematic reviews, quantitative surveys, and experimental designs to ethnographic and qualitative studies. For the presentation of results, a taxonomy was used to organize communication interventions according to their intended purpose. The catalogue of interventions was further broken down into specific components and themes that were identified in the literature as essential to either the success or failure in preventing and addressing parental vaccine hesitancy towards childhood vaccines.
... Another parental concern was in relation to safety issues about the number of injections associated with the immunisations. These concerns were emphasised in Chow et al's (2017) Comparable findings were also reported by Dubé et al (2016). In this study, some mothers reported that they firmly believed that these illnesses had now been eradicated and so declared immunisations unnecessary as they thought it improbable that their child would contract these diseases. ...
... Many of the parents in the articles included in the review reported the wish to develop natural immunity through contraction of diseases instead of immunisations. Natural immunity was perceived as stronger than vaccine immunity, which was described by some of the parents in Dubé et al's (2016) study as 'unnatural'. In addition, concerns were raised about the duration of protection of immunisations. ...
... In addition, concerns were raised about the duration of protection of immunisations. The preference for natural immunity made nine mothers decline all immunisations (Dubé et al 2016). In the same way, natural immunity is listed as a preference over immunisations in Ward et al's (2017) study, with the benefits of breastfeeding to develop natural immunity being discussed by several women. ...
... Another parental concern was in relation to safety issues about the number of injections associated with the immunisations. These concerns were emphasised in Chow et al's (2017) Comparable findings were also reported by Dubé et al (2016). In this study, some mothers reported that they firmly believed that these illnesses had now been eradicated and so declared immunisations unnecessary as they thought it improbable that their child would contract these diseases. ...
... Many of the parents in the articles included in the review reported the wish to develop natural immunity through contraction of diseases instead of immunisations. Natural immunity was perceived as stronger than vaccine immunity, which was described by some of the parents in Dubé et al's (2016) study as 'unnatural'. In addition, concerns were raised about the duration of protection of immunisations. ...
... In addition, concerns were raised about the duration of protection of immunisations. The preference for natural immunity made nine mothers decline all immunisations (Dubé et al 2016). In the same way, natural immunity is listed as a preference over immunisations in Ward et al's (2017) study, with the benefits of breastfeeding to develop natural immunity being discussed by several women. ...
... As a result, the pre-natal period may be an underutilized opportunity for initiating communication about vaccinations [23]. Few studies, to date, have examined the evolution of beliefs and practices about vaccination during pregnancy and through the child's first months of life [14,24,25]. To our knowledge, none have been conducted in British Columbia. ...
... This longitudinal qualitative study [26,27] recruited English-speaking participants through maternity care providers (physicians and midwives), complementary and alternative health care providers (acupuncturists and naturopaths), and pre-natal classes offered through a regional health authority, a local college, and a parenting resource center in Victoria, British Columbia, Canada. Women choosing midwifery care as well as those under physician care were deliberately sought, as some studies have found that mothers with midwifery-assisted birth are more likely to delay vaccinations, vaccinate selectively, or not vaccinate at all [19,24,28]. The model of maternity care differs for each patient in British Columbia, but in general, a woman receives maternity care from either a midwife, a specialist obstetrician/gynecologist, or a family physician with a maternity practice. ...
... These findings build on data from earlier studies suggesting that parents who are hesitant towards vaccination are particularly receptive to counsel about vaccination from sources they perceive to be 'alternative' to traditional or allopathic medicine, including midwives [18,24,39]. It further supports existing findings that the prenatal period is an invaluable window of opportunity to disseminate vaccination information to hesitant parents at a time when they are information seeking and open to trusted sources of information [10][11][12][13][14][40][41][42][43][44][45][46]. ...
Article
Full-text available
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.
... 31,32,43 Most quantitative studies were of moderate quality (see Table 2), but two were rated low quality. 32,44 The qualitative study by Dubé et al. 34 fulfilled the criteria of validity, relevance and quality of the results presented. ...
... Heyman et al. assessed familiarity with HPV infection and vaccination in their sample of pregnant women, finding prior knowledge in 79% and 72.3%, respectively, of the sample. 30 Five studies assessed the perceived level of knowledge of childhood vaccinations in their samples of pregnant women, 33,34,[42][43][44] showing that in most cases future mothers were not satisfied with their familiarity with the topic: the highest rate of positive perception of their knowledge was found by Danchin et al., 42 where 50% of mothers strongly agreed that they had enough knowledge to make a decision about vaccinating their child. In the study by Weiner et al., 33 42% of women reported being dissatisfied with their current knowledge level. ...
... Rosso et al. 43 found that only 30% of respondents rated their level of knowledge of vaccinations at least adequate, and in Bechini et al. 41% of women indicated a low level of knowledge. 44 In the qualitative study by Dubé et al., 34 most vaccine-hesitant mothers said that they lacked sufficient knowledge to make "the right decision". ...
Article
Full-text available
In recent years, an increase in vaccine hesitancy has led to a decrease in vaccination coverage in several countries. We conducted a systematic review of studies that assessed knowledge of and attitudes toward pediatric vaccinations, and the vaccination choices and their determinants among pregnant women. A total of 6,277 records were retrieved, and 16 full texts were included in the narrative synthesis. The published literature on the topic shows that, overall, pregnant women believe that vaccines are important for the protection of their children and the community, but various concerns and misunderstandings persist around vaccine safety and efficacy, which reduce the trust of expectant mothers in immunization. Nevertheless, such attitudes and choices vary depending on the vaccine being considered and the corresponding determinants should therefore be studied in the context of each specific vaccination. Further research on this topic is needed, particularly in non-western countries.
... Another parental concern was in relation to safety issues about the number of injections associated with the immunisations. These concerns were emphasised in Chow et al's (2017) Comparable findings were also reported by Dubé et al (2016). In this study, some mothers reported that they firmly believed that these illnesses had now been eradicated and so declared immunisations unnecessary as they thought it improbable that their child would contract these diseases. ...
... Many of the parents in the articles included in the review reported the wish to develop natural immunity through contraction of diseases instead of immunisations. Natural immunity was perceived as stronger than vaccine immunity, which was described by some of the parents in Dubé et al's (2016) study as 'unnatural'. In addition, concerns were raised about the duration of protection of immunisations. ...
... In addition, concerns were raised about the duration of protection of immunisations. The preference for natural immunity made nine mothers decline all immunisations (Dubé et al 2016). In the same way, natural immunity is listed as a preference over immunisations in Ward et al's (2017) study, with the benefits of breastfeeding to develop natural immunity being discussed by several women. ...
Article
Full-text available
Childhood immunisations have contributed to saving millions of lives worldwide. However, a growing number of parents are declining immunisations, while other parents are choosing to delay them or opting for selective immunisations. These behaviours contribute to the reduction of herd immunity and to the possible resurgence of certain diseases. The aim of this extended literature review was to investigate factors that contribute to 'vaccine hesitancy' for childhood immunisation among parents. Seven qualitative studies were included in the review and examined using thematic analysis. The main themes identified were vaccine safety, effectiveness of vaccines and healthcare factors, which suggest that vaccine hesitancy is more complex than parents simply agreeing or disagreeing for their child to be immunised. A range of factors contribute to vaccine hesitancy and patients' decisions are highly influenced by their perceived need to research information about immunisation online. Healthcare professionals involved in childhood immunisations need to be aware of these factors and behaviours that attribute to vaccine hesitancy to enhance their professional practice.
... Furthermore, the exploratory findings of experiment 1 suggest that the persuasive effect of anti-vaccine narratives might particularly hold for people with relatively neutral vaccination attitudes, compared to those with extremely positive attitudes. Though the concept of vaccine hesitancy has been used heterogeneously and encompasses a range of attitudes and behaviors (Dubé et al., 2016a), people with attitudes between both ends of the vaccine attitude continuum are considered vaccinehesitant (Dubé et al., 2016b). Based on this reasoning, our findings can indicate that especially vaccine-hesitant individuals might be affected by anti-vaccine narratives, whereas vaccinepositive individuals might be less susceptible to these effects. ...
... For these 5 items, the 7-point scale was replaced with a slider ranging from −50 (strongly disagree) to 50 (strongly agree). Following the conceptualization from earlier work (Dubé et al., 2016b), we conceptualize individuals with seemingly neutral attitudes (around scale midpoint, e.g., between −25 and 25) as more vaccine-hesitant than individuals with relatively positive attitudes (i.e., between 25 and 50). The scale's reliability was acceptable (α = 0.73) and revealed heterogeneous vaccine hesitancy scores (M = 24.69, ...
Article
Full-text available
Online vaccine-critical sentiments are often expressed in appealing personal narratives, whereas vaccine-supporting information is often presented in a non-narrative, expository mode describing scientific facts. In two experiments, we empirically test whether and how these different formats impact the way in which readers process and retrieve information about childhood vaccination, and how this may impact their perceptions regarding vaccination. We assess two psychological mechanisms that are hypothesized to underlie the persuasive nature of vaccination narratives: the availability heuristic (experiment 1, N = 418) and cognitive resistance (experiment 2, N = 403). The results of experiment 1 showed no empirical evidence for the availability heuristic, but exploratory analyses did indicate that an anti-vaccination narrative (vs. expository) might reduce cognitive resistance, decrease vaccination attitudes and reduce attitude certainty in a generally pro-vaccination sample, especially for those who were more vaccine hesitant. Preregistered experiment 2 formally tested this and showed that not narrative format, but prior vaccine hesitancy predicts cognitive resistance and post-reading attitudes. Hesitant participants showed less resistance toward an anti-vaccine text than vaccine-supporting participants, as well as less positive post-reading attitudes and attitude certainty. These findings demonstrate belief consistency effects rather than narrative persuasion, which has implications for scientific research as well as public health policy.
... Parents have been recognized as the primary decision-makers in vaccinating their children but, at the same time, targeted fence-sitters of the campaigns about preventing present and future waves of vaccine hesitancy and refusal on the part of doubting parents. Research has provided a good understanding of the complex reasons for parental fear and rejection of vaccines (Dubé et al., 2015;Selleri & Carugati, 2020;Ward et al., 2017). According to the mainstream individualistic approach, parents' social and virtual space on vaccines and vaccination seems to be inhabited by a plethora of myths, misconceptions associated with fears of autism, toxic chemicals, adverse effects, the weakening of the immune system, and beliefs in conspiracy theories. ...
... Items were presented in the form of statements, with responses on a 5-point Likerttype scale ranging from "strongly disagree" to "strongly agree." The items of the questionnaire, which had been previously used to assess mothers' representational field on vaccines and vaccination in the Italian context (Selleri & Carugati, 2020), were formulated so as to represent different aspects of the vaccination issues previously identified in literature (e.g., Dubé et al., 2015;Larson et al., 2014;Ward et al., 2017), namely: confidence in health authorities (e.g., "Professionals of the national healthcare system are prepared and updated on vaccination"), relations between vaccines and nature (e.g., "I think vaccinations are interventions against nature"), relations between vaccinations and health risks for children and peers (e.g., "If my child is not vaccinated, I put his/her health at risk"), myths about risks (e.g., "Vaccines cause autism"), belief in conspiracy theories (e.g., "Campaigns in favor of vaccination are financed by the Big Pharma"), freedom of choice (e.g., "Vaccinating children is a private choice of parents: healthcare authorities must not intervene"). ...
... Research has shown that vaccine-hesitant individuals are "active information-seekers" that are looking for "balanced" information presenting both pros and cons of vaccination in order to make an informed decision about vaccines (9,10). Their information needs are usually not fulfilled with typical information from public health authorities, as this information generally does not usually provide references to scientific studies and is often perceived as focusing on the benefits of vaccines and not discussing the potential risks of vaccines (11). Addressing those who are strongly anti-vaccines merit specific strategies. ...
... A key factor influencing vaccination decision-making is trust in the effectiveness and safety of vaccines, in the system that delivers them, including the reliability and competence of the health services and health professionals, and in the motivations of the policy-makers who decide which vaccines are needed when and where (11). Many studies have shown that vaccine hesitancy was not due to being uninformed or misinformed, but reflected a general distrust of doctors, government sources and/or pharmaceutical companies (12)(13)(14). ...
Article
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Vaccine hesitancy (the reluctance to accept recommended vaccines) is a complex issue that poses risk communication challenges for public health authorities and clinicians. Studies have shown that providing too much evidence on vaccine safety and efficacy to those who are vaccine-hesitant has done little to stem the growth of hesitancy-related beliefs and fears. The objective of this paper is to describe good practices in developing communication materials to address vaccine hesitancy. An inventory of vaccination communication materials in Canada was assessed according to the Council of Canadian Academies Expert Panel on Health Product Risk Communication Evaluation (2015). Many of the current communication products could be improved to better align with evidence-based risk communication best practices. Five best practices were identified. First, identify target audience and establish trust. Second, provide both the risks and benefits of vaccination, as most people are looking for balanced information. Third, give the facts before addressing the myths. Fourth, use visual aids. Fifth, test communication material prior to launch. Applying these best practices to current or future communication products will help vaccine providers (including physicians, nurse practitioners, pharmacists, public health professionals) to develop communication materials that are sensitive to the complex ways that people process and value information and thus more likely to optimize vaccine uptake in their communities.
... One of the main repertoires identified in this research was represented by the 'distrust' repertoires, in doctors, pharmaceutical manufacturers, authorities and medical research. The issue of distrust has been found by others to be one of the dominant attitudes of refusal or hesitation in the face of vaccination [5,7]. Similarly, other arguments and reasons, which resonates with the identified repertoires have been highlighted, such as fear of side effects [6,7] and the perception that children are too precious to subject to risk [26,27]. ...
... The issue of distrust has been found by others to be one of the dominant attitudes of refusal or hesitation in the face of vaccination [5,7]. Similarly, other arguments and reasons, which resonates with the identified repertoires have been highlighted, such as fear of side effects [6,7] and the perception that children are too precious to subject to risk [26,27]. Confirming the existence of these attitudes among the Romanian public is undoubtedly important. ...
Article
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Repertoires are basic analytic units in discourse analysis and discursive psychology, characterized as repeatable building blocks speakers use for constructing versions of actions. In this study my aim is to analyze public repertoires which are available to parents as discursive resources to substantiate their decision not to vaccinate their children. Online content, two televised talk shows and a series of interviews with parents who refused vaccination from 2017–2019 were analyzed. As a result of this analysis, I have identified a series of repertoires such as distrust repertoires, rejecting any risks when it comes to children, vaccine ineffectiveness and ‘immunity is a limited resource that should not be forced’. These repertoires do a discursive work that seem to go beyond signs of concern or challenges to vaccine safety to perform a moral and epistemic delegitimization of the current system of medical services, medical research and government authorities. Moreover, the identification of the repertoires that circulate in the public space as resources fulfil a discursive function of replacing the current system with new moral and epistemic perspectives
... However, parents in the vaccination-hesitant group do tend to be persuaded to get their children vaccinated after being briefed by the health personnel. Therefore, vaccination hesitation may be defined as a temporary conviction [40]. ...
Article
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As most of the diseases that ravaged human collectivities through millennia have been cured by scientific tools offered to the use of medicine particularly from the Industrial Revolution onwards, vaccination played a crucial role in it. Once conceived as a significant public function, vaccination has been one of the most salient signs of regulatory and social reformist state power. However, together with the rise of globalization and the general state of fluidity stemming from it, on the one hand, communication technology has diffused diverse information around the world, particularly the false ones, and on the other hand, a widespread critical climate against modern conceptions has been formed. In this context of complex reality, vaccination has lost its undoubted public function and meaning. Since 1990s in the world and 2000s in Turkey, we observe a significant, though proportionally still meagre, tendency of refusal or hesitation concerning vaccines, mostly among parents. We analyze this tendency as complex assemblage of causes, both in economic and philosophical dimensions, a multiplex phenomenon which should be understood essentially in a general framework of critique against modernity.
... Recent studies from a diverse array of nations-including Canada, France, Ireland, Italy, Spain, the United Kingdom, and the United States-suggest that distrust in conventional medicine plays a key role in vaccine hesitancy (Hornsey et al., 2020;Murphy et al., 2021;Palamenghi et al., 2020;Reuben et al., 2020;Ward et al., 2019). Similarly, results from studies in Canada, the Netherlands, the United Kingdom, and the United States reveal that some vaccine-refusing and vaccine-hesitant parents report suspicions that pharmaceutical companies and health care providers have a vested commercial interest in vaccines, but that alternative health care providers do not (Ames et al., 2017;Benin et al., 2006;Brown et al., 2012;Dubé et al., 2016;Harmsen et al., 2013;Jones et al., 2012;Salmon et al., 2005). ...
Article
Omission bias is the tendency to consider harm from inaction preferable to equivalent harm from action. In this work, we explored how individual differences in omission bias shape parental vaccine‐related decisions. Parents with a stronger omission bias showed greater negative emotional response to physician vaccine policy, placed lower trust in medical providers, and assigned a lower priority on vaccination. We observed this pattern of results even among parents who prioritize vaccination. Heightened anticipation of moral culpability for action (e.g., a child experiences vaccine side effects) and a diminished anticipation of moral culpability for possible harms of not acting (e.g., a child contracts a vaccine‐preventable disease) accounted for the effects we observed. These results suggest that parents' reluctance to vaccinate their children stems—in part—from the heightened perceived moral culpability that comes with taking action (versus not taking action). This article is protected by copyright. All rights reserved.
... Additionally, approximately one third (33%) of parents who do not vaccinate their children cite religious or philosophical reasons (Gilbert et al. 2017), which may further contribute to the low vaccination rates in some rural communities (Bell et al. 2015). Even though there are only a few studies in this review examining these factors, these findings are consistent with studies showing that vaccine hesitancy is related to alternative medicine practices (Dubé et al. 2016b ;Dubé et al. 2013;Frawley et al. 2018;McNeil et al. 2019) and religious beliefs in Canada Kulig et al. 2002) and elsewhere in the world (Kershaw et al. 2014;Rainey et al. 2011;SAGE Working Group 2014;Spaan et al. 2017). ...
Article
Objectives The purpose was to synthesize the available literature on what factors influence vaccine hesitancy of parents of preschoolers in Canada.Methods Databases (e.g., CINAHL, PubMed, OVID, Proquest) were searched for relevant research articles produced between January 2009 and October 2019. Articles were required to examine vaccine uptake in children aged 0–7, in the English language, and focused within a Canadian context. Articles were excluded if they focused on uptake of the influenza vaccine and if the study population was children with chronic health conditions. A total of 367 articles were reviewed and 12 met the criteria for inclusion in this review.SynthesisThis review found that between 50% and 70% of children are completely vaccinated at 2 years old, with up to 97% having received at least one vaccine, and 2–5% receiving no vaccines. This review found that trust and access to health care providers is significantly associated with vaccine uptake, likely more important than parents’ vaccine knowledge, and may compensate for challenges related to socio-economic status and family dynamics.Conclusion Vaccine programs need to be created that are accessible to all families, with an awareness of the significant impact of trust on vaccine uptake. Future research should include consistent measures of vaccine uptake, and data from First Nation communities, and should examine how increased trust between health care providers and parents of preschool children would increase vaccine uptake in Canada.
... Considering that primary care physicians are a valuable source of knowledge and an often-trusted confidant for most parents, a worthwhile area to investigate is the physician perspective on vaccine hesitancy. Although there is a large amount of prior literature on vaccine safety and the reasons as to why parents do not vaccinate, [19][20][21][22] fewer studies have investigated physician perceptions on this issue and how parental vaccine hesitancies have influenced their practice. This study sought to determine whether family physicians in Kansas have seen an increase in the frequency of parental refusal of vaccinations, how physicians handled these types of inquiries from parents, how physicians educated caregivers about vaccines, as well as physician perceptions as to the reasons why parents/guardians refused or delayed vaccinations. ...
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Introduction: In the past few decades, patients expressing the idea that vaccines are unsafe or unneeded have been experienced increasingly by physicians and other healthcare providers. Discussions with patients regarding their reasons for vaccine refusals are important, as it may provide information that can be utilized in an intervention to increase vaccination rates and combat the spread of diseases that are making a resurgence in the United States. The main objective of this study was to explore the perceptions of family physicians as to why parents in Kansas may be vaccine hesitant. Methods: An electronic survey was distributed to family physicians in the State of Kansas via the University of Kansas School of Medicine-Wichita Family Medicine Research and Data Information Office (FM RADIO). Several aspects of physician perceptions regarding patients' vaccine hesitancy were measured in this study, including vaccines that are most often refused, reasons for refusing vaccinations, as well as what responses physicians employ when presented with vaccine concerns. Results: The majority of physicians surveyed have experienced vaccine hesitancy or refusal in their practice, and the human papillomavirus (HPV) and flu vaccines were reported to be the primary vaccines refused for children. In addition, physicians reported frequently employing various practices in response to vaccine refusals, including requiring parents to sign a form (40%) and dismissing families from their practice (1.5%). Physician perceptions on the reasons as to why parents/guardians refuse vaccinations also were measured, and the most common response was that parents possess a fear of long-term complications for their children as a result of vaccines (74%). Additionally, the three most commonly refused vaccines were HPV, influenza, and measles, mumps, and rubella. Conclusion: Physicians must not only deal with time constraints that vaccine hesitant discussions require, but also must try and implement discussions or interventions suited to the varying reasons why parents/guardians refuse vaccines to convince parents of their safety. The results suggested that vaccine refusals by parents/guardians seemed to be affecting Kansas family physicians' clinics in more than one way. This study could be a useful tool to help physicians better understand why vaccine refusals occur and be able to combat unwarranted concerns about vaccines.
... The association between perceived risk and health behavior is not definitive. Other individual or social factors such as emotion and trust could also influence individual decisions (35). Anticipated regret plays an important role in health behavior as people try to minimize regret they expect to experience (36). ...
Article
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Despite vast improvements in global vaccination coverage during the last decade, there is a growing trend in vaccine hesitancy and/or refusal globally. This has implications for the acceptance and coverage of a potential vaccine against COVID-19. In the United States, the number of children exempt from vaccination for “philosophical belief-based” non-medical reasons increased in 12 of the 18 states that allowed this policy from 2009 to 2017 ( 1 ). Meanwhile, the overuse and misuse of antibiotics, especially in young children, have led to increasing rates of drug resistance that threaten our ability to treat infectious diseases. Vaccine hesitancy and antibiotic overuse exist side-by-side in the same population of young children, and it is unclear why one modality (antibiotics) is universally seen as safe and effective, while the other (vaccines) is seen as potentially hazardous by some. In this review, we consider the drivers shaping the use of vaccines and antibiotics in the context of three factors: individual incentives, risk perceptions, and social norms and group dynamics. We illustrate how these factors contribute to the societal and individual costs of vaccine underuse and antimicrobial overuse. Ultimately, we seek to understand these factors that are at the nexus of infectious disease epidemiology and social science to inform policy-making.
... This was a productive way of making contact because the message led to appointments for interviews with 10 parents. The same message, with minor changes, was also distributed to schools that provide an education based on anthroposophical teachings, which we anticipated would have children registered whose parents are skeptical about vaccination (Dubé et al. 2015;Sobo 2015). ...
Article
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This study aims to understand vaccine skepticism among a population where it is remarkably prevalent-more-educated Dutch parents-through 31 in-depth interviews. Whereas all respondents ascribe a central role to the individual in obtaining knowledge (i.e., individualist epistemology), this is expressed in two repertoires. A neoromantic one focuses on deriving truth through intuition and following a "natural" path and informs a risk typology: embracing (refusing) "natural" ("unnatural") risks such as "childhood diseases" ("pharmaceutical substances"). A critical-reflexive repertoire centers on scientific methods but is skeptical about the scientific consensus and informs a risk calculation: opting for the choice perceived to bear the smallest risk. Thus, the same vaccine can be rejected because of its perceived harm to natural processes (neoromantic repertoire) or because its scientific basis is deemed insufficient (critical-reflexive repertoire). Moreover, these opposing repertoires are likely to inspire different responses to the same health-related information.
... ; https://doi.org/10.1101/2021.02.11.21251562 doi: medRxiv preprint women are typically the primary family healthcare consumers, 47,48 and once pediatric COVID-19 vaccines become available, mothers will control child uptake to a large extent. 49,50 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. ...
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Background: We examined the geographic and racial/ethnic distribution of the SARS-CoV-2 vaccine age-ineligible population (0-15 years old) in the U.S., and calculated the proportion of the age-eligible population that will need to be vaccinated in a given geo-demographic group in order to achieve either 60% or 75% vaccine coverage for that population as a whole. Methods: US Census Bureau population estimates for 2019 were used to calculate the percent vaccine ineligible and related measures for counties, states, and the nation as a whole. Vaccination targets for the 30 largest counties by population were calculated. Study measures were calculated for racial/ethnic populations at the national (n=7) and state (n=6) levels. Results: Percent of population ineligible for vaccine varied widely both geographically and by race/ethnicity. State values ranged from 15.8% in Vermont to 25.7% in Utah, while percent ineligible of the major racial/ethnic groups was 16.4% of non-Hispanic whites, 21.6% of non-Hispanic Blacks, and 27.5% of Hispanics. Achievement of total population vaccine coverage of at least 75% will require vaccinating more than 90% of the population aged 16 years and older in 29 out of 30 of the largest counties in the U.S. Conclusions: The vaccine-ineligibility of most children for the next 1-2 years, coupled with reported pervasive vaccine hesitancy among adults, especially women and most minorities, means that achievement of adequate levels of vaccine coverage will be very difficult for many vulnerable geographic areas and for several racial/ethnic minority groups, particularly Hispanics, Blacks, and American Indians.
... Rosemary and Fred mentioned that they got their kids their pertussis-containing vaccine because Fred's mother "encouraged us to do it" and that "some friends that had kids said so." Another participant reported that they had not considered not vaccinating their child until a family member suggested that they should not. Ours and others [44][45][46] highlight critical themes in vaccine-refusing groups and particularly that these groups self-perpetuate their anti-vaccination beliefs through social influence from in-group members, family and friends [44]. ...
Article
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Background Despite vaccination being one of the safest and most successful public health tools to control infectious diseases, some people still doubt the efficacy and safety of vaccines. In order to address vaccine hesitancy and anti-vaccination sentiment, it is necessary to understand vaccination attitude development and vaccination behaviors. The objective of this project was to qualitatively investigate general vaccination attitudes and behavior with an additional emphasis on pertussis vaccination. Methods To identify factors that influence attitudes toward vaccination and behaviors in East Tennessee, eleven one-on-one interviews were conducted with participants recruited through convenience and purposive sampling. Interview protocol and deductive codes were developed using the Triadic Theory of Influence as a theoretical framework. Interview transcripts were analyzed qualitatively and themes were identified through constant comparison of interviews, considering both deductively and inductively coded data. Results Most participants (8) held positive attitudes towards vaccination. Participants (8) comfortable with vaccinating themselves or their children said they followed recommendations of doctors. Vaccine hesitant participants’ (3) most frequently cited concern was safety and concern about side effects. These participants also reported that they referenced non-academic or professional sources and felt confident about their knowledge of vaccines and diseases. Vaccine hesitant participants had low perception of risk of vaccine-preventable diseases, particularly pertussis. Participants with children reported that friends and family were influential when deciding to vaccinate their children. Conclusions This study identified themes in the attitudes towards vaccination of participants recruited in East Tennessee. We found that risk perception and family and social group attitudes were the primary influences on vaccination decision making. We recommend that future research includes anti-vaccination participants in their research, if possible, and further explore the relationship between perception of one’s own knowledge and health behavior outcomes.
... A selection bias is possible as most participants were recruited in healthcare settings where providers have positive views and are proactive about maternal immunization. If other recruitment sites were added where health care providers had different views about vaccines and approach to pregnancy, this could have impacted vaccine acceptance and uptake [31][32][33][34]. Although we used TPB to inform the development of our questionnaires, the internal consistency of some constructs was low and below the threshold considered acceptable. ...
Article
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Background In Canada, vaccination against pertussis (Tdap) during pregnancy has been recommended since 2018, with suboptimal uptake. We aimed to assess the determinants of intention and uptake of Tdap vaccine among pregnant women in Quebec. Methods Participants (< 21 weeks of pregnancy) were recruited in four Quebec regions. Two online surveys were administered during pregnancy (< 21 weeks and > 35 weeks). One measured vaccination intention and the other assessed the actual decision. Questionnaires were informed by the Theory of Planned Behaviour (TPB). We used logistic multivariate analysis to identify determinants of Tdap vaccination uptake during pregnancy using responses to both questionnaires. Results A total of 741 women answered the first survey and 568 (76.7%), the second survey. In the first survey most participants intended to receive the Tdap vaccine during their pregnancy (76.3%) and in the second survey, 82.4% reported having been vaccinated against Tdap during their pregnancy. In multivariate analysis, the main determinants of vaccine uptake were: a recommendation from a healthcare provider (OR = 7.6), vaccine intention (OR = 6.12), social norms (or thinking that most pregnant women will be vaccinated (OR = 3.81), recruitment site (OR = 3.61 for General Family Medicine unit) perceived behavioral control (or low perceived barriers to access vaccination services, (OR = 2.32) and anticipated feeling of guilt if not vaccinated (OR = 2.13). Safety concerns were the main reason for not intending or not receiving the vaccine during pregnancy. Conclusion We observed high vaccine acceptance and uptake of pertussis vaccine in pregnancy. The core components of the TPB (intention, social norms and perceived behavioral control) were all predictors of vaccine uptake, but our multivariate analysis also showed that other determinants were influential: being sufficiently informed about Tdap vaccination, not having vaccine safety concerns, and anticipated regret if unvaccinated. To ensure high vaccine acceptance and uptake in pregnancy, strong recommendations by trusted healthcare providers and ease of access to vaccination services remain instrumental.
... BC midwives enjoy a comprehensive scope of practice, which includes prescribing and/or administering prenatal vaccines including seasonal influenza vaccine and Tdap vaccine, and postnatal vaccines that include measles/mumps/rubella and varicella vaccines, hepatitis B immune globulin, and hepatitis B vaccine. 6 Midwives have the potential to be important advocates for vaccination in Canada, as their clientele often seek birth experiences with greater autonomy and lower medical intervention, and may be more hesitant about vaccines than the general public. 8 Support for vaccination among midwives varies depending on the setting, ranging from 56% in Ontario, Canada, 9 to over 90% in Australia. 10 Evidence exists that some health care practitioners (HCPs), including midwives, hold vaccinehesitant views in their personal and professional lives, but it is unclear what, if any, effect such views have on their practice. ...
Article
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Background: Registered midwives in British Columbia (BC) are primary health care practitioners for healthy people throughout pregnancy and for approximately 6 weeks postpartum. BC registered midwives are authorized to prescribe and administer certain vaccines to adults under their care during the perinatal period and hepatitis B vaccine to high-risk newborns. However, little has been documented about their recommendations for, and administration of, prenatal and infant vaccinations. This study surveyed midwives currently practicing in British Columbia to understand their vaccination practices. Methods: An online survey was administered to the members of the Midwives Association of BC in spring 2018. Outcome measures were the proportion of midwives who discussed, recommended, and administered the following vaccines: influenza, varicella, rubella, and infant hepatitis B. The proportion of midwives who discussed and recommended infant vaccines was measured. Barriers to discussion, recommendation, and administration of vaccines were captured. Results: Sixty-three percent of 108 respondents administered vaccines to their clients. Hepatitis B and rubella were the most frequent vaccines administered. Logistical concerns were the greatest barrier to vaccine administration. This was followed by the perception that vaccine administration is not within the scope of practice of midwives, especially for influenza vaccine. Midwives who administered vaccines were significantly more likely to discuss and recommend vaccines to their clients and their infants. Conclusions: The majority of BC midwives discuss, recommend, and administer vaccines to their clients. Our survey highlighted key areas to address to strengthen midwifery capacity to discuss, recommend, and provide prenatal and infant vaccines.
... This means being able to sustain a lifestyle where children can stay home with measles, time and effort can be expended on information gathering, and choices can be made that deviate from the norm and might cost parents financial benefits. As such, our findings on midwives' practices and attitudes mirror those of studies on the decision-making logics of vaccine-hesitant or refusing parents [65][66][67]. More research on this particular dynamic in situ is outstanding, but in the case of Austria, it appears that the attitudes of (independent) midwives and their clients reinforce one another: Personal midwife services draw in affluent clients with an incentive and the means to invest in choices; conversely, these clients respond particularly to the midwifery model of care. ...
Article
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Background Healthcare workers are considered key stakeholders in efforts to address vaccine hesitancy. Midwives’ influence in advising expectant parents on early-childhood vaccinations is unquestioned, yet they remain an understudied group. The literature on midwives’ attitudes towards vaccinations is also inconclusive. We therefore conducted an explorative qualitative study on midwives’ vaccine-hesitant attitudes towards MMR (measles-mumps-rubella) vaccinations in Austria. Methods We conducted 12 in-depth interviews on their knowledge, concerns, and beliefs with midwives who self-identified as hesitant or resistant towards early-childhood MMR vaccinations. We analyzed the data using a grounded theory approach to distill common themes and meanings. Results Healthcare workers’ stewardship to address vaccine hesitancy is commonly framed in terms of the “information deficit model”: disseminate the right information and remedy publics’ information deficits. Our findings suggest that this approach is too simplistic: Midwives’ professional self-understanding, their notions of “good care” and “good parenthood” inflect how they engage with vaccine information and how they address it to their clients. Midwives’ model of care prioritized good counseling rather than sharing scientific information in a “right the wrong”-manner. They saw themselves as critical consumers of that information and as promoting “empowered patients” who were free, and affluent enough, to make their own choices about vaccinations. In so doing, they also often promoted traditional notions of motherhood. Conclusions Research shows that, for parents, vaccine decision-making builds on trust and dialogue with healthcare professionals and is more than a technical issue. In order to foster these interactions, understanding healthcare professionals’ means of engaging with information is key to understanding how they engage with their constituents. Healthcare workers are more than neutral resources; their daily praxis influenced by their professional standing in the healthcare system. Similarly, healthcare professionals’ views on vaccinations cannot be remedied with more information either. Building better and more diverse curricula for different groups of healthcare workers must attend to their respective roles, ethics of care, and professional beliefs. Taken together, better models for addressing vaccine hesitancy can only be developed by espousing a multi-faceted view of decision-making processes and interactions of healthcare workers with constituents.
... Mothers are compelled to "work harder" and to become "literate" consumers of both products and services for their families (MacKendrick, 2018, p. 142). The growth of the anti-vaccine movement is frequently linked to mothers, the internet, and the valorization of alternative and holistic health (Dubé et al., 2015;Reich, 2016a;Smith & Graham, 2017). ...
Thesis
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Research over the last several decades offers clear evidence that mothers experience considerable pressure in carrying out the expectations of contemporary mothering, including expanded responsibilities relating to child and family health (Hays, 1996; Wolf, 2013). While we know that these pressures produce negative impacts, we know less about the strategies and tools mothers use to cope with these anxieties as they try to "do it right" (Villalobos, 2014). At the same time, research suggests that mothering is increasingly digitally-embedded, as mothers look to the internet and social media for information and support (Schoppe-Sullivan et al., 2017). This study thus explores how mothers use Facebook groups to inform health and parenting decisions. Drawing on data generated through a digital ethnography incorporating 18 months of participant observation, discourse analysis, and interviews with 29 mothers across two sets of divergent, specialized sets of Facebook groups (focusing on “evidence-based” and “natural” health and parenting), I advance three key, interconnected arguments. First, I apply theories of boundaries and boundary-work to show how specialized Facebook groups become persuasive ideological spaces for mothers who seek certainty around their healthcare beliefs and decisions. Next, I apply the concept of echo chambers to argue that mothers involved with these specialized Facebook groups engage in siloed health learning that shapes health beliefs, decisions, and even conversations with healthcare providers. Finally, I show how mothers engage in a form of digitally-mediated emotion management by turning Facebook groups that confirm their parenting ideology in order to alleviate anxieties associated with neoliberalism and individualist parenting, and to feel better about their maternal performance. I ultimately conclude that the turn to digital platforms for certainty, reassurance, and good feelings is both a logical expression and a reflection of the latest wave of maternal responsibilization.
... It is influenced by factors such as "complacency, convenience and confidence" (Who, 2014, p. 7). Generally, 'hesitancy' is related to adult vaccination recipients or parents (Attwell et al., 2018;Chow et al., 2017;Collins, 2005;Dubé et al., 2014;Dubé et al., 2015;Wehrens et al., 2014;WHO, 2014 to name the most recent studies). ...
Article
Most literature about vaccine hesitancy has been focused on parental attitudes. Less attention has been devoted to both scientists and experts (general practitioners, pediatricians, health care professionals and science journalists) who raise criticism about immunization policies and intervene in the public debate. This consideration aims to balance the current emphasis in the literature on parents’ attitudes about vaccination, offering a complementary angle to reframe and widen the controversy. Focusing on scientists and experts (who can shape and feed parents and people's attitude), an unattended complex picture of multiple attitudes towards vaccines and vaccinations has been discovered through a qualitative content analysis (QCA) of texts (appeared in the Italian press, TV and pop-science books) related to the harsh public debate, held between March 2017 and November 2018, triggered by the legislative proposal of making ten vaccinations mandatory for children. Unlike oversemplications that misleading dichotomies (such as orthodox and heterodox positions, Western science / Western medicine versus alternative medicine) reproduce, the analysis reveals nine different positions along the continuum of immunisation attitudes, ranging from radical acceptance of vaccinations (both compulsory and recommended) to radical rejection, which constitute a fuzzy set. Consequently, a twofold reality emerges: on the surface, the conflict seems between pro-vaxxers versus hesitant, pro-choice and anti-vaxxers; beneath it is amid standardized versus a varieties of contextual and personalised approaches to health.
... User concerns also related to the procurement of COVID-19 vaccines, with comments suggesting acceptance might be informed by the provision of more information regarding vaccine safety and efficacy. This latter finding is consistent with previous studies suggesting that new vaccines generate more vaccine hesitancy and that safety concerns are one of the main reasons for being reluctant to vaccinate [26][27][28]. The user dialogue -suggesting a need for more information rather than holding a position on vaccination -is likely related to the time of data collection whereby there was so much uncertainty regarding the then pending vaccines. ...
Article
To effectively end the pandemic, the acceptance of effective vaccines against COVID-19 is critical. Comments posted in online platforms act as a barometer for understanding public concerns regarding vaccination and can be used to inform communication strategies for the ‘moveable middle’. The aim of this exploratory study was to identify online dialogue regarding the nature of vaccine hesitancy related to COVID-19 vaccine(s). We analyzed user comment threads in response to news reports regarding COVID-19 vaccines on the Canadian Broadcasting Corporation national news website (with as many as 9.4 million unique visitors per day). User comments (n = 1145) were extracted from 19 articles between March 2020 and June 15th, 2020. Comments were then coded inductively for content to establish a coding framework that was subsequently applied to the dataset. Our data provide empirical support for misrepresentation as a form of misinformation and further demonstrate the utility of social media content as data for social research that informs public health communication materials. The data point to the need for, and value of, rapid communication interventions to foster vaccine acceptance. False information will continue to create challenges for delivering COVID-19 vaccines. Communication strategies to get ahead of the pace of misinformation are critical, particularly in light of boosters and the possibility of COVID-19 vaccination on an annual basis.
... Maternal immunoglobulin G antibodies are actively transferred through the placenta to provide passive immunity to newborns during the fi rst months of life until the time for infant vaccinations or until the period of greatest susceptibility has passed. Years of experience suggest that maternal immunization against infl uenza, tetanus or pertussis has an acceptable safety profi le that is well tolerated, effective and confers signifi cant benefi ts to pregnant women and their infants [12]. ...
Article
Background: Antenatal care for pregnant and postnatal mothers is the main entry gate for maternal Tetanus Toxoid (TT) vaccination. In developing countries including Tanzania, pregnant and postnatal mothers especially in rural communities have been experiencing barriers to maternal vaccination. The study aimed to explore perspectives of pregnant and postnatal mothers on accessing TT vaccine in Hai District Kilimanjaro Region Tanzania. Methods: A descriptive qualitative study was conducted during baseline assessment from October 2020 to May 2021, in 10 remote villages. Pregnant and postnatal mothers attending antenatal and postnatal services were selected purposively based on their availability and convenience, A semi-structured interview guide relevant to the study objectives was used to guide the interviews. Focus Group Discussion (FGD) and In-depth interviews (IDIs) were conducted; and thematic analysis was used to obtain themes and subthemes. Results: A total of 15 mothers aged 18 to 40 years participated in the study. Most of the mothers were Christians, married with 1 to 5 children. Majority had completed primary level education engaged in small-scale farming. Main themes were extracted namely: Unreliable vaccine information, Healthcare workers attitude, Overworked with household activities, adherence of appointment dates for vaccination after delivery and role of Traditional medicine during pregnancy. Conclusion: The role of healthcare providers are critical component for the appropriate transfer of vaccine information to the mothers and their spouses during clinic visits, to eliminate vaccine misconceptions hence improving overall tetanus vaccine uptake. Quality of information from reliable sources could be an important factor to upgrade the awareness of pregnant mothers on maternal vaccination.
... Vaccine hesitancy, defined as 'the decision to delay vaccination or the refusal to vaccinate despite available vaccination services', could challenge COVID-19 vaccine acceptance. Consistent with previous research [10], safety concerns surrounding new vaccines generate greater vaccine hesitancy and influence intention to receive a COVID-19 vaccine [11][12][13]. Safety concerns are one of the main reasons cited for being reluctant to vaccinate [8,[14][15][16]. ...
... Edvardsson et al. (2009) found that a strong relationship between nurses and parents helped in terms of discussing the sensitive issue of children being overweight. Several studies examining vaccinations also found that good interpersonal communication between parents and healthcare professionals was of paramount importance to parents (Ames et al., 2017;Dubé et al., 2016;Sobo et al., 2016). It is also well-established that parents with young children are at times insecure about their parental practices (Bektas et al., 2020;Henshaw et al., 2018) and, consequently, benefit from reconfirmation and empathy from healthcare professionals (Hennessy et al., 2020). ...
Article
Purpose: The first two years of a child's life have been found to be crucial for optimal growth and development. Support from healthcare professionals is especially important during this period. This study explored the perspectives of parents with children aged 0-2 years and healthcare professionals concerning parental needs and support provided by healthcare professionals. Methods: A qualitative research approach was adopted, which comprised semi-structured interviews with parents (N = 25) and focus group discussions with parents (N = 4) and healthcare professionals (N = 3). The data was analysed using the principles of inductive thematic analysis. Results: Overall, we found that parents preferred support that was tailored to their personal needs and practices. Building a trusting relationship between healthcare professionals and parents was also found to be important. The healthcare professionals recognized many of the parents' experiences. Some expressed that they felt bound to adhere to professional guidelines, which hindered them to provide customized support. Conclusions: Recommendation for establishing tailored support and trust are self-disclosure by professionals, addressing possible misconceptions openly, and showing interest in someone's considerations or family and cultural customs. Further research into how professional support for parents can be improved is recommended.
... Despite the unprecedented efforts by the scientific community to ensure that the vaccines were safe and efficacious, the widespread uptake of the COVID-19 vaccination had been undermined by vaccine hesitancy, similar to prior studies about vaccines where there was variable and inconsistent compliance. [7][8][9][10][11][12] Successful immunization programs require widespread public education campaigns by trusted stakeholders, such as primary care physicians. Prior studies have shown that physicians are the most trusted source of immunization information, 12-15 suggesting that physicians are a valuable source of knowledge to drive acceptance of the approved mRNA COVID-19 vaccines. ...
Article
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Introduction: This study was conducted to assess family physicians’ perception of the US Food and Drug Administration-approved mRNA Coronavirus disease 2019 (COVID-19) vaccines, their plans to be vaccinated with an approved mRNA COVID-19 vaccine, and their support for vaccination of patients and family members. Methods: The authors conducted a cross-sectional survey of 307 practicing family physicians, fulltime faculty physicians, and resident physicians in Kansas from December 14, 2020, to December 31, 2020. The study participants completed an anonymous, 20-item survey assessing family physicians’ concerns about exposure to COVID-19 and their perceptions of the mRNA COVID-19 vaccines to control SARS-CoV-2. A mixed-method approach was used to collect, analyze, and interpret the data. Results: There was a 51.1% response rate. The proportion of family physicians who reported their intentions to be vaccinated for COVID-19 was significantly higher than those who were hesitant to receive the mRNA vaccines (90.6% vs 9.4%; X2 [1, n = 307] = 201.9.1; P < .0001). Among those who were willing to be vaccinated with an approved mRNA COVID-19 vaccine, the main reasons were to prevent COVID-19 infection; protect self, family, and community; contribute to herd immunity; inspire confidence that the vaccines are safe and end the pandemic and bring life back to normal. Conclusion: Our findings suggest a significantly positive association between a physician’s concerns and their willingness to be vaccinated with an approved mRNA COVID-19 vaccine. With the authorization of 2 new mRNA COVID-19 vaccines, future studies should investigate the number of physicians in our study who received the vaccine. (J Am Board Fam Med 2021;34:898–906.)
Article
This article addresses some of the challenges faced by researchers who are seeking to identify, gain access to, conduct interviews with, and analyze data from elites. Drawing on the first author’s experience of conducting elite interviews as a source of social research regarding laws and legal processes, this article offers both theoretical and practical insights. Theoretically, we examine interviews with senior legal experts as a particular form of elite interviewing. Interviewing legal elites poses its own set of challenges that at times relate to and sometimes depart from other experiences of interviewing elite groups. Practically, we provide suggestions for how researchers new to elite interviewing and those more experienced can reflect on and navigate different stages of their field research to help capture novel insights. Paradoxically, we show that while an uncomfortable conversation can appear to the researcher that it has not gone well, often it can be a sign of a high quality elite interview.
Article
Social media has revolutionized health information-seeking behavior with crowd-based medical advice. Decreased vaccination uptake and subsequent disease outbreaks have generally occurred in localized clusters based on social norms; however, geographically unrestricted Facebook networks promote parental vaccination refusal congruent with digital identity formation. Interactions within the largest closed Facebook group for vaccination choice were analyzed through the lens of Social Influence Theory. Anti-vaccination advocates impacted first-time mothers’ expressed vaccination intentions through both informational and normative influence processes. Six overarching themes were identified as strategies used by these individuals to persuade fence sitting parents to delay or decline vaccinations, including: natural solutions, maternal empowerment, distrust of conventional medicine establishment, fear appeals, ‘Russian Roulette’ risk benefit analysis, and misinformation and misunderstandings.
Article
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L’hésitation à la vaccination (soit la réticence à accepter les vaccins recommandés) est un problème complexe qui complique la communication des risques pour les autorités sanitaires publiques et les cliniciens. Des études démontrent que fournir trop de données probantes sur l’innocuité et l’efficacité des vaccins aux personnes hésitantes à la vaccination ne permet pas de diminuer les croyances et craintes associées à l’hésitation. Le présent document a pour objectif de décrire les bonnes pratiques en matière d’élaboration de matériel de communication visant à contrer l’hésitation à la vaccination. Nous avons évalué un échantillon de matériel de communication sur la vaccination utilisé au Canada en s’appuyant sur les recommandations d’un comité d’experts sur l’efficacité de la communication des risques pour les produits de santé du Conseil des académies canadiennes (2015). Plusieurs produits de communication actuels pourraient être améliorés si on se conformait aux pratiques d’excellence en matière de communication des risques fondées sur des données probantes. Nous avons désigné cinq pratiques d’excellence. Premièrement, déterminer le public cible et établir la confiance. Deuxièmement, fournir de l’information tant sur les risques que les avantages de la vaccination, puisque la plupart des gens souhaitent obtenir des renseignements nuancés. Troisièmement, présenter les faits avant de parler des mythes. Quatrièmement, utiliser des supports visuels. Cinquièmement, tester le matériel de communication avant le lancement. Mettre ces pratiques d’excellence en œuvre avec les produits de communication actuels ou à venir aidera les vaccinateurs (dont les médecins, infirmiers praticiens, pharmaciens et professionnels de la santé publique) à créer du matériel de communication sensible aux moyens complexes que les personnes utilisent pour traiter et valoriser l’information et, par conséquent, plus susceptible d’optimiser l’adoption des vaccins au sein de leur collectivité.
Article
Although many interventions aim to reduce parents' hesitancy about childhood vaccinations, parents' experiences of vaccine attitude change trajectories remain underexplored. This constructivist grounded theory study examines trajectories of change in vaccine confidence and uptake among mothers in the Greater Vancouver region of Canada. Specifically, we explored what mothers identified as causes and facilitators to these changes, the processes involved, and how they experienced these changes in the contexts of their parenting lives. The study population comprised 23 mothers (mean age 41.3 years), each with at least one child aged 6–12 years. Nine (39%) had become more confident in vaccines, 10 (43%) more hesitant, and four (17%) experienced multiple changes over time. Trajectories of growing vaccine confidence were portrayed by participants as cognitive journeys, moving toward facts and away from fear, and influenced by a participant's growing knowledge and experience. While trajectories of increased hesitancy about vaccination involved underlying concerns about vaccines that were augmented by negative peer attitudes or negative personal experiences with vaccination or health care. In both trajectories, a mother's growing confidence as a parent was perceived as empowering her to make decisions over time. Mothers with multiple changes in vaccine attitudes either had hesitations about specific vaccines, which were allayed over time, or experienced negative vaccine reactions that caused them to pause, then later resume vaccination.
Article
Aims: COVID-19 affects family life world-wide. Determinants of hesitancy around vaccinating children against COVID-19 are critical in guiding public health campaigns. Gender differences among parents may determine willingness to vaccinate children against COVID-19. Methods: Secondary analysis of the COVID-19 Parental Attitude Study (COVIPAS) surveying care givers of children presenting for emergency care in 17 sites in 6 countries during peak pandemic (March-June, 2020). We assessed risk perceptions, vaccination history and plans to vaccinate children against COVID-19 once available. We compared responses given by father or mother and used multivariable logistic regression. Results: A total of 2025 (75.4%) surveys were completed by mothers and 662 (24.6%) by fathers, 60 did not respond to question about future vaccination. Of 2627, 1721 (65.5%) were willing to vaccinate their children. In the multivariable analysis, both fathers and mothers were more willing to vaccinate their child if the parent was older and believed that social distancing is worthwhile, and if their child was up-to-date on childhood vaccines (odds ratio (OR) of 1.02, 3.90, 1.65 for mothers and 1.04, 4.76, 2.87 for fathers, respectively). Mothers (but not fathers) were more willing if they had more than a high school education (OR 1.38), and fathers (but not mothers) were more willing to vaccinate their male children (OR 1.62), compared to female children. Conclusion: Unique differences between mothers and fathers underscore the need to view vaccine hesitancy as an acceptable parental response. Public health should plan targeted educational information for parents about a COVID-19 vaccine for children.
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Vaccine hesitancy is currently recognized by the WHO as a major threat to global health. Recently, especially during the COVID-19 pandemic, there has been a growing interest in the role of social media in the propagation of false information and fringe narratives regarding vaccination. Using a sample of approximately 60 billion tweets, we conduct a large-scale analysis of the vaccine discourse on Twitter. We use methods from deep learning and transfer learning to estimate the vaccine sentiments expressed in tweets, then categorize individual-level user attitude towards vaccines. Drawing on an interaction graph representing mutual interactions between users, we analyze the interplay between vaccine stances, interaction network, and the information sources shared by users in vaccine-related contexts. We find that strongly anti-vaccine users frequently share content from sources of a commercial nature; typically sources which sell alternative health products for profit. An interesting aspect of this finding is that concerns regarding commercial conflicts of interests are often cited as one of the major factors in vaccine hesitancy. Further, we show that the debate is highly polarized, in the sense that users with similar stances on vaccination interact preferentially with one another. Extending this insight, we provide evidence of an epistemic echo chamber effect, where users are exposed to highly dissimilar sources of vaccine information, depending the vaccination stance of their contacts. Our findings highlight the importance of understanding and addressing vaccine mis- and dis-information in the context in which they are disseminated in social networks.
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Public health responses to the vaccine‐refusal (VR) movement are hindered by inadequate research about the movement's aims, identity and perceived value for its members. This study examined how members of the VR movement in Australia described the movement and what being part of it meant to them. Descriptions of the VR movement by 696 members from across Australia were collected between January and May in 2017 via an online survey. The data were analysed using thematic discourse analysis. Members’ understandings of the movement and the beliefs underpinning these understandings were examined. Vaccine refusal was underpinned by distinct epistemic beliefs. Participants believed that mainstream vaccine promotion relies on dishonest communication of compromised research. They saw the VR movement as a science‐based movement, researching both ‘mainstream’ and ‘hidden’ knowledge, promoting scientific values and advocating for better vaccine studies. Participants believed responsible parenting requires personally researching healthcare choices. Participants constructed the movement's identity in relation to common criticisms of vaccine refusal. These were discredited and repurposed to portray the movement as being brave and righteous. Participants believed people in the movement are astute, informed, responsible and courageous. They believed many members were impacted by vaccine‐related harms, from which the movement now saves others. They saw themselves as fighting for an inconvenient truth that the mainstream ignores. Vaccine promotion needs to address the epistemic beliefs associated with vaccine refusal, yet these have been inadequately understood. Our findings contribute to understanding these beliefs. Furthermore, our findings suggest what messages targeting vaccine‐refusing people should focus on. This may include acknowledging the significant effort that vaccine‐refusing people invest in trying to protect their children, catering to vaccine‐refusing people's high engagement and desire for detailed information, and avoiding stigmatising or confrontational vaccine‐promotion strategies.
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Despite overwhelming evidence that vaccines are safe and effective, there has been a rise in vaccine hesitancy and refusal leading to increases in the incidence of communicable diseases. Importantly, providing scientific information about the benefits of vaccines has not been effective in counteracting anti-vaccination beliefs. Considering this, better identification of those likely to be vaccine hesitant and the underlying attitudes that predict these beliefs are needed to develop more effective strategies to combat anti-vaccination movements. Focusing on parents as the key decision makers in their children's vaccination, the aim of this study is to better understand the demographic and attitudinal predictors of parental vaccine hesitancy. We recruited 484 parents using Amazon MTurk and queried their attitudes on childhood vaccination, level of education, age, religiosity, political affiliation, trust in medicine, and disgust sensitivity. We found three main demographic predictors for parental vaccine hesitancy: younger age, lower levels of education, and greater religiosity. We also found vaccine hesitant parents to have significantly less trust in physicians and greater disgust sensitivity. These results provide a clearer picture of vaccine hesitant parents and suggest future directions for more targeted research and public health messaging.
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Despite strong consensus about the benefits of vaccines among global health authorities, opposition to vaccination persists and may be growing. Recent research into anti-vaccination attitudes indicates they are complicated and socially embedded, not simply the result of failure to understand vaccine science. That position is supported by theories from science communication and sociological risk, which posit that divergent views about scientific subjects rarely, if ever, result solely from a deficit of knowledge. This study reconceptualises theories of language construction to reflect sociological understandings, demonstrating how scientific and non-scientific dimensions of the vaccination debate operate according to different ‘modes’ of communication, each with ‘radically different procedures for verification’. Understanding this modal distinction may assist pro-vaccination communicators construct messages that more directly address concerns about vaccination objection currently unattended to by deficit model communication.
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Objectives : Vaccine refusal is increasing in Australia and is a major concern in high- and middle-income countries. There is evidence to suggest that some parents, even those who elect to immunise, may be vaccine hesitant with some manipulating the schedule by excluding or delaying some vaccines. The aim of this review was to gain an understanding of factors that influence vaccine decision-making in pregnant women and parents of children. Design : An integrative review approach was used to produce an analysis of existing literature on vaccine decision-making in pregnancy and parents. As the broadest of review methods, an integrative review can include a range of experimental and non-experimental research, thereby ensuring the inclusion of data from multiple perspectives. Data Sources : Online databases were searched for research related to vaccine decision-making in pregnant women and parents. Original and review articles were sought that were published in English between 2015 and 2021. Reviewed articles included qualitative and quantitative studies and systematic reviews. No mixed methods papers were located or excluded from this review. Review methods : The review method was an integrative review informed by Coughlan. Results : Papers from thirteen predominantly high- and middle-income countries were selected for this review. A total of 31 articles fit the inclusion/exclusion criteria, including qualitative, quantitative and review articles. Three main themes were identified including the role of healthcare professionals, vaccine safety concerns and alternative influences. Alternative influences included: social media, friends and family, religion, conspiracy theories and salutogenic parenting. Findings suggest that high levels of anxiety are involved in vaccine decision-making with parents seeking information from multiple sources including healthcare professionals, friends and family and social media. Conclusions : Pregnancy is an ideal time to provide education on both pregnancy and childhood vaccinations. However, some parents reported dissatisfaction in their therapeutic relationships with healthcare professionals. As a result, parents can resort to their own information seeking, in the main via social media which has been linked to vaccine refusal. Additionally, some healthcare professionals report feeling inadequately prepared for the role of immunisation promotion and provision. Parental information seeking from non-traditional sources has been shown to result in the acquisition of misinformation, exposure to conspiracy theories, the inevitable loss of vaccine confidence and subsequent vaccine refusal.
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Individuals are expected to be responsible for their own health and that of their families—and act accordingly. Yet, being in a position of responsibility might be undesirable for individuals either unable or reluctant to comply with the expectations this responsibility entails. In this article, I explore how parents experience the process of engaging responsibly with digital media in relation to the question of human papillomavirus vaccination. The study is based on interviews with eighteen Danish parents, and my findings show that these parents not only understand themselves but also other actors in terms of responsibility, and that being positioned in terms of responsibility can have negative affective consequences. I argue that meeting the expectations of biological citizenship should not necessarily be a goal in relation to complex health topics.
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Introduction The aim of this paper is to review the current situation of vaccine hesitancy, with emphasis on children with neurological disorders, and to present the role social media plays in this situation. Methods A literature review using the following search words was performed: vaccine* OR immune* AND hesitancy OR confidence AND social media. Results the search retrieved 277 results; 17 duplicates and 234 irrelevant articles were excluded. 43 articles were fully analyzed. Conclusions An increasing number of parents are becoming vaccine hesitant. Their motives are complex and nuanced and involve factors related to vaccine safety and efficiency, perceived personal risks and benefits, socio-demographic and psychological characteristics. Attitudes toward vaccination differ in adolescents from their parents. In children with neurological disorders, factors involved in vaccination decision included physicians' knowledge of neurological diseases and parents’ concerns that vaccination would exacerbate the chronic disorder. Unfortunately, the current pandemic is associated with an increase in vaccine hesitancy and brought forward unique determinants. The social media platforms can be a tool for the anti-vaccine movement to spread misinformation, but it can also be valued as a way for promoting health and pro-vaccine information.
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In this study, the constructive communication process of anti-vaccination advocates is explored to provide insight into the challenges of communicating with an engaged, educated public that is distrustful of mainstream medical and governmental organizations. Using the circuit of culture as a theoretical and methodological model, this article examines how anti-vaccination advocates use social media to construct and reinforce a belief system that counters dominate understandings of health. Findings show that, through online communication, anti-vaccination advocates create shared cultural constructs embracing the identity of health information crusader, critic, and expert. This community consumes, produces, and distributes information that reframes mainstream health information and reinforces shared values. The purposes of this study are to better understand the culture of anti-vaccination advocates, identify communication barriers, and offer practical implications for health care professionals.
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Background: Childhood vaccination is one of the most effective ways to prevent serious illnesses and deaths in children. However, worldwide, many children do not receive all recommended vaccinations, for several potential reasons. Vaccines might be unavailable, or parents may experience difficulties in accessing vaccination services; for instance, because of poor quality health services, distance from a health facility, or lack of money. Some parents may not accept available vaccines and vaccination services. Our understanding of what influences parents' views and practices around childhood vaccination, and why some parents may not accept vaccines for their children, is still limited. This synthesis links to Cochrane Reviews of the effectiveness of interventions to improve coverage or uptake of childhood vaccination. Objectives: - Explore parents' and informal caregivers' views and practices regarding routine childhood vaccination, and the factors influencing acceptance, hesitancy, or nonacceptance of routine childhood vaccination. - Develop a conceptual understanding of what and how different factors reduce parental acceptance of routine childhood vaccination. - Explore how the findings of this review can enhance our understanding of the related Cochrane Reviews of intervention effectiveness. Search methods: We searched MEDLINE, Embase, CINAHL, and three other databases for eligible studies from 1974 to June 2020. Selection criteria: We included studies that: utilised qualitative methods for data collection and analysis; focused on parents' or caregivers' views, practices, acceptance, hesitancy, or refusal of routine vaccination for children aged up to six years; and were from any setting globally where childhood vaccination is provided. Data collection and analysis: We used a pre-specified sampling frame to sample from eligible studies, aiming to capture studies that were conceptually rich, relevant to the review's phenomenon of interest, from diverse geographical settings, and from a range of income-level settings. We extracted contextual and methodological data from each sampled study. We used a meta-ethnographic approach to analyse and synthesise the evidence. We assessed methodological limitations using a list of criteria used in previous Cochrane Reviews and originally based on the Critical Appraisal Skills Programme quality assessment tool for qualitative studies. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We integrated the findings of this review with those from relevant Cochrane Reviews of intervention effectiveness. We did this by mapping whether the underlying theories or components of trial interventions included in those reviews related to or targeted the overarching factors influencing parental views and practices regarding routine childhood vaccination identified by this review. Main results: We included 145 studies in the review and sampled 27 of these for our analysis. Six studies were conducted in Africa, seven in the Americas, four in South-East Asia, nine in Europe, and one in the Western Pacific. Studies included urban and rural settings, and high-, middle-, and low-income settings. Many complex factors were found to influence parents' vaccination views and practices, which we divided into four themes. Firstly, parents' vaccination ideas and practices may be influenced by their broader ideas and practices surrounding health and illness generally, and specifically with regards to their children, and their perceptions of the role of vaccination within this context. Secondly, many parents' vaccination ideas and practices were influenced by the vaccination ideas and practices of the people they mix with socially. At the same time, shared vaccination ideas and practices helped some parents establish social relationships, which in turn strengthened their views and practices around vaccination. Thirdly, parents' vaccination ideas and practices may be influenced by wider political issues and concerns, and particularly their trust (or distrust) in those associated with vaccination programmes. Finally, parents' vaccination ideas and practices may be influenced by their access to and experiences of vaccination services and their frontline healthcare workers. We developed two concepts for understanding possible pathways to reduced acceptance of childhood vaccination. The first concept, 'neoliberal logic', suggests that many parents, particularly from high-income countries, understood health and healthcare decisions as matters of individual risk, choice, and responsibility. Some parents experienced this understanding as in conflict with vaccination programmes, which emphasise generalised risk and population health. This perceived conflict led some parents to be less accepting of vaccination for their children. The second concept, 'social exclusion', suggests that some parents, particularly from low- and middle-income countries, were less accepting of childhood vaccination due to their experiences of social exclusion. Social exclusion may damage trustful relationships between government and the public, generate feelings of isolation and resentment, and give rise to demotivation in the face of public services that are poor quality and difficult to access. These factors in turn led some parents who were socially excluded to distrust vaccination, to refuse vaccination as a form of resistance or a way to bring about change, or to avoid vaccination due to the time, costs, and distress it creates. Many of the overarching factors our review identified as influencing parents' vaccination views and practices were underrepresented in the interventions tested in the four related Cochrane Reviews of intervention effectiveness. Authors' conclusions: Our review has revealed that parents' views and practices regarding childhood vaccination are complex and dynamic social processes that reflect multiple webs of influence, meaning, and logic. We have provided a theorised understanding of the social processes contributing to vaccination acceptance (or not), thereby complementing but also extending more individualistic models of vaccination acceptance. Successful development of interventions to promote acceptance and uptake of childhood vaccination will require an understanding of, and then tailoring to, the specific factors influencing vaccination views and practices of the group(s) in the target setting. The themes and concepts developed through our review could serve as a basis for gaining this understanding, and subsequent development of interventions that are potentially more aligned with the norms, expectations, and concerns of target users.
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Despite numerous scientific studies affirming the safety and efficacy of vaccinations, decreased parental uptake has led in part to disease resurgence in the United States (Ventola, 2016). A systematic review of 42 studies revealed that exemption rates for vaccination requirements to enter public schools or daycares have been increasing and occur in geographic“clusters,” where vaccination rates fall dangerously below the national average (Wang, Clymer, Davis-Hayes, & Buttenheim, 2014). At the transition to parenthood, mothers rely on Facebook with increased intensity for health information-seeking purposes. In a rejection of the health information deficit model, the purpose of this study was to propose a conceptual model which describes how first-time mothers’ dependence on Facebook may lead to childhood vaccine avoidance, in accordance with social network theory. A model is presented and propositions are offered to explain why discerning first-time mothers, who are consistently more vaccine hesitant, may seek and rely on information from peers in closed Facebook groups rather than from health professionals. While research has separately explored both vaccine hesitancy and social network utilization for health information seeking, no conceptual model to date has linked these concepts with first-time mothers’ childhood vaccine avoidance. Published research supports the constructs included in the proposed causal pathway, and this “Maternal Facebook Dependence-Childhood Vaccine Avoidance Model” will act as a springboard for advancement in operationalization of this complex relational construct.
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This publication addresses the limited use of qualitative methods in neglected tropical disease (NTD) programmes. It describes a scoping literature review conducted to inform the development of a guide to inform the use of rapid qualitative assessments to strengthen NTD mass drug administration (MDA) programmes. The review assessed how qualitative methods are currently used by NTD programmes and identified qualitative approaches from other health and development programmes with the potential to strengthen the design of MDA interventions. Systematic review articles were reviewed and searched using key terms conducted on Google Scholar and PubMed. Results show that methods used by NTD programmes rely heavily on focus group discussions and in-depth interviews, often with time-consuming analysis and limited information on how results are applied. Results from other fields offered insight into a wider range of methods, including participatory approaches, and on how to increase programmatic uptake of findings. Recommendations on how to apply these findings to NTD control are made. The topic of human resources for qualitative investigations is explored and a guide to improve MDAs using qualitative methods is introduced. This guide has direct applicability across the spectrum of NTDs as well as other public health programmes.
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To improve uptake of influenza vaccine in pregnancy, it is important to understand the factors that predict prenatal vaccination. The aim of this study was to test the capability of the theory of planned behavior, augmented with information constructs, to predict and explain influenza vaccination uptake in a sample of 600 pregnant individuals in Canada. A baseline survey at the start of influenza season assessed beliefs, norms, perceived control, and information-seeking behavior related to influenza vaccination in pregnancy, as well as respondent demographics. A follow-up survey at the conclusion of influenza season assessed self-reported influenza vaccine uptake as well as infant vaccination intentions. Multivariable analysis indicated that attitudes toward influenza vaccination in pregnancy, subjective norms, information seeking, and past vaccination behavior predicted intentions to be vaccinated, and intentions predicted vaccine uptake. Neither perceived control nor demographics were significant predictors of intentions or vaccine uptake. These findings suggest that presumptive offering of vaccination in pregnancy by health care providers, as well as patient and public health educational interventions, may be effective in communicating norms and strengthening positive attitudes and intentions concerning influenza vaccination in pregnancy, resulting in higher vaccine coverage.
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The social responsibility logic underpinning vaccination is omnipresent in the rhetoric surrounding its acceptance and rejection. People who reject vaccination are constantly faced with arguments from the vaccinating mainstream to which they must respond. Understanding the conceptual world of vaccine rejection requires us to understand how vaccine sceptics construct answers to complaints that their choices endanger other people. This article analyses interviews with 29 vaccine-sceptical parents who are presented with claims that their choices are not just morally wrong, but dangerous to others. We argue that vaccine rejecters possess power because their decisions can result in the transmission of infectious diseases through their communities. However, they refuse to acknowledge this power because, through a variety of rationalisations, they do not accept the logic of community protection (herd immunity) and social responsibility. Strategies to prompt parents’ consideration of others can include breaking out of the ontologically individualistic framing of the disagreement.
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Even if vaccination is often described as one of the great achievements of public health, results of recent studies have shown that parental acceptance of vaccination is eroding. Health providers' knowledge and attitudes about vaccines are important determinants of their own vaccine uptake, their intention to recommend vaccines to patients and the vaccine uptake of their patients. The purpose of this article is to compare how midwives and physicians address vaccination with parents during pregnancy and in postpartum visits. Thirty semi-structured interviews were conducted with midwives and physicians practicing in the province of Quebec, Canada. Results of our analysis have shown that physicians adopt an "education-information" stance when discussing vaccination with parents in the attempt to "convince" parents to vaccinate. In contrast, midwives adopted a neutral stance and gave information on the pros and cons of vaccination to parents while leaving the final decision up to them. Findings of this study highlight the fact that physicians and midwives have different views regarding their role and responsibilities concerning vaccination. It may be that neither of these approaches is optimal in promoting vaccination uptake.
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Research dealing with various aspects of* the theory of planned behavior (Ajzen, 1985, 1987) is reviewed, and some unresolved issues are discussed. In broad terms, the theory is found to be well supported by empirical evidence. Intentions to perform behaviors of different kinds can be predicted with high accuracy from attitudes toward the behavior, subjective norms, and perceived behavioral control; and these intentions, together with perceptions of behavioral control, account for considerable variance in actual behavior. Attitudes, subjective norms, and perceived behavioral control are shown to be related to appropriate sets of salient behavioral, normative, and control beliefs about the behavior, but the exact nature of these relations is still uncertain. Expectancy— value formulations are found to be only partly successful in dealing with these relations. Optimal rescaling of expectancy and value measures is offered as a means of dealing with measurement limitations. Finally, inclusion of past behavior in the prediction equation is shown to provide a means of testing the theory*s sufficiency, another issue that remains unresolved. The limited available evidence concerning this question shows that the theory is predicting behavior quite well in comparison to the ceiling imposed by behavioral reliability.
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Many primary care pediatricians find vaccine hesitancy to be one of the most frustrating situations that they face. Parents who refuse to vaccinate their children implicitly call into question an intervention that most pediatricians see as one of the safest and most effective health care interventions of all time. Many pediatricians respond by refusing to care for children whose parents refuse vaccines, and some may consider that the parent's refusal warrants referral to child protective services. We present a case in which a pediatrician faces this dilemma, with responses from pediatricians in academia and private practice.
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Vaccines are among the most effective public health interventions against infectious diseases. However, there is evidence in the United States for parents either delaying or refusing recommended childhood vaccination. Exemptions to school immunization laws and use of alternative schedule from those recommended by the Advisory Committee on Immunization Practices and the American Academy of Pediatrics cannot only increase the risk of children contracting vaccine-preventable diseases but also increases the risk of infecting others who are either too young to be vaccinated, cannot be vaccinated for medical reasons or did not develop a sufficient immunological response to the vaccine. Healthcare providers are cited as the most influential source by parents on vaccine decision-making. Vaccine hesitancy needs to be addressed by healthcare providers and the scientific community by listening to the parental concerns and discussing risks associated with either delaying or refusing vaccines.
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Objective: To characterize provider-parent vaccine communication and determine the influence of specific provider communication practices on parent resistance to vaccine recommendations. Methods: We conducted a cross-sectional observational study in which we videotaped provider-parent vaccine discussions during health supervision visits. Parents of children aged 1 to 19 months old were screened by using the Parent Attitudes about Childhood Vaccines survey. We oversampled vaccine-hesitant parents (VHPs), defined as a score ≥50. We developed a coding scheme of 15 communication practices and applied it to all visits. We used multivariate logistic regression to explore the association between provider communication practices and parent resistance to vaccines, controlling for parental hesitancy status and demographic and visit characteristics. Results: We analyzed 111 vaccine discussions involving 16 providers from 9 practices; 50% included VHPs. Most providers (74%) initiated vaccine recommendations with presumptive (e.g., "Well, we have to do some shots") rather than participatory (e.g., "What do you want to do about shots?") formats. Among parents who voiced resistance to provider initiation (41%), significantly more were VHPs than non-VHPs. Parents had significantly higher odds of resisting vaccine recommendations if the provider used a participatory rather than a presumptive initiation format (adjusted odds ratio: 17.5; 95% confidence interval: 1.2-253.5). When parents resisted, 50% of providers pursued their original recommendations (e.g., "He really needs these shots"), and 47% of initially resistant parents subsequently accepted recommendations when they did. Conclusions: How providers initiate and pursue vaccine recommendations is associated with parental vaccine acceptance.
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Importance: Acceptance of childhood vaccinations is waning, amplifying interest in developing and testing interventions that address parental barriers to immunization acceptance. Objective: To determine the predictive validity and test-retest reliability of the Parent Attitudes About Childhood Vaccines survey (PACV), a recently developed measure of vaccine hesitancy. Design, setting, and participants: Prospective cohort of English-speaking parents of children aged 2 months and born from July 10 through December 10, 2010, who belonged to an integrated health care delivery system based in Seattle and who returned a completed baseline PACV. Parents who completed a follow-up survey 8 weeks later were included in the reliability analysis. Parents who remained continuous members in the delivery system until their child was 19 months old were included in the validity analysis. Exposure: The PACV, scored on a scale of 0 to 100 (100 indicates high vaccine hesitancy). Main outcomes and measures: Child's immunization status as measured by the percentage of days underimmunized from birth to 19 months of age. Results: Four hundred thirty-seven parents completed the baseline PACV (response rate, 50.5%), and 220 (66.5%) completed the follow-up survey. Of the 437 parents who completed a baseline survey, 310 (70.9%) maintained continuous enrollment. Compared with parents who scored less than 50, parents who scored 50 to 69 on the survey had children who were underimmunized for 8.3% (95% CI, 3.6%-12.8%) more days from birth to 19 months of age; those who scored 70 to 100, 46.8% (40.3%-53.3%) more days. Baseline and 8-week follow-up PACV scores were highly concordant (ρ = 0.844). Conclusions and relevance: Scores on the PACV predict childhood immunization status and have high reliability. Our results should be validated in different geographic and demographic samples of parents.
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Immunisation is the cornerstone of childhood disease prevention. In this context the combined measles, mumps and rubella vaccination (MMR) has proved a world-wide success, although in the UK it has been at the centre of public controversy since 1998. Through the media, the public domain has witnessed contestation among expert views about the relative risks associated with the diseases vs. the potential side-effects of the vaccination. Attainment of health protection targets has been compromised. The UK Department of Health sought to redress this through a major communication exercise. This paper reports the findings of a study of information strategies that parents use to make sense of health risk issues, particularly MMR. The findings identify the importance of social networks in reinforcing parental understanding and beliefs. While the media are identified as important sources of information, there is no evidence to suggest that parents passively receive and act upon such risk messages. Official information has been able to capitalise on the strong social normalisation of vaccination, but has not responded fully to the evolving social interpretation of risks. The study reveals a preference for personal and face-to-face engagement with health professionals, stressing the importance of user-centred health risk communication.
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Herd immunity is an important benefit of childhood immunization, but it is unknown if the concept of benefit to others influences parents' decisions to immunize their children. Our objective was to determine if the concept of "benefit to others" has been found in the literature to influence parents' motivation for childhood immunization. We systematically searched Medline through October 2010 for articles on parental/guardian decision-making regarding child immunization. Studies were included if they presented original work, elicited responses from parents/guardians of children <18 years old, and addressed vaccinating children for the benefit of others. The search yielded 5876 titles; 91 articles were identified for full review. Twenty-nine studies met inclusion criteria. Seventeen studies identified benefit to others as 1 among several motivating factors for immunization by using interviews or focus groups. Nine studies included the concept of benefit to others in surveys but did not rank its relative importance. In 3 studies, the importance of benefit to others was ranked relative to other motivating factors. One to six percent of parents ranked benefit to others as their primary reason to vaccinate their children, and 37% of parents ranked benefit to others as their second most important factor in decision-making. There appears to be some parental willingness to immunize children for the benefit of others, but its relative importance as a motivator is largely unknown. Further work is needed to explore this concept as a possible motivational tool for increasing childhood immunization uptake.
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This review examines four events related to vaccination that have occurred in recent years: (a) the ongoing recovery from the MMR/Autism scare in the UK, (b) the upgrading of the Varicella vaccine to a universal childhood vaccine, (c) the major effort of authorities to provide a vaccine for A/H1N1 influenza and its rejection by the public, and, d) the current attempts to change the HPV vaccine target from girls only to boys and girls. All of these changes have been met with shifts in the public acceptance of the relevant vaccine. These shifts are characterized not only by the number of people willing to be vaccinated, but also by the attitudes and the motives related to acceptance. Examination of the interrelationship between changes in vaccination realities, and changes in acceptance patterns suggests that today, the public has a better understanding of vaccination, is acting in a more reflexive way, and is capable of changing attitudes and behavior. All together, changes in vaccination enhance debates and dialogues about vaccines, and lead to higher awareness and more conscious acceptance.
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Parents who choose to selectively vaccinate or avoid vaccination for their children may do so at risk of compromising relations with their family physician or pediatrician. Groups that are associated with reduced rates of pedicatic vaccination, such as parents who access naturopathic care, may be particularly vulnerable to this issue. In March through September 2010, we administered a 26-item cross-sectional survey to 129 adult patients, all of whom were parents with children ≤ 16 years of age, presenting for naturopathic care in Ontario, Canada. Ninety-five parents completed the survey (response rate 74%), and only 50.5% (48 of 95) reported that their children had received all recommended vaccines. Most parents (50.5%; 48 of 95) reported feeling pressure to vaccinate from their allopathic physician and, of those who discussed vaccination with their physician, 25.9% (21 of 81) were less comfortable continuing care as a result. Five percent (4 of 81) of respondents were advised by their physician that their children would be refused care if they decided against vaccination. In our adjusted generalized linear model, feeling pressure to vaccinate (odds ratio [OR] = 3.07; 95% confidence interval [CI] = 1.14 to 8.26) or endorsing a naturopathic physician as their most trusted source of information regarding vaccination (OR = 3.57; 95% CI = 1.22 to 10.44) were associated with greater odds of having a partially vaccinated or unvaccinated child. The majority (69.6%; 32 of 46) of parent's with partially vaccinated or unvaccinated children reported a willingness to re-consider this decision. Use of naturopathic care should be explored among parents in order to identify this high-risk group and engage them in discussion regarding pediatric vaccination to encourage evidence-based, shared decision making. Physicians should ensure that discussions regarding vaccination are respectful, even if parents are determined not to vaccinate their children.
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We evaluated the association between parents' beliefs about vaccines, their decision to delay or refuse vaccines for their children, and vaccination coverage of children at aged 24 months. We used data from 11,206 parents of children aged 24-35 months at the time of the 2009 National Immunization Survey interview and determined their vaccination status at aged 24 months. Data included parents' reports of delay and/or refusal of vaccine doses, psychosocial factors suggested by the Health Belief Model, and provider-reported up-to-date vaccination status. In 2009, approximately 60.2% of parents with children aged 24-35 months neither delayed nor refused vaccines, 25.8% only delayed, 8.2% only refused, and 5.8% both delayed and refused vaccines. Compared with parents who neither delayed nor refused vaccines, parents who delayed and refused vaccines were significantly less likely to believe that vaccines are necessary to protect the health of children (70.1% vs. 96.2%), that their child might get a disease if they aren't vaccinated (71.0% vs. 90.0%), and that vaccines are safe (50.4% vs. 84.9%). Children of parents who delayed and refused also had significantly lower vaccination coverage for nine of the 10 recommended childhood vaccines including diphtheria-tetanus-acellular pertussis (65.3% vs. 85.2%), polio (76.9% vs. 93.8%), and measles-mumps-rubella (68.4% vs. 92.5%). After adjusting for sociodemographic differences, we found that parents who were less likely to agree that vaccines are necessary to protect the health of children, to believe that their child might get a disease if they aren't vaccinated, or to believe that vaccines are safe had significantly lower coverage for all 10 childhood vaccines. Parents who delayed and refused vaccine doses were more likely to have vaccine safety concerns and perceive fewer benefits associated with vaccines. Guidelines published by the American Academy of Pediatrics may assist providers in responding to parents who may delay or refuse vaccines.
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Vaccines--often lauded as one of the greatest public health interventions--are losing public confidence. Some vaccine experts have referred to this decline in confidence as a crisis. We discuss some of the characteristics of the changing global environment that are contributing to increased public questioning of vaccines, and outline some of the specific determinants of public trust. Public decision making related to vaccine acceptance is neither driven by scientific nor economic evidence alone, but is also driven by a mix of psychological, sociocultural, and political factors, all of which need to be understood and taken into account by policy and other decision makers. Public trust in vaccines is highly variable and building trust depends on understanding perceptions of vaccines and vaccine risks, historical experiences, religious or political affiliations, and socioeconomic status. Although provision of accurate, scientifically based evidence on the risk-benefit ratios of vaccines is crucial, it is not enough to redress the gap between current levels of public confidence in vaccines and levels of trust needed to ensure adequate and sustained vaccine coverage. We call for more research not just on individual determinants of public trust, but on what mix of factors are most likely to sustain public trust. The vaccine community demands rigorous evidence on vaccine efficacy and safety and technical and operational feasibility when introducing a new vaccine, but has been negligent in demanding equally rigorous research to understand the psychological, social, and political factors that affect public trust in vaccines.
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The United States has made tremendous progress in using vaccines to prevent serious, often infectious, diseases. But concerns about such issues as vaccines' safety and the increasing complexity of immunization schedules have fostered doubts about the necessity of vaccinations. We investigated parents' confidence in childhood vaccines by reviewing recent survey data. We found that most parents--even those whose children receive all of the recommended vaccines--have questions, concerns, or misperceptions about them. We suggest ways to give parents the information they need and to keep the US national vaccination program a success.
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Objective: To develop a survey to accurately assess parental vaccine hesitancy. Results: The initial survey contained 17 items in four content domains: (1) immunization behavior; (2) beliefs about vaccine safety and efficacy; (3) attitudes about vaccine mandates and exemptions; and (4) trust. Focus group data yielded an additional 10 survey items. Expert review of the survey resulted in the deletion of nine of 27 items and revisions to 11 of the remaining 18 survey items. Parent pretesting resulted in the deletion of one item, the addition of one item, the revision of four items, and formatting changes to enhance usability. The final survey contains 18 items in the original four content domains. Methods: An iterative process was used to develop the survey. First, we reviewed previous studies and surveys on parental health beliefs regarding vaccination to develop content domains and draft initial survey items. Focus groups of parents and pediatricians generated additional themes and survey items. Six immunization experts reviewed the items in the resulting draft survey and ranked them on a 1-5 scale for significance in identifying vaccine-hesitant parents (5 indicative of a highly significant item). The lowest third of ranked items were dropped. The revised survey was pretested with 25 parents to assess face validity, usability and item understandability. Conclusions: The Parent Attitudes about Childhood Vaccines survey was constructed using qualitative methodology to identify vaccine-hesitant parents and has content and face validity. Further psychometric testing is needed.
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Vaccine safety concerns can diminish parents' willingness to vaccinate their children. The objective of this study was to characterize the current prevalence of parental vaccine refusal and specific vaccine safety concerns and to determine whether such concerns were more common in specific population groups. In January 2009, as part of a larger study of parents and nonparents, 2521 online surveys were sent to a nationally representative sample of parents of children who were aged </=17 years. The main outcome measures were parental opinions on vaccine safety and whether the parent had ever refused a vaccine that a doctor recommended for his or her child. The response rate was 62%. Most parents agreed that vaccines protect their child(ren) from diseases; however, more than half of the respondents also expressed concerns regarding serious adverse effects. Overall, 11.5% of the parents had refused at least 1 recommended vaccine. Women were more likely to be concerned about serious adverse effects, to believe that some vaccines cause autism, and to have ever refused a vaccine for their child(ren). Hispanic parents were more likely than white or black parents to report that they generally follow their doctor's recommendations about vaccines for their children and less likely to have ever refused a vaccine. Hispanic parents were also more likely to be concerned about serious adverse effects of vaccines and to believe that some vaccines cause autism. Although parents overwhelmingly share the belief that vaccines are a good way to protect their children from disease, these same parents express concerns regarding the potential adverse effects and especially seem to question the safety of newer vaccines. Although information is available to address many vaccine safety concerns, such information is not reaching many parents in an effective or convincing manner.
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Much emphasis has been placed recently in sociological, policy and popular discourses on changes in lay people's attitudes towards the medical profession that have been labelled by some as a move towards the embracing of "consumerism". Notions of consumerism tend to assume that lay people act as "rational" actors in the context of the medical encounter. They align with broader sociological concepts of the "reflexive self" as a product of late modernity; that is, the self who acts in a calculated manner to engage in self-improvement and who is sceptical about expert knowledges. To explore the ways that people think and feel about medicine and the medical profession, this article draws on findings from a study involving in-depth interviews with 60 lay people from a wide range of backgrounds living in Sydney. These data suggest that, in their interactions with doctors and other health care workers, lay people may pursue both the ideal-type "consumerist" and the "passive patient" subject position simultaneously or variously, depending on the context. The article concludes that late modernist notions of reflexivity as applied to issues of consumerism fail to recognize the complexity and changeable nature of the desires, emotions and needs that characterize the patient-doctor relationship.
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Objective We evaluated the association between parents' beliefs about vaccines, their decision to delay or refuse vaccines for their children, and vaccination coverage of children at aged 24 months. Methods We used data from 11,206 parents of children aged 24–35 months at the time of the 2009 National Immunization Survey interview and determined their vaccination status at aged 24 months. Data included parents' reports of delay and/or refusal of vaccine doses, psychosocial factors suggested by the Health Belief Model, and provider-reported up-to-date vaccination status. Results In 2009, approximately 60.2% of parents with children aged 24–35 months neither delayed nor refused vaccines, 25.8% only delayed, 8.2% only refused, and 5.8% both delayed and refused vaccines. Compared with parents who neither delayed nor refused vaccines, parents who delayed and refused vaccines were significantly less likely to believe that vaccines are necessary to protect the health of children (70.1% vs. 96.2%), that their child might get a disease if they aren't vaccinated (71.0% vs. 90.0%), and that vaccines are safe (50.4% vs. 84.9%). Children of parents who delayed and refused also had significantly lower vaccination coverage for nine of the 10 recommended childhood vaccines including diphtheria-tetanus-acellular pertussis (65.3% vs. 85.2%), polio (76.9% vs. 93.8%), and measles-mumps-rubella (68.4% vs. 92.5%). After adjusting for sociodemographic differences, we found that parents who were less likely to agree that vaccines are necessary to protect the health of children, to believe that their child might get a disease if they aren't vaccinated, or to believe that vaccines are safe had significantly lower coverage for all 10 childhood vaccines. Conclusions Parents who delayed and refused vaccine doses were more likely to have vaccine safety concerns and perceive fewer benefits associated with vaccines. Guidelines published by the American Academy of Pediatrics may assist providers in responding to parents who may delay or refuse vaccines.
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Vaccinations and Public Concern in History explores vernacular beliefs and practices that surround decisions not to vaccinate. Through the use of ethnographic, media, and narrative analyses, this book explores the vernacular explanatory models used in inoculation decision-making. The research on which the book draws was designed to help create public health education programs and promotional materials that respond to patients’ fears, understandings of risk, concerns, and doubts. Exploring the nature of inoculation distrust and miscommunication, Dr. Andrea Kitta identifies areas that require better public health communication and greater cultural sensitivity in the handling of inoculation programs.
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Background This study examines mothers’ practices and attitudes in relation to their child's immunization. In this area, like in others, gaps are being observed between the public health model of risk management and the population expectations and behaviors. Methodsé Data were collected using a standardized questionnaire from 1295 women having, in 1999, one child between 7 and 8 years of age of Swiss nationality and attending the public school system in Geneva. Results Four immunization types were established based on (1) the degree of satisfaction (in relation to past choices), (2) the perception of adequate knowledge about immunization and (3) practices. The mothers were divided into the following categories: compliant (57%), compliant ambivalent (19%), moderately resistant (17%) and resistant (7%). Mothers having reached an intermediate education level are more likely to be resistant. Furthermore, women having negative attitudes towards biomedical institutions, having consulted alternative practitioners and those considering that they have a certain individual control over the health of the family are more often resistant to immunization. Conclusion Our results confirm the existence of a resistance to child immunization among a section of the population. It should not be attributed to mothers’ ignorance, but rather could reflect their perplexity towards the choices they are expected to make. In that regards, the importance some parents give to individual control over health can be in contradiction with community objectives of public health. Actions for the promotion of immunization should primarily target families who are uncertain (compliant ambivalent and moderately resistant). At the same time, the difficulties entailed in the – individual and collective – management of risks require that new forms of dialogue be developed between experts and the public.
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Continued parental acceptance of childhood vaccination is essential for the maintenance of herd immunity and disease prevention. As such, understanding parents' decision-making in relation to their children's vaccinations is vitally important. This qualitative study sought to develop an understanding of the general process parents go through when making decisions about their children's vaccinations. Interviews were conducted with U.S.-born parents living in King County, Washington who had children ≤18 months of age. These interviews were recorded and transcribed verbatim. Through the application of grounded theory, a general decision-making process was identified. Stages in this process included: awareness, assessing and choosing, followed by either stasis or ongoing assessment. The greatest variation occurred during the assessing stage, which involved parents examining vaccination-related issues to make subsequent decisions. This research suggests that three general assessment groups exist: acceptors, who rely primarily on general social norms to make their vaccination decisions; reliers, who rely primarily on other people for information and advice; and searchers, who seek for information on their own, primarily from published sources. These results imply that one-size-fits-all approaches to vaccination interventions are inappropriate. Instead, this research suggests that interventions must be targeted to parents based on how they assess vaccination.
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To describe parental vaccine decision making behaviors and characterize trust in physician advice among parents with varying childhood vaccination behaviors. Between 2008 and 2011, a mixed methods study was conducted with parents of children aged <4 years who were members of Kaiser Permanente Colorado health plan. Seven focus groups were conducted with vaccine-hesitant parents. On the basis of findings from the focus groups, a survey was developed, pilot tested, and mailed to a stratified sample of 854 parents who accepted (n = 500), delayed (n = 227), or refused (n = 127) vaccinations for one of their children. Survey results were analyzed by chi-square tests and multivariable logistic regression. Several themes emerged from the focus groups, including: 1) the vaccine decision-making process begins prenatally, 2) vaccine decision making is an evolving process, and 3) there is overall trust in the pediatrician but a lack of trust in the information they provided about vaccines. The survey response rate was 52% (n = 443). Parents who refused or delayed vaccines were 2 times more likely to report that they began thinking about vaccines before their child was born and 8 times more likely to report that they constantly reevaluate their vaccine decisions than parents who accepted all vaccines. Although parents tended to report trusting their pediatrician's advice on nutrition, behavior, and the physical examination, they did not believe their pediatrician provided "balanced" information on both the benefits and risks of vaccination. These results have implications for future interventions to address parental vaccination concerns. Such interventions may be more effective if they are applied early (during pregnancy) and often (pregnancy through infancy), and cover both the risks and benefits of vaccination.
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At the World Economic Forum in 2010, The Gates Foundation announced the "Decade of Vaccines," a $10 billion commitment to increase access to existing and new childhood vaccines. It is estimated that this effort could save 6.4 million lives and avert 426 million illnesses [1, 2] Achieving these goals will require a significant effort among global health agencies, non-governmental organizations, industry and national governments to support vaccine development and ensure a strong infrastructure for sustainable vaccine delivery. Vaccines are one of the most important public health achievements in history, resulting in significant decreases in the prevalence of many childhood diseases. However, persistent disparities exist in the adoption of new vaccines and sustained vaccination rates in both developed and developing countries. Decreasing vaccination rates in some communities have resulted in outbreaks of vaccine-preventable diseases. Disparities may be due to vaccine supply, poor infrastructure, or low prioritization of vaccines for public health spending. However, another crucial contributor to the success of vaccination programs is vaccine acceptance.
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Alternative immunization schedules increase the time a child is unvaccinated and require greater resources from providers. Understanding what drives interest in alternative immunization schedules can potentially inform the design of effective, targeted messages that help to reduce time spent counseling and decrease requests for alternative immunization schedules. This study used the Theory of Planned Behavior to explore associations between sources of vaccine information, parental vaccine concerns, peer norms for vaccine behavior and intentions to follow an alternative immunization schedule. We performed logistic regression using medical record data from a private pediatric practice in a large northeastern city. Routine data were recorded in the EMR by the pediatrician during an initial vaccine counseling conversation with the parent(s). Parents who received vaccine information from doctors were less likely to have immunization concerns while parents who got vaccine information from friends and family or from books were more likely to report specific vaccine concerns. Our multivariate analysis shows that number of reported vaccine concerns and concerns about the utility or necessity of vaccines are strongly associated with alternative immunization intentions. We also find a direct relationship between sources of information about vaccines and alternative immunization intentions. Our results suggest that vaccine concerns and non-physician information sources play an important role in alternative immunization intentions while communication from physicians may play an important role in addressing vaccine concerns and promoting adherence to the ACIP immunization schedule.