Health Education Research Advance Access published online on October 23, 2007
Health Education Research, doi:10.1093/her/cym065
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
© Published by Oxford University Press [2007].
Developing tailored immunization materials for concerned mothers
1 Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-52, Atlanta, GA 30333, USA
2 Logistics Health Incorporated, 230 North Front Street, La Crosse, WI 54603, USA
Correspondence to: * Correspondence to: D. A. Gust. E-mail: dgg6{at}cdc.gov
 |
Abstract |
|---|
 Top Abstract IntroductionMethodsResultsDiscussionFundingConflict of interest statementAcknowledgementsReferences |
|---|
The objectives of this study were to (i) identify ‘Worried’ and ‘Fencesitter’ mothers through the use of screening questions; (ii) obtain detailed information from participants about their attitudes and beliefs regarding vaccines and their interactions with their child's main health care provider, including availability of immunization information; (iii) solicit comments on draft educational materials that were developed specifically for this study and (iv) solicit comments on revised educational materials. Focus groups of mothers were conducted in two phases (Phase 1: n = 17 groups; Phase 2: n = 12 groups) and in three cities across the United States. Phase 1 focus group discussions suggested that perceived necessity and safety of vaccines contributed to mothers’ attitudes about having their child receive immunizations. Participants relied on their children's main health care provider for immunization information; however, mothers often perceived that providers did not supply enough information about vaccinations. In Phase 2, comments on the revised educational materials (brochures) were generally positive, with many mothers noting that the new brochures provided more relevant information and conveyed it in a respectful way. Science-based tailored immunization materials may assist health care providers in addressing unique information needs and may improve vaccine acceptance among specific types of mothers.
|
Introduction |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionFundingConflict of interest statementAcknowledgementsReferences |
|---|
Immunizations have reduced the incidence of vaccine preventable diseases in the United States and worldwide. However, as a result of the real and/or perceived increases in the number of childhood vaccine adverse events, some parents have become more concerned about vaccinating their children [1]. In fact, almost 15% of underimmunization (missing one or more doses of diphtheria–tetanus–acellular pertussis vaccine, measles-containing vaccine and Hepatitis B vaccine) in young children can be attributed to parental attitudes, beliefs and behaviors [2]. Furthermore, there has been a changing culture of health care provider/patient interaction where patients, and by extension parents, have increasingly sought information about illnesses and many want to be active participants in the health care decision-making process [3, 4]. Maintaining record high immunization levels when an increasing number of states are offering philosophical exemptions to immunizations is challenging. There is a critical need to communicate with parents in a respectful and forthcoming way and provide them with the balanced risk benefit information they need to make a decision about immunizing their children.
Audience segmentation divides people into segments based on shared characteristics so that interventions and educational materials can be tailored to best address their concerns and needs. An earlier survey study showed that parents can be divided into five segments based on their attitudes and beliefs about health and immunizations [5]. Three of the segments were generally supportive of immunizations (Vaccine Advocate, Health Advocate and Go Along to Get Along), while two segments, ‘Worried’ and ‘Fencesitter', were less supportive. Because these two segments had the most to offer in terms of opinions about what they needed to improve their support of immunizations and because they had the most to gain from an intervention, they were the focus of this follow-up study.
These two audience segments, identified as most concerned about immunizations (Worrieds, Fencesitters), were chosen to be the focus of this follow-up study to secure the input of mothers in these segments to inform the development of tailored educational materials. Such materials could be used by health care providers in busy office settings specifically to address questions from these two groups of parents. This is one of the first attempts to document the process of developing immunization educational materials for parents in a science-based manner. Our focus group study is restricted to women because it is reported that women are primarily responsible for their child's health care [6]. The study objectives were to (i) identify Worried and Fencesitter mothers through the use of screening questions; (ii) obtain detailed information from participants about their attitudes and beliefs regarding vaccines and their interactions with their child's main health care provider, including availability of immunization information; (iii) solicit comments on draft educational materials that were developed specifically for this study and (iv) solicit comments on revised educational materials modified based on participants' expressed concerns and suggestions.
|
Methods |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionFundingConflict of interest statementAcknowledgementsReferences |
|---|
This study is the second component of a mixed-methods approach [7] to the development of science-based tailored educational materials. Mixed-methods research is useful in that it capitalizes on the strengths of both quantitative and qualitative approaches and uses each to minimize weaknesses in the other [7]. The first component in this series of projects used a quantitative survey to determine parent segments [5]. The current study used qualitative focus groups to obtain more detailed information from the two specific segments, as well as their feedback on draft educational materials developed specifically for this study.
Sample
Out of a total of 
520 mothers screened for eligibility, 129 agreed to participate in this study. Purposive sampling (choosing people who will illuminate the study questions) was used to recruit mothers from day care centers, churches, mothers' groups, Montessori schools, referrals from other mothers and telephone calling in Atlanta, Georgia, La Crosse, Wisconsin and Los Angeles, California, from November 2003 to July 2004. The three locations were chosen to represent different regions of the country. Mothers were told that focus groups were being put together to better learn about mothers' attitudes and beliefs about vaccines for their children and to learn their thoughts about educational materials. They were informed that all information shared would be strictly confidential, that they would not be identified by name when the data were analyzed, and that discussions would take 90 min. The inclusion criteria were mothers aged 20–45 years, either non-Hispanic White, non-Hispanic Black or Hispanic, having at least one child 
6 years of age and giving responses to three key screening questions (reduced from 44 in the original study) that placed them in one of the segments of interest (Worrieds, Fencesitters). The three screening questions were as follows: ‘If I vaccinate my child, he/she may have a serious side effect (e.g. severe allergic reaction including difficulty breathing, hives)', (0—strongly disagree to 10—strongly agree; Worried 7–10, Fencesitter 4–6); ‘In general, how safe do you think immunizations are for children?’ (0—not at all safe to 10—completely safe; Worried 1–4, Fencesitter 5–7) and ‘How confident are you in the safety of the routinely received childhood immunizations?’ (1—very confident; 4—not at all confident; Worried 3 and 4, Fencesitter 2). To be categorized as a Worried or Fencesitter mother, responses to all screening questions had to fall within the range indicated above. Centers for Disease Control (CDC) staff analyzed the screening surveys to determine if the respondents met the inclusion criteria.
We attempted to recruit mothers for three focus groups (one non-Hispanic White, one non-Hispanic Black and one Hispanic) representing each of the two segments (Worrieds, Fencesitters) in each of the three cities, for a total of six focus groups per city. Recruitment for the Hispanic focus group in Atlanta did not meet its target number because mothers were reluctant to give their contact information to the recruiters. Many of the potential participants declined the screening survey after learning the sponsor was a government agency (CDC). Each established focus group had five to nine participants. The activities of these focus groups were divided into two phases:
Phase 1—Obtain detailed information about mothers' attitudes and beliefs about vaccines and toward their child's main health care provider's provision of immunization information and obtain their comments on draft educational materials developed for these parent segments (including suggestions on topics to address concerns).
Phase 2—Review and provide comments on revised educational materials tailored to address concerns expressed in Phase 1 of the study.
All mothers who screened as Worrieds or Fencesitters were invited to participate in both phases of the focus group activities. However, because of the intervening time (3 to 8 months) between activities of the focus groups (Phase 1 and Phase 2), we expected that some mothers who participated in Phase 1 would not be able to participate in Phase 2 and, therefore, we invited 20 additional mothers from our pool of potential eligible participants to take part in this study; for those mothers in the Phase 2 focus group who did not participate in the Phase 1 group (n = 16), the draft educational materials were mailed to them and they were provided a brief description of the Phase 1 focus group discussion 2–4 weeks before the scheduled discussion. In total, there were 113 mothers who participated in Phase 1 focus groups and 81 in Phase 2 (65 mothers participated in both Phase 1 and Phase 2). Table I presents the focus group locations and number of participants.
|
Procedure
Females, of the same ethnicity and race as the focus group participants, moderated the in-person focus group discussions. Sessions lasted
90 min and were audiotaped. Participants were provided explanations about the current study and were informed that their participation was voluntary so they could refuse to answer any questions or leave the focus group at any time. Written informed consent was obtained from all. CDC's Institutional Review Board approval was obtained for the study. All participants also received a monetary reimbursement for their time. In Phase 1, mothers were first asked about their attitudes and beliefs about immunizations and their interactions with their children's main health care provider, including availability of immunization information. Mothers were then asked to provide feedback on draft educational materials developed specifically for this study. The draft educational materials presented basic information about vaccine safety and necessity, but varied in the formatting used. In order to systematically assess mothers' responses to specific formats, a box was inserted into the generic educational material (see Table II). There were six pairs of draft materials presented to mothers as options (test versus control). The standard or most commonly used message or presentation was chosen to be the control except in the case of the CDC logo where the control was a fictitious organization and logo. In each pair, mothers were asked to comment on (i) disease photograph versus a drawing of a child with no visible disease with a physician; (ii) quote from a professor of chiropractic (non-fictional) versus a quote from the Director of the CDC's National Immunization Program (non-fictional); (iii) name and logo of the CDC (non-fictional) versus the Coalition for Vaccine Information (fictional), (iv) simple statistics documenting a decline in disease prevalence versus a general description that diseases have declined; (v) statement about a parent's responsibility to vaccinate their child versus a statement of the importance of a child being up to date on their immunizations and (vi) description of an unvaccinated child who died from diphtheria (non-fictional) versus a description of the seriousness of diphtheria. Each ethnic/race group in each of the two segments was given only two of the six sets of materials to compare and discuss due to time limitations of the focus group discussions (Table II). Based on the feedback from the Phase 1 focus group activities, we created new educational materials using the preferred formats and the topics suggested to address concerns. The purpose of the Phase 2 focus group activities was for mothers to review these new revised materials and provide comments.
|
Moderator's guide
The moderator facilitated the discussion in Phase 1 using a semi-structured guide. Two constructs from the Health Belief Model were used to develop the guide, perceived benefits and perceived barriers to health action. The Health Belief Model is a behavioral theory that is used to explain and predict preventive health behavior. Its other components are perceived susceptibility to a disease, perceived severity of the disease and perceived effectiveness of the health action [8]. The guide was designed to elicit information about each mother's perception of (i) immunization necessity and safety; (ii) their interactions with their child's health care provider, including availability of information and (iii) their comments about two of the six sets of draft materials. Questions in the moderator's guide included ‘Do you think vaccines are necessary? Why/why not?’, ‘Do you think vaccines are safe? Why/why not?’, ‘What is the biggest concern about childhood vaccines that you have heard from others?’, ‘If you had a question about a childhood vaccine, where would you go?’, ‘Is your child's main health-care provider easy to talk to?’, ‘Do you trust the vaccine advice your child's main health-care provider gives you?’ and ‘Are you getting all the information you need or want about immunizations? If no, what information are you not getting?’, ‘How would you like to receive it?’, ‘What do you think is the main point of these fliers?’, ‘What is the difference between the two?’, ‘Which do you prefer? Why?’ (the entire guide is available upon request from the first author).
In Phase 2 of the focus groups, the moderator elicited information from participants about the credibility of the revised materials, how the materials made them feel and any suggestions for improvement.
Qualitative analysis
Nvivo [9], a qualitative data analysis program, was used to organize the data and code themes from transcribed discussions. Two researchers (D.A.G. and A.K.) independently read and coded two randomly chosen focus group discussions (10%) for the categories ‘immunization necessity and safety’ and ‘interactions with their child's health care provider and availability of immunization information’ in order to assess intercoder reliability. The researchers read and discussed their coding to reach consensus. Percent agreement was 87% and Cohen's Kappa was 0.75. One researcher (D.A.G.) performed the final coding of all focus groups. Quotes provided in the following section were selected on the basis of their clear representation of the key themes.
|
Results |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionFundingConflict of interest statementAcknowledgementsReferences |
|---|
Phase 1
The focus was on obtaining detailed information from the Worried and Fencesitter mothers about their attitudes and beliefs regarding immunizations, their interactions with their child's main health care provider, including the availability of immunization information, as well as their comments on draft educational materials and suggested topics to address concerns. The two main attitude themes were related to (i) concerns about immunization necessity and safety and (ii) dissatisfaction with information presented by their child's main health care providers. There were no obvious differences among groups by location. Ethnic/race differences are mentioned where appropriate.
Concerns about immunization necessity and safety
Worried segment.
Input from mothers in this segment was consistent with the screening question responses showing these mothers to have more concerns about immunization necessity and safety than Fencesitters. Most of these mothers believed that not all vaccines are necessary (Table III). Many noted that the varicella (chicken pox) vaccine is not necessary because chicken pox is not perceived as a life-threatening disease. Mothers, especially non-Hispanic White mothers, talked more about chiropractors and what their specific chiropractor told them about immunizations. Believing that the body can heal itself (making vaccines unnecessary) was a common comment among these mothers. Some mothers remarked that while vaccines may be necessary for some people ‘... in the U.S. where it's [disease] been eradicated, there isn't as high of a need for vaccines for children ...’. Regarding vaccine safety, the majority of mothers had concerns about the risk of autism, mercury in vaccines and that too many vaccines could overload the child's immune system. These were considered as additional topics for the revised brochure. Importantly, most of these mothers were aware of state exemptions from childhood immunization requirements.
|
Fencesitter segment.
Mothers in this segment did not express extreme concern about vaccine necessity and safety, but, rather, uncertainty about them (Table II). The majority of these mothers believed that vaccines are for the most part necessary and safe, although many had reservations about whether the benefits outweighed the risks. Similar to the Worried mothers, these mothers also thought the chicken pox vaccination is not necessary. That some mothers questioned the safety of vaccines is exemplified by the following quote, ‘I'm kind of mixed on it, I feel like, yeah, they do prevent widespread disease, but what are the risks to the individual kid?’. Most mothers wanted to know when their child should not get a vaccine, possible long-term effects of vaccines, what would happen if their child were not vaccinated and if there is some kind of natural immunity their child could obtain instead of having to receive vaccines. These were considered as additional topics for the revised brochure.
Dissatisfaction with information presented by their child's health care providers
Worried segment.
Children's main health care providers were overall the most respected source of immunization information among Worried mothers. However, mothers generally felt that they did not take their concerns seriously. A desire for balanced information was prevalent among mothers; exemplary is one mother's reply, ‘I think the information I was provided was pretty much one-sided. They [child's main health care provider] don't want to get into many details about severe side effects or anything ...’.
Fencesitter segment.
Children's main health care providers were also the most respected source of immunization information among the Fencesitter mothers. Mothers varied, however, in terms of satisfaction with their child's health care providers. Some mothers reported they had a good relationship with their child's provider, as illustrated by the following quote, ‘Yes, she does talk to us about vaccinations and she will sit down and really talk to us about it', whereas more felt they did not, as exemplified by the quote, ‘... They never explain anything'.
Comments on draft educational materials
Table II shows the participants' preferences for options in the educational materials presented to them (test and control). Overall, mothers did not like (i) the description of a boy who died from diphtheria due to being unvaccinated compared with a description of the seriousness of diphtheria or (ii) the proimmunization quote by a chiropractor compared with a quote from the Director of the National Immunization Program. The description of the child who died was interpreted as a scare tactic by many mothers. In addition, they found the proimmunization quote from the chiropractor not credible because they believe chiropractors lack immunization expertise and misleading because they did not believe chiropractors support immunizations. The graphic photographs of children with disease (versus a drawing of a child with no visible disease) and a statement suggesting that parents should be responsible for preventing disease through vaccination of their children (versus a statement of the importance of a child being up to date on their immunizations) received mixed reviews. Some mothers felt disturbed by the graphic photograph and thought it was being used as a scare tactic, but others (non-Hispanic Black and Hispanic Fencesitters and non-Hispanic Black Worrieds) liked seeing what chicken pox looked like and what could happen to their children if they were not vaccinated. Some mothers felt the responsibility statement was coercive, making them feel guilty. Others, though, liked the link to family and indicated that it made them feel responsible and obligated to keep vaccinating their children (non-Hispanic Black and Hispanic Fencesitters). Finally, the CDC logo (versus the logo of the fictional Coalition for Vaccine Information) and the use of prevalence statistics (versus a general description of the decline in disease prevalence) were the most well-liked variables included in the draft materials. The CDC logo was perceived as believable and the use of statistics made mothers feel as though their intelligence was respected.
In addition to responding to specific questions during review of the draft educational materials, both Worried and Fencesitter mothers of their own initiative suggested that additional topics be addressed, such as the names of the vaccines, how vaccines are tested and vaccine risks. One woman put it succinctly, ‘This flier is very vague. It needs to go into—What's the process of vaccinations?’ Other more general suggestions that guided the revision of the educational materials included being less biased toward immunizations, not condescending to parents, not appearing to judge parents who question immunizations and presenting ‘all the facts’ so parents can make their own informed decision.
Phase 2
In this phase, we revised the educational materials based on information and feedback acquired in Phase 1, shared the materials with participants and solicited their comments.
Revision of educational materials
We developed three revised test brochures. Revisions were made based on information obtained during the Phase 1 focus groups including mothers' attitudes about immunizations and their interactions with their child's health care provider, as well as their responses to the draft materials and their suggested topics. One revised brochure was tailored specifically to the Worried and one to the Fencesitter mothers (called Facts about Immunizations). The third brochure was developed for both segments and answered questions about the immunization process (called The Vaccination Process for Children). Specific topics covered in each brochure are listed in Table IV. Because the CDC logo and use of prevalence statistics were the formats that fared best among mothers in Phase 1, these were used in all three brochures.
|
Comments on revised educational materials
Without exception, mothers preferred the revised educational materials presented in Phase 2 compared with the draft educational materials presented in Phase 1. Most comments were positive, noting that the new brochures were more credible and made them feel more knowledgeable and safe because they had more relevant (for them) information (Table V). It is important to note that while most mothers liked the brochures, some mothers thought they still did not provide enough information (despite inclusion of a reference list) and others were concerned they would not be able to find the references that were used throughout the materials online or at the library. Suggestions regarding improvements were considered and the brochures have been revised further. The final versions of these brochures will be evaluated in an upcoming study in a clinic setting.
|
|
Discussion |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionFundingConflict of interest statementAcknowledgementsReferences |
|---|
The primary purpose of this study was to use input from mothers to develop educational materials designed to answer the questions and address concerns of two segments of parents most concerned about immunizations, Worrieds and Fencesitters. The initial screening and recruitment technique we used were successful, as mothers in our Worried and Fencesitter groups clearly exhibited the basic attitudes of these segments outlined in the earlier study [5]. Expanding on that earlier study, the present qualitative study allowed us not only to obtain more details related to mothers' attitudes and beliefs but also to gain their responses to draft educational materials. Not unexpectedly, we found that most mothers in these segments had questions about immunization necessity and safety. While they overwhelmingly considered their child's main health care provider a respected source of information, they were at the same time largely dissatisfied with the information they received from them. Consequently, we developed educational brochures tailored to answer the questions of both the Worried and Fencesitter mothers that could be useful to physicians and other health care providers when talking to and providing information to mothers about their specific immunization concerns.
Several factors seemed to influence mothers' determination of the necessity and safety of childhood vaccines. In terms of necessity, many participants in our focus groups believed that some vaccine preventable diseases are not severe, that there is relatively little vaccine preventable disease in the United States, and that the body can heal itself, a belief conveyed to parents by most chiropractors [10]. In terms of safety concerns, media reports of mercury in vaccines and media reports linking vaccines with chronic illnesses and disabilities such as autism, contributed greatly to concerns among mothers in the Worried segment, while less so to mothers in the Fencesitter segment. According to the Health Belief Model [8], the likelihood that a parent will immunize their child is based on the perceived benefits of immunization weighed against the perceived barriers (e.g. vaccine safety risks, accessibility to health care), while also taking into account their child's susceptibility to a disease and the severity of the disease (necessity). Another perceived barrier to immunization, and one that seemed to underlie mothers' concerns in this study, was lack of immunization information from their child's main health care provider. This perceived lack of information was associated with negative attitudes about immunizations. In an earlier study, a larger proportion of parents who reported not having access to enough information about vaccines to make a good decision about immunizing their children also had several specific immunization concerns compared with parents who were neutral or agreed they had access to enough information [11]. Moreover, studies have demonstrated the positive effect of providing information to some patients with cancer and other chronic diseases [12–14] and more and more patients and healthy individuals want to be involved in their health care decisions [3]. With all of that in mind, providing information that parents will find useful and respectful of their needs and concerns is essential to maintain or improve the health care provider–patient/parent relationship. This improved relationship may help maintain high immunization levels in our country and prevent unnecessary reemergence and outbreaks of some vaccine preventable diseases. It may also reduce the frustration of some health care providers who are uncertain of how to best address the concerns of Worrieds and Fencesitters.
Educational materials for Worried and Fencesitter mothers were revised based on information obtained from the Phase 1 focus group discussions about immunizations as well as from their feedback on the draft educational materials. The important themes of vaccine safety and necessity were highlighted in the revised materials for both groups. Several studies have been conducted that have either helped in the development of educational materials [15], in redesigning educational materials [16] or in evaluating educational materials [17]. Just as in our study, obtaining the opinions of and feedback from the target audiences served to be a useful process. In our assessment of the six pairs of options within the draft educational materials, the incorporation of the CDC logo and use of simple prevalence statistics within the materials were well liked by all of the focus groups that reviewed them; the CDC logo was perceived as credible and the use of statistics was perceived as transparent and respectful to the intelligence of the mothers. Based on feedback on the six formatting options plus feedback on the basic information about vaccine safety and necessity, we found that these mothers appreciated educational materials that overall (i) provided information backed up with statistics; (ii) did not use scare tactics and (iii) were not coercive; (iv) were credible; (v) were unbiased and (vi) were not judgmental about mothers who had questions about vaccines. Based on mothers' preferences, the revised materials included the CDC logo and presented information in simple statistical terms whenever possible.
Specific questions and concerns expressed by mothers during the Phase 1 focus group activities (suggested topics) were addressed in the two tailored brochures. For instance, Worried mothers wanted to know more about the alleged link between vaccines and autism and Fencesitter mothers wanted to know if their child could get a disease if not vaccinated. Because both Worried and Fencesitter mothers had several questions about the vaccination process, a separate third brochure was developed that addressed their many common questions. Another recent study also developed an intervention (immunization education package) to improve risk/benefit communication between physicians and parents [18]. The intervention included a contraindication screening sheet, an exam room poster entitled ‘7 Questions Parents Need to Ask About Baby Shots', an information sheet with answers to the questions and an office-based in-service conducted by an opinion leader. Our intervention differs in that it is tailored to specific segments of mothers concerned about vaccine safety and not in full agreement that vaccines are necessary. It is similar to the one developed by Davis et al. [18] in that parent–physician discussion is also identified as critically important, as it has been repeatedly shown that parents prefer to receive immunization information from their child's health care provider [5, 19].
This study has several limitations typical of qualitative research. First, there is an inability to conduct traditional statistical analyses of the responses with focus group data. Second, while we recruited mothers who screened as being in either the Worried or Fencesitter segment and their characteristics were comparable to that of a previous study where these segments were identified, their feedback on the draft materials may not be representative of all Worried and Fencesitter mothers in the country. However, the purpose of qualitative studies is to provide details and insight not obtainable from more quantitative approaches such as surveys. Third, while we included mothers representative of three ethnic/race backgrounds, we were not able to perform subgroup analysis based on those characteristics. Fourth, we were unable to recruit enough Hispanic Worried women to hold a focus group in Atlanta due to Hispanic women's concerns about contact with a government agency. This indicates that, at least in the near future, other strategies may be needed to solicit this group's opinions on immunization. Fifth, segments in the survey were based on a sample of men and women, while the focus groups in this study were comprised only of women. Sixth, the sample size was relatively small, though it has been shown that this type of audience research, even with small sample sizes, can greatly benefit the development of educational materials [20]. The strength of this study is that we were able to locate Worried and Fencesitter mothers and obtain detailed information about their vaccine concerns as well as feedback on educational materials. This process was invaluable in directing our efforts in developing science-based tailored educational materials on childhood vaccines.
In conclusion, we conducted a two-phase focus group study to develop tailored immunization educational materials for two segments of mothers most concerned about immunizations, Worrieds and Fencesitters. These segments comprise 16% of all parents [5]. The screening and recruiting technique was successful in that the focus group participants in this study appear to be representative of the Worried and Fencesitter parents identified in the earlier study [5]. Focus group discussions indicated that a lack of information from health care providers may be a barrier to immunization acceptance. Given the fact that mothers overwhelmingly reported their child's main health care providers as their primary source of information, and given that providers do not have enough time to talk about all of these issues with all mothers, educational materials are needed that can help them answer the questions of concerned mothers. Finally, our results are encouraging in that educational materials tailored to the specific needs of the Worried and Fencesitter segments received generally positive responses. Presentation of these tailored brochures by children's health care providers to parents in an empathetic and respectful manner could aid in improving the health care provider–parent relationship, increasing vaccine acceptance and ultimately preventing vaccine preventable diseases. We have therefore also developed a provider toolkit to be used in an office setting that includes (i) a three question survey that can identify Worried and Fencesitter segments, (ii) the tailored brochures for the Worried and Fencesitter mothers and (iii) the Vaccination Process brochure that can be given to any parent with questions about the process of vaccinations. This toolkit has been reviewed by the American Academy of Pediatrics' Section on Infectious Diseases and their comments have been incorporated. Based on results from this study, we plan to further evaluate the effectiveness of this toolkit in helping parents obtain sufficient information to make a good decision about immunizing their children and in helping clinicians improve their relationship with parents concerned about immunizations within the time constraints of their practice.
|
Funding |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionFundingConflict of interest statementAcknowledgementsReferences |
|---|
National Vaccine Program Office.
|
Conflict of interest statement |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionFundingConflict of interest statementAcknowledgementsReferences |
|---|
None declared.
|
Acknowledgements |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionFundingConflict of interest statementAcknowledgementsReferences |
|---|
The authors would like to thank Tanja Popovic, Shawna Mercer, John Iskander and Chris Casey for helpful comments on an earlier draft of this manuscript. Appreciation is also extended to LaDetra White, Lisa Watson, Phyllis Gilbert, Violeta Abitia, Antiowana Williams, Kay Wais, Monica Moreno, Gwen Marzet, and Kathryn Johnson for their assistance in conducting the focus groups. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. Portions of this report were presented 8 March 2006 at the 40th National Immunization Conference, Atlanta, GA.
|
References |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionFundingConflict of interest statementAcknowledgementsReferences |
|---|
1. Chen RT. Vaccine risks: real, perceived and unknown. Vaccine (1999) 17(Suppl. 3):S41–6.[CrossRef][Web of Science][Medline]
2. Gust DA, Strine TW, Maurice E, et al. Underimmunization among children: effects of vaccine safety concerns on immunization status. Pediatrics (2004) 114:e16–22.
3. Benbassat J, Pilpel D, Tidhar M. Patient's preferences for participation in clinical decision making: a review of published surveys. Behav Med (1998) 24:81–8.[Web of Science][Medline]
4. Woolf SH, Chan EC, Harris R, et al. Promoting informed choice: transforming health care to dispense knowledge for decision making. Ann Intern Med (2005) 143:293–300.
5. Gust DA, Brown C, Sheedy K, et al. Immunization attitudes and beliefs among parents: beyond a dichotomous perspective. Am J Health Behav (2004) 29:81–92.[Web of Science]
6. Case A, Paxson C. Mothers and others: who invests in children's health? J Health Econ (2001) 20:301–28.[CrossRef][Web of Science][Medline]
7. Johnson R, Onwuegbuzie A. Mixed methods research: a research paradigm whose time has come. Educ Res (2004) 33:14–26.
8. Janz NK, Becker MH. The Health Belief Model: a decade later. Health Educ Q (1984) 11:1–47.[Web of Science][Medline]
9. Sage, Richards L. Using NVivo in Qualitative Research (1999) London: Sage.
10. Campbell JB, Busse JW, Injeyan HS. Chiropractors and vaccination: a historical perspective. Pediatrics (2000) 105:E43.[CrossRef][Medline]
11. Gust DA, Kennedy A, Shui I, et al. Parent attitudes toward immunizations and healthcare providers: the role of information. Am J Prev Med (2005) 29:105–12.[CrossRef][Web of Science][Medline]
12. Ryan S, Hassell A, Dawes P, et al. Control perceptions in patients with rheumatoid arthritis: the impact of the medical consultation. Rheumatology (Oxford) (2003) 42:135–40.[CrossRef][Medline]
13. Tang PC, Newcomb C. Informing patients: a guide for providing patient health information. J Am Med Inform Assoc. (1998) 5:563–70.
14. Rainey LC. Effects of preparatory patient education for radiation oncology patients. Cancer (1985) 56:1056–61.[CrossRef][Web of Science][Medline]
15. Burgener M, Arnold M, Katz JN, et al. Older adults' knowledge and beliefs about osteoporosis: results of semistructured interviews used for the development of educational materials. J Rheumatol (2005) 32:673–7.
16. Parra-Medina D, Wilcox S, Thompson-Robinson M, et al. A replicable process for redesigning ethnically relevant educational materials. J Womens Health (Larchmt) (2004) 13:579–88.[CrossRef][Medline]
17. Nehl E, Blanchard C, Conerly RC, et al. Evaluation of the American Cancer Society's breast cancer-related documents by cancer survivors. J Cancer Educ (2003) 18:106–14.[CrossRef][Web of Science][Medline]
18. Davis TC, Fredrickson DD, Bocchini C, et al. Improving vaccine risk/benefit communication with an immunization education package: a pilot study. Ambul Pediatr (2002) 2:193–200.[CrossRef][Web of Science][Medline]
19. Gellin BG, Maibach EW, Marcuse EK. Do parents understand immunizations? A national telephone survey. Pediatrics (2000) 106:1097–102.
20. Witte K, Meyer G, Martell D. Effective Health Risk Messages: A Step by Step Guide (2001) Newbury Park, CA: Sage Publications.
Received on September 26, 2006; accepted on August 26, 2007
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||