PCORI funded the Pilot Projects to explore how to conduct and use patient-centered outcomes research in ways that can better serve patients and the healthcare community. Learn more.

Background

Many parents are concerned about the vaccines that doctors give to children. Around 1 in 10 parents delay or refuse one or more vaccines for their children. One of the main concerns parents have is that children get too many vaccines at a time during a doctor’s visit.

Understanding parents’ views and preferences about vaccines for their children can help improve decisions by doctors and policy makers about how vaccines are given.

Project Purpose

The research team wanted to

• Describe parents’ views on how to improve the process of giving vaccines to children
• Understand why parents do not follow the standard times that children get vaccines

See how parents felt about different ways that vaccines could be scheduled for children

Methods

Researchers asked parents from all over the country with children aged 6 months to 59 months to complete a survey on a website.

The survey asked parents how they have chosen to vaccinate their children. The parents could respond to the questions with one of six options:

• “I have generally or always followed my doctor’s recommendations.”
• “I have followed a different schedule that specifies which vaccines my child gets and when he gets them.”
• “I don’t follow a specific schedule, but I have a general approach in mind for choosing which vaccines my child will get and when.”
• “I don’t have a predetermined plan for vaccines—I decide about each vaccine at each visit.”
• “My child has not had any vaccinations.”
• “I have done something else.”

The survey then asked parents about how they plan to vaccinate their children, the most important reason for this plan, and how to improve the vaccination experience. The survey also asked parents to rate how much they liked different vaccine schedule options.

Findings

In total, 1,222 parents responded to the survey. Twelve percent of parents reported using nonstandard schedules:

• 6 percent of parents chose, “I don’t follow a specific schedule, but I have a general approach in mind for choosing which vaccines my child will get and when.”
• 3.2 percent of parents chose, “I have followed a different schedule that specifies which vaccines my child gets and when he gets them.”
• 2.5 percent of parents chose, “My child has not had any vaccinations.”

Parents gave two main reasons that they did not follow the standard schedule for children’s vaccines:

• They believed that children get too many vaccines at once.
• They were worried about ingredients in the vaccines.

A little less than half of parents who said they do not get vaccines on the standard schedule said that they want more choices, and about a quarter said they needed better vaccine information.

Finally, a little more than half (51 percent) of parents who said they do get vaccines on the standard schedule said that nothing could improve the vaccine schedule, and 22 percent said that they would like to get better information about vaccines.

Limitations

People who agreed to complete the survey may be more likely to feel a certain way about the standard vaccine schedule than those who did not respond. In addition, people may not actually do what they say they do when answering a survey. Parents may have felt pressure to answer survey questions the way they think they are supposed to rather than how they really feel.

Conclusions

Parents may have better experiences with children’s vaccinations if they get information earlier about vaccine side effects and safety. Parents may also have better experiences if they can work with doctors to set a vaccination schedule. Finally, doctors and others may work better with parents if they understand what parents want and find different ways to meet their needs.

Sharing the Results

The researchers published several journal articles about the project (see below).

PCORI funded the Pilot Projects to explore how to conduct and use patient-centered outcomes research in ways that can better serve patients and the healthcare community. Learn more.

Background

Parent concerns about the safety of childhood vaccines are one of the most salient issues in child health care today. More than 1 in 10 parents report delaying or refusing one or more vaccines for their children. The most common parent concern is that children are receiving too many vaccines in one doctor’s visit.

This pilot project described the full range of parent preferences about administration of multiple vaccines, identified effective approaches to giving parents information, and measured well-informed preferences among a nationally representative sample. The long-term goal of this work is to enable parent preferences to be more fully incorporated in policy and clinical decisions about vaccine administration.

Project Purpose

To describe parents’ (1) perspectives on how to improve the process of childhood vaccinations; (2) rationales for use of nonstandard vaccination approaches; and (3) reactions to hypothetical alternatives to the standard schedule.

Study Design

Three studies were conducted: (1) a qualitative study of parent decision-making patterns regarding vaccines; (2) an analysis of geographic clustering of underimmunization among children in Kaiser Permanente Northern California; and (3) a cross-sectional, Internet-based survey of a national sample of parents of children aged six months to 59 months.

This abstract focuses on the cross-sectional survey. The survey asked parents about their approach to the vaccine schedule via six mutually exclusive response options. The response options were “I have generally or always followed my doctor’s recommendations,” “I have followed a different schedule that specifies which vaccines my child gets and when he gets them,” “I don’t follow a specific schedule, but I have a general approach in mind for choosing which vaccines my child will get and when,” “I don’t have a predetermined plan for vaccines—I decide about each vaccine at each visit,” “My child has not had any vaccinations,” and “I have done something else.”

We asked each parent a series of follow-up questions that elicited details about their vaccination approach and asked them to identify the most important reason for choosing this approach. We asked questions about how to improve children’s experiences of vaccinations. We posed two questions describing hypothetical alternative vaccination schedules and asked parents to rate whether they would like these schedules for their own child.

Data Analysis

We conducted bivariate analyses of the association between vaccination schedule approaches and parent characteristics using the chi-square test for categorical variables and the Kruskal-Wallis test for ordinal variables. We created multivariate models to test the hypothesis that parents using nonstandard approaches were more likely to be white and to have higher socioeconomic status. These models used forced-entry logistic regression with schedule approach as the dependent variable. Except where noted, we used probability sampling weights provided by the survey vendor to weight the sample to represent the US population of parents with children 0 to <5 years of age.

Quality of Data and Analysis

Survey questions were developed based on themes identified in the qualitative study. We also conducted cognitive pretesting of the survey instrument to evaluate the face validity of the questions and their wording.

Findings

Of the 1,222 respondents, 12% reported using nonstandard approaches: 3.2% used a specific schedule, 6.0% had no specific schedule, and 2.5% declined all vaccinations. The most common rationales were that too many vaccines are given at once and discomfort with vaccine ingredients. Regarding how to improve the process, parents using the standard schedule most often said nothing could be improved (51%) or better vaccine information (22%). Those using nonstandard approaches most often would have liked more choice (40%) or better vaccine information (26%).

Limitations

Nonresponse bias is a potential limitation of most surveys. The recruitment rate into the original Internet survey panel was higher than the response rate to a typical telephone survey. This study asked parents to report their vaccination practices and elicited opinions about hypothetical alternative vaccination schedules. However, people’s actual behavior does not always mirror their reports or their responses to hypothetical scenarios. Results may be affected by social desirability bias and reporting bias.

Conclusions

Parents’ experiences with the childhood vaccination process might be improved by offering vaccine information earlier, providing more information about vaccine side effects and safety, and allowing more flexibility about vaccine scheduling. Parents with different vaccination approaches express different priorities, suggesting that clinicians and policy makers may wish to develop methods of rapidly identifying individual parents’ approaches and create tailored ways to address their needs.