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.
