Clinicians Approach to Parents Who Refuse to Vaccinate: What Works - Research Paper Example

?Outline ment of the problem Significant number of parents refuse to vaccinate their children, posing a threat to rise in vaccination preventable diseases. 2.Thesis statement It is important to know the causes of avoidance of vaccination to draft health related messages pertaining to vaccination 3.Title of the paper Clinician's approach to parents who refuse to vaccinate: What works? 4. Abstract 5. Introduction 6. Methods Retrieval of articles from PUBMED 7. Discussion a. Causes of avoidance of vaccination b. Is avoidance of vaccination associated with increased risk of diseases? 8.Conclusion 9.References: APA format-6th edition. Statement of the problem Significant number of parents refuse to vaccinate their children, posing a threat to rise in vaccination preventable diseases. Thesis statement It is important to know the causes of avoidance of vaccination to draft health related messages pertaining to vaccination Title: Clinician's approach to parents who refuse to vaccinate: What works? Abstract Immunization in childhood is very important to prevent vaccine-preventable infectious diseases. However, many parents refuse to immunize their children due to several reasons and perceptions of immunization, threatening the risk of rise of these infectious diseases which are a source of mortality and morbidity. This research aims to identify causes of refusal or hesitancy to vaccination of children by parents so that implications can be made as what is the best clinician approach towards parents who refuse to vaccinate their children. For the purpose of this research, articles were retrieved from PUBMED and discussion of findings were done, based on which it is concluded that it is important for health professionals, especially pediatricians and pediatric nurses, to educate parents about the safety and efficacy of vaccination. For this purpose they must spend extra time with the parents and be sensitive while addressing their queries pertaining to vaccination. Introduction Vaccination is the most successful and universally applied strategy for prevention of some childhood infectious diseases. However, many parents refuse to vaccinate their children due to concerns over safety and utility of vaccines. This threatens the risk of increase in the vaccine preventable diseases which are associated with significant mortality and morbidity. This research aims to identify causes of refusal or hesitancy to vaccination of children by parents so that implications can be made as what is the best clinician approach towards parents who refuse to vaccinate their children. Methods The articles were retrieved from PUB MED after typing the terms “refusal for vaccination”. The inclusion criteria were articles after 2004 and those displayed in English. Only quality and peer reviewed articles were taken into consideration. Several articles were displayed and the following articles were selected after scanning through the abstracts of the articles. Discussion Parents who refuse to vaccinate their children consciously are stubborn and need to be handled with sensitivity to convince them about the benefits of vaccination. In a study by Gullion and Henry (2008), the researchers explored various attitudes and beliefs of parents who chose not to vaccinate their child consciously/ The study was a semistructured interview and from the data, thematic analysis was done through which 2 themes were identified: 1) "A desire to collect information on vaccines." 2) "Trust issues with medical community." According to the researchers, it is very important to understand the differences between the knowledge of an expert and knowledge of a lay person to craft appropriate health messages. This is because, decision making process of this group is strongly influenced by framing of knowledge by experts. Asking parents to do something just because the message came frm a doctor, no longer works in this group of people who view themselves in partnership with experts and see themselves as bringers of legitimate findings about safety of vaccines. In the study by Salmon et al the researchers found several explanations for exemption like "the parent was mistaken about the vaccination status of the child, the child had received the vaccine before the age required by state law and the parent was not willing to have the child revaccinated, the vaccine record was not available at the time of school entry, or the exemption for pertussis was necessary for school entry and stayed on the books as the child advanced to higher grades even though the child was past the age recommended for pertussis vaccination." Salmon et al (2005) conducted a case-contro study to determine the resons for nonmedical exemptions of vaccination and also to explore the differences in perceptions of vaccination and vaccination information source by parents. The study was mainly conducted through survey in which the parents of children who were exempted from some vaccinations were mailed the surveys. the response rate for the surveys was 56.1 percent the main outcome measures were parental reports. From data analysis of the responses for the survey it was evident that 75.5 percent of the children received some vaccination. the most commonly exempted vaccination was against varicella. the most commonly stated reason for vaccination is that the vaccination might cause some harm to the baby. the parents of exempted vaccination children reported low perception towards safety and efficacy of vaccination, a low level of trust in the government and low perceived susceptibility and severity to vaccine-preventable diseases. Parents of children who were exempted from vaccination were less likely to have confidence in public, health medical and government resources with regard to vaccine information and were more likely to report confidence in alternative medical professionals. Based on these results, the authors concluded that continued efforts are essential to educated parents about the safety and utility of vaccines. In the study by Luthy et al (2010), the researchers conducted a cross-sectional study to ascertain the causes of hesitancy of parents in immunizing their children. This study collected data from a convenience sample of participants through immunization hesitancy survey which included questions pertaining to hesitancy regarding immunization. Through data analysis, two themes were identified: One was about concerns regarding the safety of immunization and the other was about lack of perception of the need for vaccination. Of the safety issues, the most commonly reported concerns were adverse reactions, overload of the immune system and autism. Several concerns pertaining to the time frame of immunization and administration of multiple immunizations were issued by the parents. Several parents opined that they were not given appropriate information about immunization and hence felt that pediatricians spend more time in addressing their queries pertaining to immunization. based on the reports of the study, the authors maintained that pediatricians need to be more careful while imparting information to parents about immunization, especially in those who are hesitant about vaccinating their children. In a telephonic survey by Dannetun et al (2005), the researchers found that the most common reason for non-vaccination of MMR vaccination or postponement of the vaccination was fear of side effects associated with the vaccination. According to the study by Kennedy et al (2005), the main reason for opposition for routine and compulsory vaccination was concerns regarding safety and utility of vaccination. It is important to educate parents to vaccinate their children because decreased vaccination is associated with risk of development of infection. The case-control study by Glanz et al (2011) demonstrated increased risk of varicella infection in those who are not vaccinated. Conclusion It is important for health professionals, especially pediatricians and pediatric nurses, to educate parents about the safety and efficacy of vaccination. For this purpose they must spend extra time with the parents and be sensitive while addressing their queries pertaining to vaccination. References Dannetun, E., Tegnell, A., Hermansson, G., Giesecke, J. (2005). Parents’ reported reasons for avoiding MMR vaccination. Scandinavian Journal of Primary Health Care, 23, 149-153. Glanz, J.M., McClure, D.L., Magid, D.J., Daley, M.F., France, E.K., and Hambridge, S.J. (). Parental Refusal of Varicella Vaccination and the Associated Risk of Varicella Infection in Children. Arch Pediatr Adolesc Med.,164(1), 66-70. Gullion, J.S., Henry, L., and Gullion, G. (2008). Deciding to Opt Out of Childhood Vaccination Mandates. Public Health Nursing, 25 (5), 401–408. Kennedy, A.M., Brown, C.J., and Gust, D.A. (2005). Vaccine Beliefs of Parents Who Oppose Compulsory Vaccination. Public Health Reports, 120, 252- 258. Luthy, K.E., Beckstrand, R.L., and Callister, L.C. (2010). Parental Hesitation in Immunizing Children in Utah. Public Health Nursing, 27 (1), 25–31. Salmon, D.A., Moulton, L.H., Omer, S.B., de Hart, M.P., and Stockley, S. (2005). Factors Associated With Refusal of Childhood Vaccines Among Parents of School-aged Children. Arch Pediatr Adolesc Med., 159, 470-476. Annotated Bibliography Dannetun, E., Tegnell, A., Hermansson, G., Giesecke, J. (2005). Parents’ reported reasons for avoiding MMR vaccination. Scandinavian Journal of Primary Health Care, 23, 149-153. This study was a telephone survey to assess reasons for non-vaccination or postponement of MMR vaccination. The study was conducted by epidemiologists. the main measures of outcomes were reasons of parents for nonvaccination. From the results of the study it was evident that the main cause for nonvaccination is fear of side effects and source of information pertaining to side effects was media, followed by Child Health center. This article highlights the importance of health professionals in discussing about the safety of MMR vaccination and address the concerns of the parents. The main limitations in this study were small sample size and unable to assume exemptor status based on the theoretical opposition of the parent. Glanz, J.M., McClure, D.L., Magid, D.J., Daley, M.F., France, E.K., and Hambridge, S.J. (2010). Parental Refusal of Varicella Vaccination and the Associated Risk of Varicella Infection in Children. Arch Pediatr Adolesc Med.,164(1), 66-70. The researchers of this study are epidemiologist and the study conducted by them is a matched case-control study. The main objective of this study was to quantify the risk of acquiring varicella infection in those children in who the parents refused to administer varicella infection. Data collection was done from pediatric patients diagnosed with varicella infection. The data analysis was done through conditional logistic regressional analysis. The main exposures studied in this research was varicella vaccine refusal and the outcome measured was varicella infection. The results demonstrated that more than 5 percent of varicella cases were attributable to parental vaccine refusal. the main limitation of this study is selection of participants from a single managed health care plan because of which generalisability of findings cannot be made. The next limitation is the fact that physicians are likely to diagnose varicella in those who are unvaccinated rather than those who are vaccinated, thus giving scope for bias. the third limitation is the limited cases of vaccine refusal. Gullion, J.S., Henry, L., and Gullion, G. (2008). Deciding to Opt Out of Childhood Vaccination Mandates. Public Health Nursing, 25 (5), 401–408. In this study, the researchers explored various attitudes and beliefs of the parents who chose not to vaccinate their children consciously. The investigators explored various ways in which these parents processed information on the pros and cons of vaccination in childhood. The first author of this study is a chief epidemiologist at the Denton county health department in Texas. The second author is an assistant professor in the Department of Sociology at Texas Wesleyan University, Texas. Semistructured interviews that were in-depth in nature were conducted. the sample population were 25 parents who refused to vaccinate their children and these were identified through targeted and snowball sampling. In the interviews, the parents were asked about their actions and processes before their decisions not to vaccinate their children. The study concluded that it is a major challenge for public health professionals to balance scientific data with medical legitimacy and epidemiology. Thus, in order to craft appropriate health messages, it is important for the professional to understand the differences between scientific knowledge and layman's knowledge. This is a quality paper. the main limitations in this study are lack of homogeneity of sample, decreased breadth of sample because of inadequate exploration of sample size and finally, missing of some participants because of fear and lack of trust. This study provides an excellent overview of the various causes that parents have while not vaccinating their children, thus providing feed for drafting health related messages to the parents. Kennedy, A.M., Brown, C.J., and Gust, D.A. (2005). Vaccine Beliefs of Parents Who Oppose Compulsory Vaccination. Public Health Reports, 120, 252- 258. Kennedy et al (2005) conducted a study to describe vaccination beliefs in parents who refused compulsory vaccination in their children. Data was collected from 2002 health styles and data analysis was done using Chi-square analysis. Independent predictors of opposition were identified through multivariate logistic regression analysis. This study identified issues pertaining to safety and utility of vaccines which prevented the parents from administering compulsory vaccination. Another important contributing factor was residence in a state that permitted philosophical exemption of vaccination. This study concluded that it is very important to provide basic information about vaccine and vaccine preventable diseases to parents to decrease opposition to compulsory vaccination and educate the parents about the safety of vaccinations. Luthy, K.E., Beckstrand, R.L., and Callister, L.C. (2010). Parental Hesitation in Immunizing Children in Utah. Public Health Nursing, 27 (1), 25–31. The authors of this cross-sectional descriptive study were public health professionals from Utah and performed this study to determine the hesitation among parents in that community in immunizing their children. Data collection in the study was done through immunization hesitancy survey in which there were questions as to why parents hesitated in immunizing their children and also about concerns associated with immunization. According to this study, 2 major themes exist: 1) Concerns about the safety of immunization. 2)Lack of perception of the need for immunization. This study identified that many parents did not recognize the need for multiple vaccinations within a set frame of time because of which they failed to immunize their children regularly. The authors of this study concluded that it is very important to share information pertaining to immunization with parents who are hesitant. the researchers in this study identified the need to increase parental awareness about the benefits and safety of vaccinations. This is a cross sectional quality research with no place for bias and ambiguity. This research article throws light about the importance of spending extra time by health professionals while discussing about vaccinations with parents. Salmon, D.A., Moulton, L.H., Omer, S.B., de Hart, M.P., and Stockley, S. (2005). Factors Associated With Refusal of Childhood Vaccines Among Parents of School-aged Children. Arch Pediatr Adolesc Med., 159, 470-476. The researchers of this study were public health experts from Johns Hopkins Bloomberg School of Public Health, Baltimore and thus have credibility in conducting this case-control study. The main scope of this study is to investigate the rate of nonmedical exemptions to immunization requirements in school and also to determine various reasons for exemptions. The study was conducted in the form of surveys that were mailed to the parents of both vaccinated and exempt children. Most of the children who were exempted received some vaccination and the most commonly exempted vaccination was against varicella. The authors found that parents of children who were exempted from vaccination have less trust in the medical system, public health and government resources. They concluded that more efforts are essential to educate parents about the safety and efficacy of vaccination. The main limitation in this study is the potential for nonresponse bias, because; parents of exempt children were less likely to complete the survey than those who vaccinated their children. Another main limitation of this study is the inability to compare parental characteristics. This study provides an overview of various causes of no medical exemption of vaccination, which the physician needs to be aware while counseling parents about vaccination. Read More