Why parents refuse childhood vaccination: a qualitative study using online focus groups

BMC Public Health

Gerjo Kok³  Hester E de Melker¹  Theo GW Paulussen²  Robert AC Ruiter³  Liesbeth Mollema¹  Irene A Harmsen³ 

[1] National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, P.O. Box 1, 3720, BA Bilthoven, The Netherlands;TNO Healthy Living (Netherlands Organization for Applied Scientific Research), P.O. Box 2215, 2333 AL Leiden, The Netherlands;Department of Work & Social Psychology, Maastricht University, P.O. Box 616, 6200, MD Maastricht, The Netherlands

关键词: Beliefs;    Decision-making;    Qualitative study;    On-line focus group;    Immunization;    Childhood vaccination;   

Others  :  1161441
DOI  :  10.1186/1471-2458-13-1183

 received in 2013-08-13, accepted in 2013-12-09,  发布年份 2013

【 摘 要 】

Background

In high income countries, vaccine-preventable diseases have been greatly reduced through routine vaccination programs. Despite this success, many parents question, and a small proportion even refuse vaccination for their children. As no qualitative studies have explored the factors behind these decisions among Dutch parents, we performed a study using online focus groups.

Methods

In total, eight online focus groups (n = 60) which included Dutch parents with at least one child, aged 0–4 years, for whom they refused all or part of the vaccinations within the National Immunization Program (NIP). A thematic analysis was performed to explore factors that influenced the parents’ decisions to refuse vaccination.

Results

Refusal of vaccination was found to reflect multiple factors including family lifestyle; perceptions about the child’s body and immune system; perceived risks of disease, vaccine efficacy, and side effects; perceived advantages of experiencing the disease; prior negative experience with vaccination; and social environment. The use of online focus groups proved to be an effective qualitative research method providing meaningful data.

Conclusion

Information provided by the NIP turned out to be insufficient for this group of parents. More trust in the NIP and deliberate decisions might result from increased parental understanding of lifestyle and disease susceptibility, the impact of vaccinations on the immune system, and the relative risks of diseases and their vaccines. The public health institute should also inform parents that the NIP is recommended but non-mandatory.

【 授权许可】

   
2013 Harmsen et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]UNICEF and WHO: Immunization summary. A statistical reference containing data through. 2011. [http://www.childinfo.org/files/immunization_summary_2012_en.pdf webcite]
• [2]Woonink F: Objections against vaccination: from the perspective of the refuser. Infectieziekte Bulletin 2009, 20:50-51.
• [3]Van Lier EA, Oomen PJ, Giesbers H, Drijfhout IH, de Hoogh PAAM, de Melker HE: Vaccinatiegraad Rijksvaccinatieprogramma Nederland [Vaccination coverage of the National Immunization Programme in the Netherlands]. Bilthoven: Rijksinstituut voor Volksgezondheid en Milieu (RIVM); 2011. Report No.: 210021014/2011
• [4]Rondy M, van Lier A, van de Kassteele J, Rust L, de Melker H: Determinants for HPV vaccine uptake in the Netherlands: a multilevel study. Vaccine 2010, 28:2070-2075.
• [5]Kemmeren JM, de Melker HE: The National Immunisation Programma in the Netherlands. Bilthoven: Rijksinstituut voor Volksgezondheid en Milieu (RIVM); 2010. Report No.: 210021012/2010
• [6]Bults M, Beaujean DJ, Richardus JH, Steenbergen JE, Voeten HA: Pandemic influenza A (H1N1) vaccination in The Netherlands: parental reasoning underlying child vaccination choices. Vaccine 2011, 29:6226-6235.
• [7]Ruijs WLM, Hautvast JLA, Ansem WJC, van Ijzendoorn G, van der Velden K, Hulsher MEJL: How orthodox protestant parents decide on the vaccination of their children: a qualitative study. BMC Public Health 2012, 12:408. BioMed Central Full Text
• [8]Gust D, Brown C, Sheedy K, Hibbs B, Weaver D, Nowak G: Immunization attitudes and beliefs among parents: beyond a dichotomous perspective. Am J Health Behav 2005, 29:81-92.
• [9]Benin AL, Wisler-Scher DJ, Colson E, Shapiro EU, Holmboe ES: Qualitative analysis of mothers’ decision-making about vaccines for infants: the importance of trust. Pediatrics 2006, 117:1532-1541.
• [10]Hilton S, Petticrew M, Hunt K: Combined vaccines are like a sudden onslaught to the body’s immune system: parental conerns about vaccine 'overload’ and 'immune-vulnerability’. Vaccine 2006, 24:4321-4327.
• [11]Smailbegovic MS, Laing GJ, Bedford H: Why do parents decide against immunization? The effect of health beliefs and health professionals. Child Care Hlth Dev 2003, 29:303-311.
• [12]Mills E, Jadad AR, Ross C, Wilson K: Systematic review of qualitative studies exploring parental beliefs and attitudes toward childhood vaccination identifies common barriers to vaccination. J Clin Epidemiol 2005, 58:1081-1088.
• [13]Sporton RK, Francis SA: Choosing not to immunize: are parents making informed decisions? Fam Pract 2001, 18:181-188.
• [14]Zwaanswijk M, Tates K, van Dulmen S, Hoogerbrugge PM, Kamps WA, Bensing JM: Young patients’, parents’, and survivors’ communication preferences in paediatric oncology: results of online focus groups. BMC Pediatr 2007, 7:35. BioMed Central Full Text
• [15]Tates K, Zwaanswijk M, Otten R, van Dulmen S, Hoogerbrugge PM, Kamps WA, Bensing JM: Online focus groups as a tool to collect data in hard-to-include populations: examples from pediatric oncology. BMC Med Res Methodol 2009, 9:15. BioMed Central Full Text
• [16]Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psychology 2006, 3:77-101.
• [17]Meszaros JR, Asch DA, Baron J, Hershey JC, Kunreuther H, Schwartz-Buzaglo J: Cognitive processes and the decisions of some parents to forego pertussis vaccination for their children. J Clin Epidemiol 1996, 49:697-703.
• [18]Whyte MD, Whyte IVJ, Cormier E, Eccles DW: Factors influencing parental decision- making when parents choose to deviate from the standard paediatric immunization schedule. J Community Health Nurs 2011, 28:204-214.
• [19]Bond L, Nolan T: Making sense of perceptions of risk of diseases and vaccinations: a qualitative study combining models of health beliefs, decision-making, and risk perception. BMC Public Health 2011, 11:943. BioMed Central Full Text
• [20]Brown KF, Kroll JS, Hudson MJ, Ramsay M, Green J, Long SJ, Vincent CA, Fraser G, Sevdalis N: Factors underlying parental decisions about combination childhood vaccinations including MMR: a systematic review. Vaccine 2010, 28:4235-4248.
• [21]Brewer N, Chapman GB, Gibbons FX, Gerrard M, McCaul KD, Weinstein ND: Meta-analysis of relationship between risk perception and health behaviour: the example of vaccination. Health Psychol 2007, 26:136-145.
• [22]Gust DA, Woodruff R, Kennedy A, Brown C: Parental perceptions surrounding risks and benefits of immunization. Semin Pediatr Infect Dis 2003, 14:207-212.
• [23]Van Velzen E, de Coster E, van Binnendijk R, Hahné S: Measles outbreak in an anthroposophic community in The Hague, The Netherlands, June-July 2008. Euro Surveill 2008, 13:18945.
• [24]Harmsen IA, Ruiter RAC, Paulussen TGW, Mollema L, Kok G, De Melker HE: Factors that influence vaccination decision-making by parents who visit an anthroposophical child welfare center: a focus group study. Adv Prev Med 2012, 2012:1-7.
• [25]Thickner S, Leman PJ, Woodcock A: 'It’s just the normal thing to do’: exploring parental decision-making about the 'five-in-one’ vaccine. Vaccine 2007, 25:7399-7409.
• [26]Brown KF, Long SJ, Ramsay M, Hudson MJ, Green J, Vincent CA, Kroll JS, Fraser G, Sevdalis N: UK parents’ decision-making about measles-mumps-rubella (MMR) vaccine 10 years after the MMR-autism controversy: a qualitative analysis. Vaccine 2012, 30:1855-1864.
• [27]May T: Public communication, risk perception, and the viability of preventative vaccination against communicable diseases. Bioethics 2005, 19:407-421.
• [28]Gust DA, Kennedy A, Shui I, Smith PJ, Nowak G, Pickering LK: Parent attitudes toward immunizations and healthcare providers: the role of information. Am J Prev Med 2005, 29:105-1127.
• [29]Kennedy AM, Gust DA: Parental vaccine beliefs and child’s school type. J Sch Health 2005, 75:276-280.
• [30]Betsch C, Brewer N, Brocard P, Davies P, Gaissmaier W, Haase N, Leask J, et al.: Opportunities and challenges of web 2.0 for vaccination decisions. Vaccine 2012, 30:3727-3733.
• [31]Betsch C, Sachse K: Debunking vaccination myths: strong risk negations can increase perceived vaccination risks. Health Psychol 2012. Advance online publication. doi: 10.1037/a0027387