Advertisement

A Randomized Trial to Increase Acceptance of Childhood Vaccines by Vaccine-Hesitant Parents: A Pilot Study

      Abstract

      Objective

      A cluster randomized trial was performed to evaluate an educational intervention to improve parental attitudes and vaccine uptake in vaccine-hesitant parents.

      Methods

      Two primary care sites were randomized to provide families with either usual care or an intervention (video and written information) for vaccine-hesitant parents. Eligible parents included those presenting for their child's 2-week well-child visit with performance on the Parent Attitudes about Childhood Vaccines (PACV) survey suggesting vaccine hesitancy (score ≥25). Enrollees completed PACV surveys at the 2-month well-child visit and vaccination status at 12 weeks of age was assessed. The primary outcome was the difference in PACV scores obtained at enrollment and 2 months between the 2 groups. The proportion of on-time vaccination was also compared at 12 weeks.

      Results

      A total of 454 parents were approached, and 369 (81.3%) participated; 132 had PACV scores of ≥25 and were enrolled, 67 in the control group (mean PACV score 37) and 55 in the intervention group (mean PACV score 40). Two-month PACV surveys were completed by 108 (∼90%) of enrollees. Parents in the intervention group had a significant decrease in PACV score at 2 months compared to control (median difference 6.7, P = .049); this remained significant after adjustment for baseline PACV score, race/ethnicity, and income (P = .044). There was no difference in the on-time receipt of vaccines between groups at 12 weeks.

      Conclusions

      A brief educational intervention for vaccine-hesitant parents was associated with a modest but significant increase in measured parental attitudes toward vaccines.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Omer S.B.
        • Richards J.L.
        • Ward M.
        • et al.
        Vaccination policies and rates of exemption from immunization, 2005–2011.
        N Engl J Med. 2012; 367: 1170-1171
        • Robison S.G.
        • Groom H.
        • Young C.
        Frequency of alternative immunization schedule use in a metropolitan area.
        Pediatrics. 2012; 130: 32-38
      1. Gilkey MB, McRee AL, Brewer NT. Forgone vaccination during childhood and adolescence: findings of a statewide survey of parents. Prev Med. In press.

        • Glanz J.M.
        • Newcomer S.R.
        • Narwaney K.J.
        • et al.
        A population-based cohort study of undervaccination in 8 managed care organizations across the United States.
        JAMA Pediatr. 2013; 167: 274-281
        • Omer S.B.
        • Salmon D.A.
        • Orenstein W.A.
        • et al.
        Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases.
        N Engl J Med. 2009; 360: 1981-1988
        • Chen S.Y.
        • Anderson S.
        • Kutty P.K.
        • et al.
        Health care-associated measles outbreak in the United States after an importation: challenges and economic impact.
        J Infect Dis. 2011; 203: 1517-1525
      2. Imported measles case associated with nonmedical vaccine exemption—Iowa, March 2004.
        MMWR Morb Mortal Wkly Rep. 2004; 53: 244-246
      3. Measles—United States, 2011.
        MMWR Morb Mortal Wkly Rep. 2012; 61: 253-257
        • Sugerman D.E.
        • Barskey A.E.
        • Delea M.G.
        • et al.
        Measles outbreak in a highly vaccinated population, San Diego, 2008: role of the intentionally undervaccinated.
        Pediatrics. 2010; 125: 747-755
        • Leuridan E.
        • Sabbe M.
        • Van Damme P.
        Measles outbreak in Europe: susceptibility of infants too young to be immunized.
        Vaccine. 2012; 30: 5905-5913
        • Glanz J.M.
        • McClure D.L.
        • Magid D.J.
        • et al.
        Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children.
        Pediatrics. 2009; 123: 1446-1451
        • Glanz J.M.
        • McClure D.L.
        • Magid D.J.
        • et al.
        Parental refusal of varicella vaccination and the associated risk of varicella infection in children.
        Arch Pediatr Adolesc Med. 2010; 164: 66-70
        • Glanz J.M.
        • McClure D.L.
        • O'Leary S.T.
        • et al.
        Parental decline of pneumococcal vaccination and risk of pneumococcal related disease in children.
        Vaccine. 2011; 29: 994-999
      4. American Academy of Pediatrics. Immunization/families. Available at: http://www2.aap.org/immunization/families/families.html. Accessed March 1, 2013.

      5. Centers for Disease Control and Prevention. Vaccine safety. Available at: http://www.cdc.gov/vaccinesafety/index.html. Accessed March 1, 2013.

        • Dempsey A.F.
        • Schaffer S.
        • Singer D.
        • et al.
        Alternative vaccination schedule preferences among parents of young children.
        Pediatrics. 2011; 128: 848-856
        • Klein N.P.
        • Kissner J.
        • Aguirre A.
        • et al.
        Differential maternal responses to a newly developed vaccine information pamphlet.
        Vaccine. 2009; 28: 323-328
        • Kempe A.
        • Daley M.F.
        • McCauley M.M.
        • et al.
        Prevalence of parental concerns about childhood vaccines: the experience of primary care physicians.
        Am J Prev Med. 2011; 40: 548-555
        • Opel D.J.
        • Mangione-Smith R.
        • Taylor J.A.
        • et al.
        Development of a survey to identify vaccine-hesitant parents: the Parent Attitudes About Childhood Vaccines survey.
        Hum Vaccin. 2011; 7: 419-425
      6. Chidren's Hospital of Philadelphia. Vaccine education center. 2010. Available at: http://www.chop.edu/service/vaccine-education-center/home.html. Accessed October 21, 2010.

        • Freed G.L.
        • Clark S.J.
        • Butchart A.T.
        • et al.
        Parental vaccine safety concerns in 2009.
        Pediatrics. 2010; 125: 654-659
        • Gust D.A.
        • Darling N.
        • Kennedy A.
        • et al.
        Parents with doubts about vaccines: which vaccines and reasons why.
        Pediatrics. 2008; 122: 718-725
        • Chatterjee A.
        • O'Keefe C.
        Current controversies in the USA regarding vaccine safety.
        Expert Rev Vaccines. 2010; 9: 497-502
        • Gust D.A.
        • Kennedy A.
        • Weber D.
        • et al.
        Parents questioning immunization: evaluation of an intervention.
        Am J Health Behav. 2009; 33: 287-298
      7. Plotkin S.A. Orenstein W.A. Offit P.A. Vaccines. 6th ed. Saunders Elsevier, New York, NY2008
      8. Parents of Kids with Infectious Diseases. Available at: http://www.pkids.org/. Accessed October 4, 2012.

      9. Glanz K. Rimer B.K. Viswanath K. Health Behavior and Health Education. 4th ed. Wiley, San Francisco, Calif2008
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • et al.
        Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Kennedy A.M.
        • Gust D.A.
        Measles outbreak associated with a church congregation: a study of immunization attitudes of congregation members.
        Public Health Rep. 2008; 123: 126-134
        • Gust D.A.
        • Strine T.W.
        • Maurice E.
        • et al.
        Underimmunization among children: effects of vaccine safety concerns on immunization status.
        Pediatrics. 2004; 114: e16-e22
        • Smith P.J.
        • Humiston S.G.
        • Parnell T.
        • et al.
        The association between intentional delay of vaccine administration and timely childhood vaccination coverage.
        Public Health Rep. 2010; 125: 534-541
      10. Zacharyczuk C. Multifaceted approach advocated for vaccine-hesitant parents. Infect Dis Child. In press.

        • Opel D.J.
        • Diekema D.S.
        • Lee N.R.
        • et al.
        Social marketing as a strategy to increase immunization rates.
        Arch Pediatr Adolesc Med. 2009; 163: 432-437
        • Opel D.J.
        • Robinson J.D.
        • Heritage J.
        • et al.
        Characterizing providers' immunization communication practices during health supervision visits with vaccine-hesitant parents: a pilot study.
        Vaccine. 2012; 30: 1269-1275
        • Opel D.J.
        • Taylor J.A.
        • Mangione-Smith R.
        • et al.
        Validity and reliability of a survey to identify vaccine-hesitant parents.
        Vaccine. 2011; 29: 6598-6605