Rethinking Childhood Vaccines and Parent Hesitancy and Refusal: A Look at Web-based Decision Aids and Parental Vaccine Preference Development

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  • February 28, 2019
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  • Yarnall, James
    • Affiliation: Gillings School of Global Public Health, Public Health Leadership Program
Abstract
  • ABSTRACT BACKGROUND: Childhood vaccine refusal and delay are significant contributors to diminishing vaccination rates and the recent outbreaks of vaccine-preventable diseases. Parents that refuse or delay include those strongly against vaccines but also include a much larger population of parents uncertain about vaccine efficacy, safety, and importance. Conventional education interventions to reduce parent uncertainty and refusal have demonstrated mixed results, and the studies focused on these interventions are poor in quality. One new promising intervention type involves the use of vaccine-related web-based decision aids to help parents clarify their values concerning childhood vaccinations in addition to general vaccine education. The objective of this systematic review is to explore the strength and certainty of evidence surrounding the use of web-based decision aids in reducing parent uncertainty and increasing vaccine uptake. METHODS: A systematic literature review of the PubMed and EMBASE databases was conducted to find and screen articles for eligibility. A PICOTTSS table was created to define the eligibility criteria for the articles. Quality assessment of eligible articles was done to determine strength and certainty of evidence by appraising study design, source and study populations, sources of bias, study results, applicability, and clinical meaning. RESULTS: The search strategy revealed three articles, all focusing on the application of one MMR-based decision aid. The studies reported significant decreases in parental decisional conflict and improved attitudes towards vaccination, with borderline significant increases in vaccine uptake and nonsignificant changes to intention to vaccinate and vaccine knowledge. Quality assessment found poor to moderate strength and certainty of evidence for the outcomes of interest, with sample size, study design, and selection and confounding bias identified as the main issues. CONCLUSION: The evidence supporting the use of decision aids for parental uncertainty and refusal is weak due to a small number of studies with low to moderate validity. Additional studies of greater number and sample size will be required to determine the true benefit of web-based decision aids in combating vaccine uncertainty and refusal. Future studies should also focus more on clinically meaningful outcomes (such as vaccine uptake) to support the implications of future findings. ABSTRACT BACKGROUND: The recent measles outbreaks in the United States and Europe are the most recent outcomes of declining vaccine coverage among vulnerable populations of children due to the rise of vaccine refusals and delays among parents. Much of the existing research on this issue has focused on underlying characteristics of non-vaccinators and ambivalent parents, including attitudes towards vaccines and health care, reasoning behind non-vaccination and delay, and perceived credibility of various information sources. However, few studies have looked into how or when vaccine preferences develop. In this study, we sought to explore when parental preferences for vaccines develop in relation to a pregnancy (before, during, or after). As a secondary objective, we examined self-reported influences on vaccine decision-making. METHODS: We recruited and administered a short survey to mothers and fathers at the University of North Carolina Women's Hospital in Chapel Hill, NC, following the birth of their child from February to April 2015. RESULTS: Of the 304 eligible parents, 169 (56%) consented to taking the survey; 166 (55%) completed the entire survey. 72% (119) of surveyed parents reported deciding on their vaccine preferences for their newborn before conception. Parents who were older (χ2 = 22.26, p < 0.001), Caucasian (χ2 = 22.38, p < 0.001), married (χ2 = 30.76, p < 0.001), and had attained higher levels of education (χ2 = 36.52, p < 0.001) were significantly more likely to develop pre-conception vaccine preferences. The presence of past partner conversations and the desire for more information on vaccines were also significant predictors of pre-conception vaccine preference development. After adjustment in the logistic regression model, only education (OR = 1.988, p = 0.025) and past vaccine conversations (OR = 0.411, p = 0.048) remained significant. The most common influences for vaccine decision-making were family and friends, medical staff, and organizations like the Center for Disease Control and Prevention (CDC) and American Academy of Pediatrics (AAP). CONCLUSION: Our study documents that a majority of parents establish vaccine decision-making and preferences before conception. Notable influences from friends, family, and medical sources are part of the process. Given these findings, the distribution of vaccine information before conception should be considered.
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  • In Copyright
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  • Track: HC&P
  • Paper type: Research or research design
Advisor
  • Viera, Anthony
Reviewer
  • Lohr, Jacob
Degree
  • Master of Public Health
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2015
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  • 95a44c0b-5e6e-4083-a8ab-eac984e1affa

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