The majority of parents have concerns and misconceptions about immunizations, yet they still have their children immunized. When their concerns are specifically about autism and the number of vaccines an infant receives, parents are much less likely to have their child receive all of the recommended vaccines.
These results from a national household survey conducted for the CDC are the first time that American parents’ level of confidence in vaccines and the recommended schedule of immunizations for children have been assessed. While vaccination levels of children 19-35 months are above national goals of 90%, it is not parent beliefs or confidence that may be the primary determinants of having their child immunized – only 23% of them reported ‘no concerns’ with vaccines.
The survey also documented that the important sources of information about immunizations for parents were health care professionals (85% named them), family members (46%), the internet (24%) and friends (22%). Unfortunately, the survey did not ask respondents to distinguish between static information websites and interactive ones such as social network sites (a note to survey designers: you must at least make the distinction between these two types even if you don’t ask for their specific names or sponsors). Otherwise, we could say with almost complete confidence that parents' decisions about having a child fully immunized are solely based on social interactions. And that conclusion has significant implications for the theories and models we employ to develop interventions to maintain or boost levels of childhood immunizations (or introduce new childhood vaccines) – they become more social and less purely psychological or individually-focused.
This social idea is vitally important as concerns parents have about immunizations likely propel some of their interactions with others (who they seek out and listen to) and their information–seeking behaviors (which is a social phenomenon too). What are the specific concerns they have?
- The pain the child experiences when receiving so many shots during a doctor’s visit (36%)
- Their child is getting too many vaccines in one visit (36%)
- Their child is getting too many vaccines in the first two years of live (34%)
- Vaccines may cause fevers. (32%)
- Vaccines may cause learning disabilities, such as autism (30%)
- The ingredients in vaccines are unsafe (25%)
- Vaccines are not tested enough for safety (17%)
- Vaccines may cause chronic disease (16%)
- Vaccines are given to prevent diseases children are not likely to get (11%)
- There are not enough of some vaccines for my child to get them on time (9%)
- Vaccines are to prevent diseases that are not serious (8%)
The investigators then looked at what concerns characterized the small number of parents who said their children would receive some but not all vaccines. From the list above, only concerns about too many vaccines in the first two years of life and that vaccines may cause learning disabilities (autism) were significantly more frequent than expected by chance, while the belief that vaccines were for diseases that were not serious was significantly less frequent than one would expect in this group.
Unfortunately, the survey included too few parents who stated they were not having their child immunized at all to be able to conduct any meaningful analysis that might have shed some light on what pattern of concerns they may have.
The authors conclude by noting that parents having concerns about immunizations for their children should not be seen as a negative event. In fact, the majority of parents do follow recommendations anyway. This study does document that concerns about childhood immunizations are pervasive among parents – 77% report having at least one. The data also gives US planners (we would not generalize this to other countries) a quantitative handle on which concerns out of all the ones that have come out of qualitative research may be the most important ones to focus on from a population perspective (that is, are most prevalent). In-person or digitally mediated clinical encounters will be needed to solicit specific concerns and directly address them for individual parents. The authors of this study specifically address the dynamics of the health care practice visit and recommend more time and effort be given to improve parent satisfaction with office visits, fully explore and discuss parents immunization concerns (which they note is not necessarily constrained by time but by provider communication skills), and improving provider knowledge and confidence to discuss the childhood immunization schedule with parents.
These results also lead me to suspect:
If we don’t acknowledge that concerns about vaccines are pervasive among parents, we lose credibility when acting ‘as if’ only people who don’t get their children immunized have worries. By acknowledging the pervasiveness of their concerns, and that parents find answers to their questions and carry on (‘norming’ or making this behavioral scenario the usual case, not the deviant one), we might also inoculate more parents against the persuasive effects of anti-vaccine proponents who might seem more empathic to these concerns than the public health and health care communities.
There are many more components of a social marketing effort to maintain and improve immunizations that I have written about in relation to the H1N1 pandemic preparation activities of a few years ago. Communication is one part of the effort, but price, distribution, the role of groups who are critical to success (health care providers to name just one), and designing better products (immunization delivery methods for example) and services (the parents’ and children's experience during the visit) are factors that must be attended to as well.
Kennedy, A., LaVail, K., Nowak, G., Basket, M. & Landry, S. (2011). Confidence about vaccines in the United States: Understanding parents’ perceptions. Health Affairs;30:1151-1159.