An Exploratory Qualitative Assessment of Factors Influencing Childhood Vaccine Providers' Intention to Recommend Immunization in the Netherlands

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2012 Feb 16

PMID 22333837

Citations 15

Authors

Liesbeth Mollema

Jojet M Staal

Jim E van Steenbergen

Theo Gwm Paulussen

Hester E de Melker

Affiliations

Soon will be listed here.

Abstract

Background: Under the Dutch national immunization program (NIP), childhood vaccination is not mandatory, but its recommendation by childhood vaccine providers (CVP) is important for maintaining high vaccination coverage. We therefore examined factors related to providers' intentions to recommend vaccinations to parents of young children.

Methods: We conducted four focus group discussions with nurses and physicians who provide vaccines to children 0-4 years old in diverse regions of the Netherlands. Three groups represented CVPs at child welfare centers (CWCs) serving the general population, with the fourth representing anthroposophical CWCs. Elements of the Theory of Planned Behaviour (TPB) were used to design the groups; thematic analysis was used to structure and analyze the dataset.

Results: Four main themes emerged, including 1) perceived responsibility: to promote vaccines and discuss pros and cons with parents (although this was usually not done if parents readily accepted the vaccination); 2) attitudes toward the NIP: mainly positive, but doubts as to NIP plans to vaccinate against diseases with a low perceived burden; 3) organizational factors: limited time and information can hamper discussions with parents; 4) relationship with parents: crucial and based mainly on communication to establish trust. Compared to CVPs at standard CWCs, the anthroposophical CWCs spent more time communicating and were more willing to adapt the NIP to individual cases.

Conclusions: Our qualitative assessment provides an overview of beliefs associated with providers' intention to recommend vaccinations. They were motivated to support the NIP, but their intentions to recommend vaccinations were affected by the perceived relevance of the vaccines, practical issues like limited time and by certain types of resistant parents. These results will inform future studies to test the magnitude and relative impact of these factors.

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References

Benin A, Wisler-Scher D, Colson E, Shapiro E, Holmboe E . Qualitative analysis of mothers' decision-making about vaccines for infants: the importance of trust. Pediatrics. 2006; 117(5):1532-41. DOI: 10.1542/peds.2005-1728. View

Leask J, Quinn H, Macartney K, Trent M, Massey P, Carr C . Immunisation attitudes, knowledge and practices of health professionals in regional NSW. Aust N Z J Public Health. 2008; 32(3):224-9. DOI: 10.1111/j.1753-6405.2008.00220.x. View

Prislin R, Nader P, De Guire M, Hoy P, Pung M, Ross S . Physicians' immunization knowledge, attitudes, and practices: a valid and internally consistent measurement tool. Am J Prev Med. 1999; 17(2):151-2. DOI: 10.1016/s0749-3797(99)00054-9. View

Kempe A, Daley M, McCauley M, Crane L, Suh C, Kennedy A . Prevalence of parental concerns about childhood vaccines: the experience of primary care physicians. Am J Prev Med. 2011; 40(5):548-55. DOI: 10.1016/j.amepre.2010.12.025. View

Keane M, Walter M, Patel B, Moorthy S, Stevens R, Bradley K . Confidence in vaccination: a parent model. Vaccine. 2005; 23(19):2486-93. DOI: 10.1016/j.vaccine.2004.10.026. View

Askelson N, Campo S, Lowe J, Dennis L, Smith S, Andsager J . Factors related to physicians' willingness to vaccinate girls against HPV: the importance of subjective norms and perceived behavioral control. Women Health. 2010; 50(2):144-58. DOI: 10.1080/03630241003705094. View

Cotter S, Ryan F, Hegarty H, McCabe T, Keane E . Immunisation: the views of parents and health professionals in Ireland. Euro Surveill. 2003; 8(6):145-50. DOI: 10.2807/esm.08.06.00416-en. View

Kahn J, Rosenthal S, Tissot A, Bernstein D, Wetzel C, Zimet G . Factors influencing pediatricians' intention to recommend human papillomavirus vaccines. Ambul Pediatr. 2007; 7(5):367-73. DOI: 10.1016/j.ambp.2007.05.010. View

Wright T, Van Damme P, Schmitt H, Meheus A . Chapter 14: HPV vaccine introduction in industrialized countries. Vaccine. 2006; 24 Suppl 3:S3/122-31. DOI: 10.1016/j.vaccine.2006.05.118. View

10.

Streefland P, Chowdhury A . Patterns of vaccination acceptance. Soc Sci Med. 1999; 49(12):1705-16. DOI: 10.1016/s0277-9536(99)00239-7. View

11.

Heininger U . An internet-based survey on parental attitudes towards immunization. Vaccine. 2006; 24(37-39):6351-5. DOI: 10.1016/j.vaccine.2006.05.029. View

12.

Paulussen T, Hoekstra F, Lanting C, Buijs G, HiraSing R . Determinants of Dutch parents' decisions to vaccinate their child. Vaccine. 2005; 24(5):644-51. DOI: 10.1016/j.vaccine.2005.08.053. View

13.

van Lier E, Oomen P, Oostenbrug M, Zwakhals S, Drijfhout I, de Hoogh P . [High vaccination coverage of the National Immunization Programme in the Netherlands]. Ned Tijdschr Geneeskd. 2009; 153(20):950-7. View

14.

Swennen B, Van Damme P, Vellinga A, Coppieters Y, Depoorter A . Analysis of factors influencing vaccine uptake: perspectives from Belgium. Vaccine. 2001; 20 Suppl 1:S5-7; discussion S1. DOI: 10.1016/s0264-410x(01)00307-3. View

15.

Petrovic M, Roberts R, Ramsay M . Second dose of measles, mumps, and rubella vaccine: questionnaire survey of health professionals. BMJ. 2001; 322(7278):82-85. PMC: 26597. DOI: 10.1136/bmj.322.7278.82. View

16.

Loewenson P, White K, Osterholm M, MacDonald K . Physician attitudes and practices regarding universal infant vaccination against hepatitis B infection in Minnesota: implications for public health policy. Pediatr Infect Dis J. 1994; 13(5):373-8. DOI: 10.1097/00006454-199405000-00008. View

17.

Pielak K, McIntyre C, Tu A, Remple V, Halperin B, Buxton J . Identifying attitudes, beliefs and reported practices of nurses and doctors as immunization providers. J Adv Nurs. 2010; 66(7):1602-11. DOI: 10.1111/j.1365-2648.2010.05326.x. View

18.

Davis T, Fredrickson D, Arnold C, Cross J, Humiston S, Green K . Childhood vaccine risk/benefit communication in private practice office settings: a national survey. Pediatrics. 2001; 107(2):E17. DOI: 10.1542/peds.107.2.e17. View

19.

Kahn J, Zimet G, Bernstein D, Riedesel J, Lan D, Huang B . Pediatricians' intention to administer human papillomavirus vaccine: the role of practice characteristics, knowledge, and attitudes. J Adolesc Health. 2005; 37(6):502-10. DOI: 10.1016/j.jadohealth.2005.07.014. View

20.

Sturm L, Mays R, Zimet G . Parental beliefs and decision making about child and adolescent immunization: from polio to sexually transmitted infections. J Dev Behav Pediatr. 2005; 26(6):441-52. DOI: 10.1097/00004703-200512000-00009. View