Randomised cluster trial to support informed parental decision-making for the MMR vaccine

Abstract

BackgroundIn the UK public concern about the safety of the combined measles, mumps and rubella [MMR] vaccine continues to impact on MMR coverage. Whilst the sharp decline in uptake has begun to level out, first and second dose uptake rates remain short of that required for population immunity. Furthermore, international research consistently shows that some parents lack confidence in making a decision about MMR vaccination for their children. Together, this work suggests that effective interventions are required to support parents to make informed decisions about MMR.This trial assessed the impact of a parent-centred, multi-component intervention (balanced information, group discussion, coaching exercise) on informed parental decision-making for MMR.MethodsThis was a two arm, cluster randomised trial. One hundred and forty two UK parents of children eligible for MMR vaccination were recruited from six primary healthcare centres and six childcare organisations. The intervention arm received an MMR information leaflet and participated in the intervention (parent meeting). The control arm received the leaflet only. The primary outcome was decisional conflict. Secondary outcomes were actual and intended MMR choice, knowledge, attitude, concern and necessity beliefs about MMR and anxiety.ResultsDecisional conflict decreased for both arms to a level where an 'effective' MMR decision could be made one-week (effect estimate = -0.54, p < 0.001) and three-months (effect estimate = -0.60, p < 0.001) post-intervention. There was no significant difference between arms (effect estimate = 0.07, p = 0.215). Heightened decisional conflict was evident for parents making the MMR decision for their first child (effect estimate = -0.25, p = 0.003), who were concerned (effect estimate = 0.07, p < 0.001), had less positive attitudes (effect estimate = -0.20, p < 0.001) yet stronger intentions (effect estimate = 0.09, p = 0.006). Significantly more parents in the intervention arm reported vaccinating their child (93% versus 73%, p = 0.04).ConclusionsWhilst both the leaflet and the parent meeting reduced parents' decisional conflict, the parent meeting appeared to enable parents to act upon their decision leading to vaccination uptake.

What are the factors that contribute to parental vaccine-hesitancy and what can we do about it?

“…20 Although this study did not specifically enroll mothers who were vaccine-hesitant, it did find that both types of messages (gain and loss-framed) were positively associated with maternal intent to immunize their infants against influenza (gain-frame OR D 2. 44 Parents in the intervention arm participated in a group meeting focused on MMR. The purpose of the meeting was to provide balanced vaccine information, group discussion, and coaching.…”

Cost effectiveness of a web-based decision aid for parents deciding about MMR vaccination: a three-arm cluster randomised controlled trial in primary care

“…29 Data on first-dose MMR uptake. These were collected from GP practices 9 months after recruitment.…”

A Systematic Review on Health Interventions Used in Enhancing Vaccination Uptake

“…Changing knowledge, attitude, belief, behaviour, and self-efficacy towards making positive decision to vaccinate children has been shown in studies using population and parents based educational intervention [16][17][18][19]. Social marketing was described as the process that applies traditional marketing principles and techniques to influence target audience behaviours that benefit society as well as the individual [20].…”