Understanding attitudes toward adolescent vaccination and the decision-making dynamic among adolescents, parents and providers

Abstract

BackgroundWith several new vaccine recommendations specifically targeting adolescents, improving adolescent vaccination rates has become a major health priority. Vaccination attitudes are an important, modifiable target for new interventions. Prior research has examined primarily the attitudes and beliefs of adolescents, parents or healthcare providers separately without exploring the decision-making dynamic among these stakeholders. We sought to identify potentially modifiable barriers in the vaccine decision process among adolescents, parents and healthcare providers that could be addressed through interventions implemented within the adolescent’s medical home.MethodsWe conducted a qualitative study of adolescents, their parents and healthcare providers, recruited from four primary care practices in Michigan. For each practice, three separate focus group discussions (adolescents, parents and healthcare providers, for a total of 12 focus groups) were conducted to explore vaccination attitudes, possible interventions to improve vaccine uptake and access to and use of technology for vaccination interventions. Themes that emerged from the focus group discussions were categorized using an inductive, iterative process, and analysis focused on highlighting similarities and differences among the three perspectives.ResultsParticipants included 32 adolescents, 33 parents and 28 providers. The majority of parents and adolescents were female. Lack of knowledge about recommended adolescent vaccinations was universally recognized among the three groups and was perceived to be the underlying driver of low immunization rates. Notably, each group did not appear to fully appreciate the challenges faced by the other stakeholders with respect to adolescent vaccination. Adolescents were seen as having a greater role in the vaccine decision-making dynamic than previously suggested. Provider-based interventions such as educational tools and reminder-recall notices were identified as important components of any immunization program. Overall, there was high receptivity among all stakeholders toward integrating technology such as email and Internet into new vaccination interventions.ConclusionsWe identified potentially modifiable attitudinal barriers to adolescent vaccination among the three key stakeholders. However, there were notable differences in attitudes and preferences across the three perspectives, indicating that for an intervention to be successful it will require a dynamic partnership with the target audiences.

School-based HPV immunization of young adolescents: Effects of two brief health interventions

“…Data indicate that provider recommendation is strongly associated with vaccine intent 17,18 and uptake 19 and had a health care provider delivered the health messages, perhaps increased first dose uptake would have resulted. Brief messages may be most effective when delivered by a trusted health care provider in a setting where vaccines can be delivered immediately after delivery, thereby diminishing the intentionbehavior gap.…”

Identifying and Overcoming Perceived Barriers of Providers towards HPV Vaccination: A Literature Review

“…A large number of providers report perceptions of parent concerns for safety as a barrier [18,19,22]. Parental fear of side effects and the vaccine being dangerous to their child have been cited in the literature, with higher concern if the child is 9-12 (46.3%) versus 13-18 (41.4) years of age [19,23].…”

“…Such a requirement would arrange providers with the opportunity to both encounter adolescents and encourage HPV vaccination at the recommended age for routine vaccination, bundling it with other recommended routine adolescent vaccinations. This strategy may allow for HPV vaccination to be generically presented, avoiding stigmatization associated with the vaccine's indication of preventing an infection that is frequently sexually transmitted [22].…”

“…Providers have identified additional educational interventions for patients and families such as distribution of vaccine-specific vaccine information statements (VIS) available from the CDC or other informational brochures, having pharmaceutical representative present information, and playing health information via a television in waiting rooms as helpful [22]. Providers have found strongly recommending the vaccine as safe and to be given at the age of 11-12 as well as discussing the benefits of cancer prevention often results in a positive parental response and subsequent approval for vaccination [15].…”

“…Children in the targeted age group are often generally seen for urgent-care appointments and parents are hesitant to vaccinate while they are currently ill, despite no contraindication to vaccination [7,17,22]. Providers also report parental vaccine safety concerns and not having adequate time to comprehensively discuss these concerns during visits as a barrier [19,22]. The three-dose series requires additional return visits, and a lack of scheduled reminders and reminder strategies from the office can lead to parents forgetting to return with their adolescent for subsequent doses [19].…”