When parents won’t vaccinate their children: a qualitative investigation of australian primary care providers’ experiences

Abstract

BackgroundIncreasingly, the experiences and perceptions of parents who decline vaccination are the subject of investigation. However, the experiences of clinicians who encounter these parents in the course of their work has received little academic attention to date. This study aimed to understand the challenges faced and strategies used when general practitioners and immunising nurses encounter parents who choose not to vaccinate their children.MethodsPrimary care providers were recruited from regions identified through the Australian Childhood Immunisation Register (ACIR) as having higher than national average rates of registered objection to childhood vaccination. Interviews began with an exploration of provider experiences with parents who accept, are hesitant towards, and who decline vaccination. Participants were asked specifically about how they addressed any difficulties they encountered in their interactions. Thematic analysis focused on encounters with parents – challenges and strategies.ResultsTwenty-six general practitioners (GPs), community and practice nurses (PNs) were interviewed across two regions in NSW, Australia. Providers’ sense of professional identity as health advocates and experts became conflicted in their encounters with vaccine objecting parents. Providers were dissatisfied when such consultations resulted in a ‘therapeutic roadblock’ whereby provider-parent communication came to a standstill. There were mixed views about being asked to sign forms exempting parents from vaccinating their children. These ranged from a belief that completing the forms rewarded parents for non-conformity to seeing it as a positive opportunity for engagement. Three common strategies were employed by providers to navigate through these challenges; 1) to explore and inform, 2) to mobilise clinical rapport and 3) to adopt a general principle to first do no harm to the therapeutic relationship.ConclusionsMany healthcare providers find consultations with vaccine objecting parents challenging and some, particularly more experienced providers, employ successful strategies to address this. Primary care providers, especially those more junior, could benefit from additional communication guidance to better the outcome and increase the efficiency of their interactions with such parents.

Understanding non-vaccinating parents’ views to inform and improve clinical encounters: a qualitative study in an Australian community

“…Heightened parental anxiety may be brought to the encounter if vaccination refusal incurs financial penalties, as imposed in Australia or child care exclusion, as legislated in some Australian states 5. Parents may feel an intensified need to justify their viewpoint, adding further pressure to the conversation between health professionals and parents who intend to decline vaccination 12. Additional pressure may be imposed on both clinicians and parents due to the absence of a no-fault vaccine injury compensation scheme in Australia, leaving parents with the sole responsibility in rare cases in which there is a significant, long term adverse outcome causally related to the administration of vaccine 13.…”

“…The perspectives of non-vaccinating parents may seem incomprehensible to health professionals15 leading to a ‘therapeutic roadblock’12 where provider-parent communication comes to a standstill. Health professionals may struggle with the perception that parents without formal medical, epidemiological or infectious disease expertise decline the opportunity to prevent illness in their own children and contribute to the well-being of the greater community 16…”

Understanding the perceived logic of care by vaccine-hesitant and vaccine-refusing parents: A qualitative study in Australia

“…Providing the ‘correct’ information on vaccines improves knowledge but does not improve intent to vaccinate, indicating that simply ‘correcting myths’ about vaccines in information campaigns or public health interventions may not be effective in changing vaccination behaviours [2, 16–18]. In addition, trying to persuade non-vaccinating parents to accept vaccines is usually ineffective and often dissatisfying to both parents and health professionals [19, 20]. If Kata [21] is correct in stating that the views of vaccine rejecting parents are based on a post-modern philosophy that values a variety of forms of evidence and rejects the binary position of truth/fact emanating from the popular framing of science, then it would be near-impossible to change behaviours or beliefs emanating from science, medicine or the Government, since these are all sites of distrust [22].…”

Unvaccinated children as community parasites in National Qualitative Study from Turkey

“…The parental vaccination decision is known to be complex and multidimensional, being influenced by past experiences, information sources including peers/family, emotions, routine ways of thinking with risk perceptions, trusting the health personnel, and decision-making processes [4][5][6]. Some factors leading to vaccine refusal may be the same all over the world, such as lack of time, inappropriate behaviors of staff, poor awareness, and fear of adverse events [4,[7][8][9][10][11]. Previous studies have proposed some interventions to overcome vaccine hesitancy, such as parental counseling, improving access to vaccines, implementation of free vaccines, maximizing child health supervision, offering combination vaccines, using electronic medical records, and reminder phone calls to families [10,11].…”