Parents and their children

  Population considerations:

  • Awareness of vaccine schedules. Many parents are not aware of the recommended immunization schedule (Hoeben, 1997). A nationwide study of over 13,500 children found that lower immunization rates were correlated with parent-cited barriers of confusing immunization schedules (Taylor 2002).
  • Pain and discomfort. Pain, distress and common adverse reactions may interfere with parental compliance and aggravate anti-vaccine sentiment (Jacobson 2001).
  • Misconceptions. Parents deciding whether their children should be immunized make lack knowledge about vaccine safety and efficacy (Burns 2005). There is an apparent decrease in public confidence due to the wide distribution of inaccurate and misleading information relating to vaccines (Blackford, 2001).  Some common misconceptions identified by the CDC about immunizations include:
    • Immunizations are unnecessary because the diseases in question are no longer an issue.
    • People who are immunized still get the disease.
    • Certain batches of vaccines cause more morbidity and mortality.
    • Vaccines cause many harmful side effects and deaths, and may have unknown long-term effects.
    • Giving multiple vaccines simultaneously increases side effects and overloads the immune system.
  • Parental forgetfulness. Because of poor record-keeping, parents often cannot recall which immunizations their children have received. Parents routinely believe their children are up-to-date on immunizations when they are not (Rodewald, 1999). Likewise, a nationwide survey revealed that half of the children whose parents said they received no immunizations actually had completed them (Rodewald, 1999). Frequently, information provided by parents on past immunizations is insufficient or incorrect and therefore provides an unreliable basis for future immunizations (Hoeben, 1997). 
  • Inadequate health insurance. Many insurance plans in the private sector deny coverage of basic preventative health services, such as childhood immunizations, leaving the cost to the parent (Evers, 2000).
  • Time and transportation. Many parents have difficulty taking time from work and obtaining transportation to get their children immunized (Hoeben, 1997).
  • Awareness of resources. Many parents of low-income children are not aware of the Vaccines for Children Program (VFC) and continue to cite cost as a barrier to immunization. The VFC program has funded immunizations for uninsured, underinsured and Medicaid insured children under the age of 19 since its inception in 1994 (Brenner, 2001). 
  • Cost. High cost may be the single most important barrier for all child/adolescent immunizations (Humiston, 2005).
  • Access to health care. Many children do not have a primary care provider and lack continuous medical care. They see a doctor or visit an emergency room/clinic sporadically, and only for illnesses. Without a source of regular care, these children do not have their immunization status assessed and have little opportunity to receive the full schedule of vaccines (Wood, 1996). Some adolescents, especially those who are economically disadvantaged or without health insurance, receive what little care they do get at schools or community clinics, rather than from primary care health professionals. As a result, important adolescent immunizations are missed (Grace, 2006). 
  • Awareness of vaccine preventable disease. Parents of school-aged children may have little firsthand knowledge of the diseases that are now preventable with immunizations. The dramatic reduction in vaccine-preventable diseases also has decreased public awareness of these illnesses (Blackford 2001).
  • Awareness of childhood and adolescent immunizations. Most families are aware of the need for immunizations for infants, but this is not the case for children and/or adolescents (Humiston, 2005). There is low public awareness of the need to immunize older children and adolescents against infections widely considered as problems already handled in childhood (Grace, 2006).
  • Lack of recommendations. Immunizing adolescents is not a high priority for health care providers, who view teens as healthy and treat them more often for acute care rather than preventative health services (Grace, 2006).

  Strategies to address these considerations:

  • Dispel misconceptions. Because the anti-vaccine movement communicates with many parents through websites, health care providers should consider providing parents with materials that present more balanced information on the risks and benefits of immunization (Burns 2005). The CDC has identified common misconceptions about immunization and has proposed some solutions using individual and provider education:
Misconception Solution

Diseases had already begun to disappear before vaccines due to better sanitation

Education: The largest drop in the number of vaccine-preventable diseases coincides with the introduction of immunization.

People who are immunized still get the disease.

Education: Most immunizations are effective in 85-98% of children.

Certain batches of vaccines cause more morbidity and mortality.

Education: Every vaccine lot is safety-tested by the manufacturer. No lot has ever been identified as unsafe.

Vaccines cause many harmful side effects and deaths, and may have unknown long-term effects.

Education: Most vaccine side effects are minor and temporary, death is extremely rare, and the benefits far outweigh the risks.

The diseases that the vaccine is preventing do not exist in the United States anymore.

Education: Vaccines have reduced the incidence of the diseases, but, without vaccines, a few diseases can turn into epidemics.

Giving multiple vaccines simultaneously increases side effects and overloads the immune system.

Education: Simultaneous immunization with multiple vaccines has no adverse effect on the normal immune system.

  • Educate in non-traditional settings.  Contact with children and parents in settings like Special Supplemental Food Program for Women, Infants, and Children (WIC), the Aid to Families with Dependent Children (AFDC) and other publicly funded programs could provide an opportunity to educate parents about immunizations, to screen immunization status and, at a minimum, to refer children for needed immunizations (Birkhead, 1995).
  • Increase access. Increasing access to immunizations in the health care setting can be achieved by increasing the number or convenience of the hours of service, bringing the service closer to the individual and offering the service in new settings (e.g., emergency departments) (Humiston, 2005).
  • Enhance affordability. Out of pocket immunization costs can be reduced by providing insurance, reducing copayments or offering free immunizations (Humiston, 2005). Public and hospital-based clinics provide immunizations through federal- and state-funded programs that finance the purchase of vaccines for low-income, uninsured and underinsured children (Pickering, 2002).
  • Educate parents. Motivating patients and parents to follow through with these immunizations is likely to play a significant role in efforts to achieve higher immunization rates. This can be done by educating families about the incidence and severity of the diseases that they prevent, as well as the safety and efficacy of the vaccine (Humiston, 2005). Educating parents about various aspects of immunizations, including premedication information, possible adverse effects, and risks versus benefits, would allay unfounded fears, dispel misconceptions and promote informed decision-making (Hoeben, 1997).
  • Enlist elderly family members. Parents in contemporary society may not relate to the helplessness parents experienced in the past as their children succumbed to now-preventable diseases. On the other hand, some grandparents or elderly family members may have vivid memories of such childhood diseases. Therefore, enlisting grandparents in efforts to promote immunization may give them an opportunity to make a difference in the health of their grandchildren (Hoeben, 1997).  
  • Use reminder/recall system. Health care provider reminders are effective in increasing the immunizations rates and are relatively simple and inexpensive to implement. Various strategies have been used, including chart stickers, computer notifications, vital sign stamps and checklists (Humiston, 2005).
  • Assess immunization status. The immunization status of every child should be assessed each time a child is seen for health care, whether for preventative or curative services. Parents should bring the immunization record to each health care visit (Pickering, 2002).
  • Use mobile immunization teams. If people cannot or will not come to the immunization site, then mobile immunization teams may be useful (Grabenstein 2006). This method and cost can be better utilized by delivering multiple immunizations simultaneously and administering or offering other services on the same trip (Foege, 1973).
  • Provide school-based services. Schools enroll 99.7% of all children ages 7 to 13 years, offering an established setting to access children. Therefore, school-based programs are frequently pursued because they allow easy access to children without parent-assisted health care visits, and youths can be immunized before the age at which they will likely engage in high risk behaviors (Cassidy, 1998).
  • Adolescent protocol. Establishing a new adolescent baseline protocol, a goal already supported by professional initiatives such as the CDC’s National Immunization Program, would help increase immunization rates among this population (Grace, 2006).

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