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

Charitha Gowda,Kevin J Dombkowski,Sarah E Schaffer,Amanda F Dempsey

doi:10.1186/1471-2458-12-509

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.

Highlights

With several new vaccine recommendations targeting adolescents, improving adolescent vaccination rates has become a major health priority
We conducted a qualitative study of adolescents, their parents and healthcare providers recruited from four primary care practices in Michigan
Across the four practices, adolescents, parents and 28 healthcare providers participated in the focus groups (Table 1)

Summary

Introduction

With several new vaccine recommendations targeting adolescents, improving adolescent vaccination rates has become a major health priority. Several new vaccines, including the meningococcal conjugate (MCV4), tetanus-diphtheriaacellular pertussis (Tdap), human papillomavirus (HPV), and most recently seasonal influenza (Flu) vaccines, have been recommended for adolescents, making vaccination a major component of adolescent primary health care [1,2,3,4] Despite their importance, in the United States immunization rates for adolescent vaccines lag behind those of childhood vaccines [5,6,7]. Inductive analyses have demonstrated that some of the most common barriers to vaccination include lack of education about vaccines and vaccinepreventable diseases, infrastructural issues, financial concerns, and the attitudes of adolescents, parents, and providers toward vaccination [8,9,10,11] This complex interplay between vaccination coverage and individual, population and health system determinants is depicted in a conceptual model developed by Briss et al (2000). This model illustrates commonly identified factors influencing vaccination coverage and categories for health interventions that are posited to have beneficial public health outcomes if implemented [12]

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Discussion

Conclusion