‘Health Chatter’: Research Department of Behavioural Science and Health Blog
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    What we know about parents’ decisions about vaccines: Reviewing the research

    By Lauren Rockliffe, on 30 August 2016

    Vaccines help prevent infectious diseases. It is important that most people get vaccines and if enough people are vaccinated, protection is also given to people who have not been vaccinated. This is known as herd immunity. Even though most children do get the vaccines they are offered, there are still some areas in the UK where there have been outbreaks of disease.

    In general, parents in the UK need to give permission for children under the age of sixteen to have a vaccination. Whilst many parents choose for their children to be vaccinated, some parents decide not to. It is important for us to understand why parents might decide not to vaccinate their children, so that we can address any issues that might be stopping parents from vaccinating. Only once we understand the reasons for non-vaccination can we start to think of ways to tackle them, to try and increase uptake of childhood vaccinations. The best way for us to find out what these issues might be is to review existing research in this field, much of which has been qualitative. Qualitative research aims to understand a topic by finding out people’s opinions, attitudes, motivations etc. This is often done by conducting interviews or focus groups.

    In our review, published this week, we aimed to do just this; to look at qualitative studies in the UK that had looked at vaccines for children, to try to understand what might influence parents’ decisions about vaccination. We reviewed a total of 34 studies. The results of each of these studies were then re-analysed to find common themes between them.

    We found that parents make decisions about vaccination in two different ways: some made decisions automatically, and others made more intentional decisions.

    Automatic decisions

    Automatic decisions are decisions that are made by parents without too much thought. When parents made these types of decisions they were often happy to go along with the advice about vaccination that was being given to them from health professionals. Parents also made automatic decisions when they did not feel like they had a choice and/or when they were copying the decisions other people had made about vaccinating their children. These types of decisions are often made quickly and parents did not appear to weigh up the pros and cons of vaccination when making them.

    Intentional decisions

    Intentional decisions are decisions that parents have taken more time to think about. When parents made these types of decisions they often weighed up what they perceived to be the risks and benefits of vaccinating and often judged how appropriate it was to vaccinate their child based on other people’s advice or experiences. Many parents making intentional decisions felt responsible and/or were worried about being judged by other parents for the decision they were making. Parents’ emotions had an effect when making intentional decisions, as did the media and what was being reported about vaccination.

    Additional factors

    The media affected the trust that parents had in information they received about vaccination, and in medical professionals, the government and the NHS. Trust (or a lack of trust) was important for parents when making both automatic and intentional decisions. Practical issues, for example travelling to the vaccination clinic, having a lack of time or being unable to get an appointment, also affected the decisions of parents who had decided to vaccinate, regardless of whether they had made an automatic or intentional decision.

    What does this tell us?

    Many parents who made automatic decisions had decided to vaccinate their child. However, some of these parents had decided to vaccinate because they felt pressured to do so. Other parents had copied other people and not vaccinated their child. Some parents who made intentional decisions had involved others in their decision-making, by speaking to family members, friends or work colleagues.

    The findings of this review highlight how important social factors are for parents when making decisions about vaccinating their child. The impact of one child not having a vaccination may go beyond just that child being unprotected, as that decision may influence other parents’ decisions. By understanding more about the decisions parents make about vaccinating their children we will be in a better position to start to think of things we can do to encourage more parents to give permission for their children to have childhood vaccinations.

    The importance of vaccination for everyone

    By Alice Forster, on 19 August 2016

    It’s important that most people get vaccines

    Most people get the vaccines offered to them as part of the NHS immunisation programme. They help prevent, and reduce the spread of diseases. Because of vaccines we no longer have smallpox anywhere in the world and polio is almost wiped out too.

    For some vaccines, fewer people from some ethnic minority backgrounds get them compared to everyone else in the UK. For example, children from Nigerian, White Polish or Somali backgrounds are less likely than other groups to be vaccinated against Diphtheria in London (1). For other vaccines, more people from some ethnic minority backgrounds get them compared to everyone else. For example, one study found that children from Black and Asian backgrounds living in the London borough of Brent had higher uptake of the first dose of the MMR vaccine than children from White backgrounds (2).

    Because of the way vaccination works, it’s really important that most people get the vaccines they are offered. If enough people get vaccines, protection is given to the people who cannot get them for medical reasons or are too young. So although the vast majority of people get vaccines, it’s still useful to understand why some people do not, so we can work out how we might be able to increase the number of people who get them. Because of the differences in who is and is not getting vaccines, we decided to explore what it was that might make children from ethnic minority backgrounds more or less likely to get vaccines.

    What did we do?

    In our new review, we looked at published studies where parents from ethnic minority backgrounds have been spoken to about why they had or had not chosen to vaccinate their children. We just looked a studies that had used qualitative methods, like interviewing parents and speaking to small groups of parents all at once (called focus groups). We used a technique called Thematic Synthesis to bring all of the findings together, which involves a number of researchers labelling the things that people had said and finding common themes within these labels.

    What did we find?

    Not surprisingly we found that most of the things that had convinced parents from ethnic minority backgrounds to get vaccines for their children, or had stopped them from doing so, were the same as the things that parents in general tell us. For example, parents had said that they were happy to go along with the doctor’s recommendation; that their decision had been influenced by other people and had found that things like transport problems had stopped them getting vaccines.

    But there were also some things that had affected parents’ decisions about vaccines that were linked to ethnicity. For some parents, their religion instructed them about whether vaccines were needed for their children. Other parents were influenced by their experiences of having lived in other countries. For some, this made them appreciate the healthcare that is offered in the UK, but others felt that particular vaccines were not needed because they were not offered to them back home. Scare stories in newspapers or on the television can sometimes cause parents to worry about vaccines. We found that some parents who did not speak English had not heard these stories and so did not have the worries that other parents might. Some parents had wanted information about vaccines to be given to them in the language they speak at home. Finally, vaccines go through many years of testing and are studied in groups of people from all different ethnic backgrounds. Some parents said that they wanted to know about this testing, so that they could be reassured that their children would react to the vaccines in the same way as other children.

    We now have a better understanding of why some people do and do not get vaccines

    This research has helped us to understand why children from some ethnic minority backgrounds might be more likely to get some vaccines. It also told us the type of information that parents from ethnic minority backgrounds want to know about vaccines to be confident that giving their child a vaccine is the right thing. In some situations it might be a good idea to tailor information about vaccines to parents from particular ethnic minority backgrounds to make sure they are getting all the information they want to have.

     

    References

    1. Wagner KS, van Wijgerden JCJ, Andrews N, Goulden K, White JM: Childhood vaccination coverage by ethnicity within London between 2006/2007 and 2010/2011. Arch Dis Child 2014, 99(4):348-353. DOI: 10.1136/archdischild-2013-304388
    2. Mixer RE, Jamrozik K, Newsom D: Ethnicity as a correlate of the uptake of the first dose of mumps, measles and rubella vaccine. J Epidemiol Community Health 2007, 61(9):797-801. DOI: 10.1136/jech.2005.045633

    A cancer false alarm could discourage people from checking out future symptoms

    By Susanne Meisel, on 6 February 2015

    As I have discussed here, delays in a diagnosis of cancer are one reason why the UK fares worse in cancer survival than other countries . This has led to campaigns like this one to remind the public to go and get symptoms checked out early. However, most people who go and have tests will ultimately get the ‘all-clear’- in other words they will not be diagnosed with cancer. This is of course good news, however having experienced a false alarm might have some unintended consequences. It may impact on mood and anxiety levels long after the all-clear has been given. What’s more, a false alarm may influence future symptom appraisal because it may lead people to think that it’s just another false alarm, so they won’t bother to go to the GP again.

    Our researchers looked at all available research studies which reported information on false alarms and subsequent symptom attribution or help-seeking published between 1990 and February 2014 to see whether this assumption was true. They included only studies that looked at adult patients who presented with symptoms and did not include studies where additional tests were required after routine cancer screening, because the effect of a false alarm may be different in this context.
    Our researchers found 19 national and international studies that met their criteria. Six of these were carried out in the UK, three in other European countries, six in the USA, three in Canada and one in Australia. The most frequently studied cancer was breast cancer, followed by gynaecological, bowel, testicular, head and neck, brain cancer and multiple cancer sites.

    Our researchers found that, as predicted, people often explained a delay in seeking help for a symptom due to being overly reassured by a previous false alarm. This was true across different types of cancer. Interestingly, a previous false alarm often resulted in normalising novel symptoms and attributing them to the previous benign diagnosis even in the case of symptoms occurring months or years after the false alarm. This finding is concerning, because having had an all-clear diagnosis in the past does not guarantee that you won’t develop cancer in the future. Therefore, it is really important to remain vigilant and go and get checked every time a new symptom appears, or a symptom won’t go away.

    Feeling ‘foolish’ and under-supported the first time help was sought for a symptom was another important theme that emerged from the review. Patients who felt dismissed, and who felt that they did not get enough explanation about what to do if the symptoms did not go away or if new symptoms appeared were less likely to seek help in the future.

    However, there were some limitations to the review – for example our researchers might have missed some studies as in the majority of cases they were not directly investigating the effects of false alarms; moreover, the ones they did find were based on small number of patients who were interviewed after they had been diagnosed with cancer . Therefore, we are planning to do some more research in the future which will specifically focus on the topic.

    These findings highlight how important it is to provide balanced information to patients when they are investigated for possible cancer symptoms, making sure not to cause unnecessary anxiety and at the same time avoiding false reassurance. Furthermore, the results show that it is important to take patients’ concerns seriously and encourage patients to see a doctor promptly if they have new possible cancer symptoms or if symptoms don’t go away even if they have been checked before. Early diagnosis will only be successful if patients feel assured that they are not perceived as hypochondriacs or wasting the GP’s time.

    Article Reference:Renzi C, Whitaker KL, Wardle J: Over-reassurance and undersupport after a ‘false alarm’: a systematic review of the impact on subsequent cancer symptom attribution and help seeking BMJ Open 2015;5:2 e007002 doi:10.1136/bmjopen-2014-007002   http://bmjopen.bmj.com/content/5/2/e007002.full#ref-11