Identifying factors behind the general practice use of the term ‘decline’ for the childhood immunisation programme in New Zealand

Abstract

INTRODUCTION:The role of healthcare providers and their use of systems is one of the most important factors in vaccination uptake. AIM:To identify reasons and find patterns behind why immunisation providers code the word 'decline' in their system for childhood immunisation events. METHODS:A qualitative study involving face-to-face semi-structured interviews with staff members involved in immunisation delivery. General practices were purposively selected for having either high or low rates of registered children coded on the electronic practice management system as having declined immunisation events. Thematic analysis was undertaken using an inductive approach to link themes to the data. RESULTS:A total of 35 interviews were conducted with practice nurses; 21 were from practices with high rates of registered children recorded as having declining immunisation events, and 14 practices with low rates of declining. Common themes were: effective use of systems, early and ongoing engagement, adequate health care practitioner time and practitioner experience. Practices with low rates of coded decliners had stronger approaches for early and ongoing engagement, and were less likely to use formalised decline forms. As practice immunisation coverage rates improved over time, there was perceived to be less expressed vaccine hesitancy from families. CONCLUSIONS:The reasons for coding individuals as 'decliners' are a complex mixture of individual, community, practitioner and practice systems. Front-line providers need adequate tools, time and resourcing to support effective and ongoing engagement with families. Community factors have influence but can change over time.

From the Editor: One job, two jobs, three jobs, four …

“…two papers are about immunisations. 7,8 in their paper about outreach childhood immunisation services, roberts and colleagues uncover wide variation between District Health Boards (DHBs) in the proportion of children immunised by outreach services. There is also a skewed distribution of costs.…”

“…The research by turner and colleagues provides further insights into the ways that engagement with families might assist immunisation delivery and reflects again the need to prioritise human interactions over impersonal systems. 8 The systems within which healthcare providers work are still very important. eggleton reports his work with the Northland DHB to establish a method of measuring access to local general practices.…”