Partnering with parents to remove barriers and improve influenza immunization rates for young children

Abstract

Background: Despite the ongoing public health initiatives to increase pediatric influenza immunization rates to 80%, only a few US health centers have been able to meet this goal. The suboptimal immunity to influenza poses individual and societal risks for vaccine-preventable cases of influenza and its complications. Local problem: At a diverse, urban, family health center, its influenza immunization rate of 44% represented the lowest uptake rate compared with all other early childhood vaccines, increasing the risk of morbidity and mortality in young children, including hospitalization and death. Methods: To identify key barriers to influenza immunization, the investigators interviewed parents of children aged 6 through 24 months at this urban family health center via randomized sampling using an open-ended telephone survey. Interventions: Based on the concerns parents expressed through the survey, a program was designed and implemented that included reminder calls, parent education, proactive appointment scheduling, and social media reminders. Results: After implementing a parent-driven quality-improvement program for 6 months during influenza season, the health center's pediatric influenza immunization rates rose to 57% compared with 44% during the year before. Conclusions: Childhood immunization is a critical priority to protect the health and wellness of children. Increasing parent engagement in discussions about increasing immunization rates not only promotes awareness surrounding vaccines but also allows primary care providers to learn from parents to create a patient-centered immunization program. Programs that specifically target immunization efforts toward parental concerns have the potential for increased vaccine acceptance and improved health outcomes.

Parental Acceptance, Parental Hesitancy, and Uptake of Seasonal Influenza Vaccination among Children Aged 6–59 Months: A Systematic Review and Meta-Analysis

“…A total of 36 studies published from 2004 to 2023 were finally analysed and summarised [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 23 , 24 , 25 , 26 , 27 , 28 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ] ( Table 1 ). Most of the studies were performed in Asia ( n = 15, 42%) and the Americas ( n = 14, 39%), followed by Europe ( n = 5, 14%) and Oceania ( n = 2, 6%).…”

“…Parents of children aged under five years expressed concerns that it was too young for their children to receive SIV, and they worried that SIV would have a negative effect on interactions with other vaccines to be received by their children [ 23 , 24 , 25 ]. These parents also worried that their young children may catch influenza from the vaccine [ 26 , 27 ]. Furthermore, they believed that natural immunity to influenza was better for their young children [ 28 ].…”

Influenza vaccination among U.S. pediatric patients receiving care from federally funded health centers

“…Additionally, health information technology can be used to better facilitate important vaccine conversations, including patient and provider reminders and prompts in electronic health record systems and patient portals [54] , [55] , [56] . Other potential vehicles for improvement include parent education, proactive appointment scheduling, and strong provider recommendations [48] , [57] . Findings suggest that HRSA-funded health centers can serve as critical providers in engaging and serving diverse constituencies, reducing disparities in influenza vaccination, and increasing immunity among the nation’s most underserved communities.…”

“…Similarly, the study did not examine the role of knowledge, attitudes, and practices toward vaccines among parents of pediatric health center patients, which might influence the decision to obtain influenza vaccinations. Recent literature illustrates that parental concerns about seasonal influenza vaccine exist, including beliefs that the vaccine causes influenza illness, the vaccine is unnecessary because influenza illness is mild, and the vaccine is not effective [46][47][48][49]. Beyond concerns specific to influenza vaccine, more generalized concerns may influence decisions to vaccinate.…”

Text Message Reminders to Improve Immunization Appointment Attendance in Alberta, Canada: The Childhood Immunization Reminder Project Pilot Study

“…The literature has shown that parental forgetfulness of immunization appointments is a key barrier to 18-month vaccine uptake [ 10 , 11 ]. Factors contributing to this forgetfulness in Canadian parents include the following: (1) the perception that infant vaccines are completed by 12 months of age, (2) the end of paid parental leave and return to work, (3) a 6-month gap between appointments, and (4) the inability of some booking systems to schedule an appointment 6 months in advance [ 12 , 13 ].…”