The Relationship Between Parent Attitudes About Childhood Vaccines Survey Scores and Future Child Immunization Status

Abstract

IMPORTANCE Acceptance of childhood vaccinations is waning, amplifying interest in developing and testing interventions that address parental barriers to immunization acceptance. OBJECTIVE To determine the predictive validity and test-retest reliability of the Parent Attitudes About Childhood Vaccines survey (PACV), a recently developed measure of vaccine hesitancy. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort of English-speaking parents of children aged 2 months and born from July 10 through December 10, 2010, who belonged to an integrated health care delivery system based in Seattle and who returned a completed baseline PACV. Parents who completed a follow-up survey 8 weeks later were included in the reliability analysis. Parents who remained continuous members in the delivery system until their child was 19 months old were included in the validity analysis. EXPOSURE The PACV, scored on a scale of 0 to 100 (100 indicates high vaccine hesitancy). MAIN OUTCOMES AND MEASURES Child’s immunization status as measured by the percentage of days underimmunized from birth to 19 months of age. RESULTS Four hundred thirty-seven parents completed the baseline PACV (response rate, 50.5%), and 220 (66.5%) completed the follow-up survey. Of the 437 parents who completed a baseline survey, 310 (70.9%) maintained continuous enrollment. Compared with parents who scored less than 50, parents who scored 50 to 69 on the survey had children who were underimmunized for 8.3% (95% CI, 3.6%–12.8%) more days from birth to 19 months of age; those who scored 70 to 100, 46.8% (40.3%–53.3%) more days. Baseline and 8-week follow-up PACV scores were highly concordant (ρ = 0.844). CONCLUSIONS AND RELEVANCE Scores on the PACV predict childhood immunization status and have high reliability. Our results should be validated in different geographic and demographic samples of parents.

Neonatal Vitamin K Refusal and Nonimmunization

“…There have been recent efforts to develop tools to identify vaccine-hesitant parents based on assessment of their knowledge, attitudes, and beliefs, but the vaccine hesitancy was assessed only once the child was overdue for vaccines. 22,23 Our finding suggests the possibility of early identification and intervention starting at birth, a time when parents may be most receptive to health information. 24,25 Strategies might include anticipatory guidance through postpartum home visits by a public health nurse, instead of waiting for the infant's first encounter with the medical system or until the first immunization is missed.…”

What are the factors that contribute to parental vaccine-hesitancy and what can we do about it?

“…This method provides greater power for these types of analyses and has been successfully used by other researchers in this area. 12,40,70 Most reported interventions are primarily educational in nature, yet the decision-making process for vaccine-hesitant families is likely very complex and influenced by factors which are difficult to measure, such as influences by social networks. This complexity likely contributes to the lack of evidence for effective interventions.…”

From package to protection: how do we close global coverage gaps to optimize the impact of vaccination?

“…The results revealed the validity of the PACV score in predicting the parents who will have under-immunized children. Indeed, the parents who were identified as "hesitant" by the PACV score were more likely to have under-immunized children for 46.8% more days (95% CI, 40.3%-53.3%) than those who were identified as less hesitant [6]. The format in which providers initiated the vaccine discussion with parents was also shown to be a predictor of parental decision [6].…”

“…Indeed, the parents who were identified as "hesitant" by the PACV score were more likely to have under-immunized children for 46.8% more days (95% CI, 40.3%-53.3%) than those who were identified as less hesitant [6]. The format in which providers initiated the vaccine discussion with parents was also shown to be a predictor of parental decision [6]. Indeed, a presumptive approach and provider pursuit of vaccine recommendation led to vaccine acceptance among 47% of initially resistant parents [6].…”

“…The format in which providers initiated the vaccine discussion with parents was also shown to be a predictor of parental decision [6]. Indeed, a presumptive approach and provider pursuit of vaccine recommendation led to vaccine acceptance among 47% of initially resistant parents [6].…”