Responding to Vaccine Hesitant Parents Krista Rietberg, MPH Lauren Greenfield BSN, RN David Bibus, MPH Jeffrey Duchin, MD Public Health - Seattle & King County Communicable Disease, Epidemiology and Immunization Section

Background Decreasing immunization rates School exemption data Pertussis “hot spots” Alternative providers Local, national media targeting vaccine safety Public Health Seattle & King County

Methodology Conducted focus groups using a professional research organization Three parent focus groups –two with children 7-35 months of age –one prenatal to 6 months of age Two physician focus groups –pediatricians –family practitioners Public Health Seattle & King County

Recruitment of Parents Flyers –pediatric and OB offices –organic food stores –holistic centers –midwifery offices –island community grocery store Received a monetary incentive for participation Public Health Seattle & King County

Parent Groups Criteria for Participation Decision makers about immunizations Have given serious consideration Have researched or sought information about immunizations Some in each group who did not vaccinate or selectively vaccinated Public Health Seattle & King County

Parent Groups Demographics 29 total participants –18 women and 11 men –20 Caucasian –24 had at least some college education –7 “actively researched” immunizations –10 “spent much time and effort” researching –12 “gave it some thought” –the majority took their children to a pediatrician or family doctor, some used naturopaths Public Health Seattle & King County

Physician Recruitment Existing database provided by research organization Received a monetary incentive for participation Public Health Seattle & King County

Physician Groups Criteria for Participation See at least 15 patients per week who are expectant parents or children younger than three years Practice comprised of at least 20% combined expectant parents and children younger than three years Have engaged in discussions with parents regarding immunizations or have some concerns regarding vaccine safety and efficacy Public Health Seattle & King County

Physician Demographics Pediatricians (10) –six male and four female –practiced throughout King County –average of children under three per week –average 1-4 expectant parents –seven in group practice, two in partnerships, and four hospital based Public Health Seattle & King County

Physician Demographics Family Physicians (9) –seven men and two women –most practiced in Seattle –average of children under three per week –average 1-10 expectant parents –five in group practice, two in public clinics two in solo practice Public Health Seattle & King County

Parent Groups Public Health Seattle & King County

Parent Group Misconceptions: Diseases are not serious enough to warrant immunization Natural immunity from the disease is better than immunity from immunizations Child will receive adequate immunity through breast milk Not likely to be exposed to disease so early in life Public Health Seattle & King County

Parent Group Why Vaccinate? Recommendation from health care provider Benefits outweigh risks Societal obligation Travel Personal experience with disease Public Health Seattle & King County

“I think if more children aren’t vaccinated then the diseases are going to keep coming back. It’s important to prevent that.” (parent of 7 to 35 month old child) Public Health Seattle & King County

Parent Group Why Parents Hesitate Vaccine safety and efficacy concerns “Treatable” diseases not perceived as life threatening Concerned about immune system overload Distrust of vaccine industry Personal experience Public Health Seattle & King County

“I would say that my confidence in the vaccines, per se, is probably more tied to my confidence in the people recommending them.” (pre/postnatal parent) Public Health Seattle & King County

What Parents Want From Providers Acknowledge vaccine risks and have open conversations about them Listen and answer questions Accommodate an alternate or selective vaccine schedule Public Health Seattle & King County

Trustworthy Most Recommendation from: –Physician –CDC –Medical Society –Friend or family member –Local health department Least –News story about vaccine safety –News story about serious disease –Information or recommendation on Internet Public Health Seattle & King County

Impact Most Recommendation from: –Physician –CDC –Medical society Vaccine safety article in parenting magazine Least News story about vaccine safety Information or recommendations on the Internet News stories about serious disease Public Health Seattle & King County

“I try to find an original source…with the Internet you don’t know if it was written by a 15 year-old as an after school project or…an M.D.” (Parent of 7 to 35 month old) Public Health Seattle & King County

What Would it Take? Willingness of provider to openly discuss risks and benefits of immunizations Travel to a foreign country Disease outbreak in community Willingness of provider to delay or alter immunization schedule Public Health Seattle & King County

What Would it Take? “If it was of public health significance, I would do it.” (Parent of 7 to 35 month old ) Public Health Seattle & King County

Reactions to Disease Photos Surprise - most parents had never seen the diseases Fear Motivated to vaccinate Reinforcement for having vaccinated child Want the context of the photos Credible if produced by the CDC, local health department - not vaccine manufacturer Public Health Seattle & King County

Physician Groups Public Health Seattle & King County

Slowly he would cruise the neighborhood, waiting for that occasional careless child who confused him with another vendor.

How Providers Communicate With Hesitant Parents Listen Address concerns Tend to not offer too much information Rely on Vaccine Information Statement Public Health Seattle & King County

How Providers Communicate With Hesitant Parents Offer alternative schedule Try not to be “too pushy” Relate personal experience in caring for patients with vaccine-preventable diseases Direct to appropriate resources Public Health Seattle & King County

Conclusions: Physician Groups Differences between family practice and pediatric physicians: –Pediatricians more likely to recommend universal vaccination (hepatitis B, varicella) –Pediatricians more likely to give strong recommendations Personal experience significant factor in both groups Public Health Seattle & King County

Conclusions: Parent Groups Made decisions based on poor or limited information Had difficulty understanding immunization information Relied on provider’s recommendations Public Health Seattle & King County

Conclusions: Parent Groups Want risk/benefit information Personal experience significant factor Seeing photos of diseases can have impact Want to have flexibility to alter schedule Public Health Seattle & King County

Key Messages for Parents Diseases are serious Immunizations are single most important way to prevent diseases Decision to not vaccinate isn’t risk-free Public Health Seattle & King County

Recommendations To Providers Listen Openly discuss risks and benefits Be knowledgeable about current vaccine safety issues Public Health Seattle & King County

Recommendations To Providers Have resources available Consider alternative schedules when necessary Provide a public health or community perspective Provide a strong recommendation Public Health Seattle & King County

Limitations Cannot be generalized to entire population Hesitant parent is difficult population to recruit Focus group dynamics Need strong facilitator Public Health Seattle & King County

Future Considerations Provider Immunization Education Program Materials for parents, providers Immunization updates Addressing vaccine safety issues Working with communities to address high exemption rates Public Health Seattle & King County

Future Considerations Educate providers regarding key messages, effective communication strategies Consider quantitative study targeting vaccine hesitant parents Public Health Seattle & King County

“You have to tailor your approach to a way that’s going to encourage vaccination…We just have to find, for every family, an approach that works to help them feel comfortable with vaccinations.” (Pediatrician) Public Health Seattle & King County