1. A BMRB Social Research presentation to: 3 rd Welsh Immunisation Conference 1 st March 2006 Sarah Oliver Kathryn Warrener

2. Childhood Immunisation: How do Welsh parents really feel?

3. Background and aims Long term concern amongst parents about specific childhood immunisations –e.g., Meningitis C, MMR, 5-in-1 Context of media coverage, and public information campaigns Health professionals play crucial role in parents’ experience Need to monitor experiences, knowledge and attitudes of parents of young children and health professionals

4. Research method Parents 17 waves, twice yearly since 1997 Representative sample of 200 interviews with parents of 0-2s Face-to-face in-home interviews Health professionals 2 annual surveys since 2004 Telephone survey of 200 GPs, 250 Health Visitors and 250 Practice Nurses

5. What’s on the news?

6. Scare stories in the media Source: Daily Mail, Thursday 9 February 2006

7. Attitudes towards overload % Agree Children immunised against too many diseases at one time Base: All primary care givers of 0 - 2s (Nov 05 n = 212)

8. The scare stories … February 1998: Wakefield’s first report suggesting link between MMR and autism/bowel disease 2000 – 2001: Continued public concerns from Dr Wakefield, though claims rejected by Department of Health February 2002: Second report from Wakefield from studies into his suggested link 2002: Heightened media publicity

9. Any advertising, information or publicity TV programme Newspaper article TV advertisement Awareness of information, advertising and publicity Base: All primary care givers of 0 - 2s (Nov 05 n = 212)

10. Base: All parents who spontaneously recall seeing/ hearing advertising, information or publicity (Nov 05 n= 132) Content of information MMR Immunisation in general

11. Persuade not to immunise Would it persuade them not to immunise their child? Base: All parents who spontaneously recall seeing/ hearing advertising, information or publicity (Nov 05 n= 132)

12. What’s on the news? Large amounts of publicity over last few years, especially on MMR Reduced awareness of publicity since Feb 02 BUT still MMR led However, decreasingly likely to persuade parents not to immunise

13. Where do parents find out more?

14. Ideal and actual information sources Base: All primary care givers of 0 - 2s (Nov 05 n = 212)

15. Ideal and actual information sources Base: All primary care givers of 0 - 2s (Nov 05 n = 212)

16. Discussions about immunisations before child was immunised Benefits (HP) Any HP Side effects (HP) Side effects (someone else) Mar 03 May 04 Nov 04 Feb 02Sep 02 Oct 03 Nov 05May 05 Base: All primary care givers of 0 - 2s (Nov 05 n = 212)

17. Side effects discussed (spontaneous recall) Base: All primary care givers of 0 –2s who discussed side effects, Nov 05

18. Side effects discussed (spontaneous recall) Base: All primary care givers of 0 –2s who discussed side effects, Nov 05

19. The suggested link between MMR and autism 49% HP 31% someone else Rare side effects discussed (prompted recall) Base: All primary care givers of 0 –2s who discussed side effects, May 05 (n=207)

20. The suggested link between MMR and autism The possibility of overloading a child’s immune system The suggested link between MMR and bowel disease or Crohn’s disease The suggested link between whooping cough and epilepsy 49% HP 31% someone else Rare side effects discussed (prompted recall) Base: All primary care givers of 0 –2s who discussed side effects, May 05 (n=207)

21. What health professionals report discussing with parents (after prompting) Base: All GPs (210), HVs (245), PNs (238); Nov 05

22. GPs Health Visitors Practice Nurses Strongly agree Tend to agree May 05 Nov 05 78% 82% 74% 80% Base: All primary care givers of 0 - 2s (Nov 05 n = 212) Parents’ trust in immunisation information from …

23. GPs Health Visitors Practice Nurses Strongly agree Tend to agree NHS May 05 Nov 05 May 05 78% 82% 74% 68% 75% 80% Base: All primary care givers of 0 - 2s (Nov 05 n = 212) Parents’ trust in immunisation information from …

24. GPs Health Visitors Practice Nurses Gov’t Strongly agree Tend to agree NHS May 05 Nov 05 May 05 Nov 05 May 05 78% 82% 74% 42%41% 68% 75% 80% Base: All primary care givers of 0 - 2s (Nov 05 n = 212) Parents’ trust in immunisation information from …

25. Where do parents find out more? Widespread use of written information, BUT –prefer to use, and have trust in health professionals Most discuss immunisation with HPs, including minor side effects BUT –less recall of discussing rare side effects

26. MMR – what do Health Professionals believe?

27. Whether MMR can cause specific conditions (% saying “Yes”) Conditions where there are recognised adverse reactions to the MMR immunisation Don’t know/ Not heard of condition 10% 17% 9% 11% 20% 21% Base: All GPs (210), HVs (245), PNs (238); Nov 05

28. (% saying “Yes”) Whether MMR can cause specific conditions Don’t know/ Not heard of condition 2%8%2% 9%3% Base: All GPs (210), HVs (245), PNs (238); Nov 05

29. (% saying “Yes”) Whether MMR can cause specific conditions Don’t know/ Not heard of condition 2%8%2% 9%3%1%3%1% Base: All GPs (210), HVs (245), PNs (238); Nov 05

30. (% saying “Yes”) Whether MMR can cause specific conditions Don’t know/ Not heard of condition 2%8%2% 9%3%19%34%12%1%3%1% Base: All GPs (210), HVs (245), PNs (238); Nov 05

31. A child who is 5 years of age Whether would advise that MMR should be given in specific situations % Saying “yes” Base: All GPs (210), HVs (245), PNs (238); Nov 05

32. A child with a close family history of epilepsy A child who is 5 years of age A child with a close history of autism Whether would advise that MMR should be given in specific situations % Saying “yes” Base: All GPs (210), HVs (245), PNs (238); Nov 05

33. A child with a close family history of epilepsy A child who is 5 years of age A child with a close history of autism A child who had a serious reaction following immunisation with DTP-Hib vaccine Whether would advise that MMR should be given in specific situations % Saying “yes” Base: All GPs (210), HVs (245), PNs (238); Nov 05

34. A child with a close family history of epilepsy A child who is 5 years of age A child with a close history of autism A child who had a serious reaction following immunisation with DTP-Hib vaccine A child who is in contact with someone immunosuppressed Whether would advise that MMR should be given in specific situations % Saying “yes” Base: All GPs (210), HVs (245), PNs (238); Nov 05

35. Agreement with statements about MMR % Agree Base: All GPs (210), HVs (245), PNs (238); Nov 05

36. MMR – what do HPs believe? Knowledge gaps on rare side effects and when to advise MMR BUT –high levels of confidence in MMR

37. MMR – what do parents believe?

38. Spontaneous awareness of immunisations MMR Base: All primary care givers of 0 - 2s (Nov 05 n = 212)

39. Spontaneous awareness of immunisations MMR Hib Polio Men C 5 in 1 vaccine Base: All primary care givers of 0 - 2s (Nov 05 n = 212)

40. MMR ‘completely safe/slight risk’ Safety of MMR Base: All primary care givers of 0 - 2s (Nov 05 n = 212)

41. Perceived safety of immunisations Old Polio (by mouth) % completely safe / slight risk MMR Men C Base: All primary care givers of 0 - 2s (Nov 05 n = 212)

42. Perceived severity of diseases Meningitis Rubella Measles % very serious Polio Mumps Base: All primary care givers of 0 - 2s (Nov 05 n = 212)

43. Whether any immunisations present a greater risk than the diseases they protect against MMR Any immunisation Base: All primary care givers of 0 - 2s (Nov 05 n = 212)

44. Mean: 7 out of 10 * Number of children out of every ten that primary care givers think are given the combined MMR vaccine Perceived uptake of MMR Base: All primary care givers of 0 - 2s (May 05 n = 207)

45. MMR – what do parents believe? MMR is still most top of mind immunisation Encouraging recovery in perceived level of risk of MMR BUT –Still considered least safe immunisation against least serious diseases –Still believe 3 in 10 children are not given MMR

46. MMR – what do parents actually do?

47. Making a decision about immunisation

48. Delaying & refusing MMR: past and future Base: All primary care givers of 0-2s (W15 n = 219) Delayed for safety reasons but since had it done/ intend to have it done Delayed for other reasons, but since had it done/ intend to have it done Delayed indefinitely or refused

49. Delaying & refusing MMR: past and future Base: All primary care givers of 0-2s (W15 n = 219) Delayed indefinitely, refused or would refuse in the future Delayed for safety reasons but since had it done/ intend to have it done Delayed for other reasons, but since had it done/ intend to have it done Delayed indefinitely or refused

50. MMR – what do parents do? Despite beliefs about MMR and its uptake: –2 in 3 parents have all immunisations done without question –Under 1 in 10 feel strongly enough to refuse it for their child –Both of these behaviours have improved over time

51. So, how do parents really feel about MMR?

52. MMR still a very big issue, with concerns over safety, and possible gaps in knowledge BUT –Decreasing awareness of negative publicity –Recovery in levels of trust in MMR –Ongoing trust in HPs

53. A BMRB Social Research presentation to: 3 rd Welsh Immunisation Conference 1 st March 2006 Sarah Oliver Kathryn Warrener