Sporton R K, Francis S A
Pharmacy Department, Lister Hospital, East and North Herts NHS Trust, Stevenage, Hertfordshire, UK.
Fam Pract. 2001 Apr;18(2):181-8. doi: 10.1093/fampra/18.2.181.
Childhood immunization is an important aspect of childhood preventive health, world wide, with programmes such as the Expanded Programme on Immunization organized by the World Health Organization. Unlike other countries, the immunization programme is not compulsory in the UK, and the decision whether to immunize a child or not is parental.
The objective of this study was to explore the decision-making process of parents who have chosen not to have their children immunized.
This was a qualitative study, using semi-structured interviews with parents either in their own homes or at their places of work. The study was set in an inner city area with a high level of deprivation. The district immunization co-ordinator and health visitors within the area referred parents to the researcher. Parents subsequently were selected using purposive maximum variation sampling. Data were analysed using consistent and systematic review. An initial coding frame that was derived from the first few transcripts was revised and developed through its application to subsequent transcripts. The final stage of analysis involved comparing the data using the revised coding frame for drawing conclusions and verification.
Interviews were completed with 13 parents. Parents discussed their perceptions of childhood diseases and immunization, and the risk-benefit analysis that occurred between the two. All parents identified the risk of side effects as a reason for choosing not to immunize. A proposed model of the decision-making process that represented the experiences of the parents in this study is presented. In response to the question of immunization, three actions were described by parents: a routine response, an emotional response and delaying the decision by entering a questioning stage followed by a cyclical process of seeking and evaluating information. Key to this model was a stage of reflection that most parents described irrespective of their initial action in response to the question of immunization. Parents also discussed their responsibilities in terms of the consequences of their decisions. Health professionals were perceived as providing unbalanced information that was an obstacle in decision making.
The parents included in this study had chosen not to immunize at least one of their children. Most parents felt they had made an informed decision, based on an assessment of the risks and benefits of immunization and an acceptance of responsibility for that decision. Health professionals were not perceived as providers of balanced information. It is therefore important that parents have easy access to accurate information concerning the pros and cons of treatment, and have the opportunity to discuss their concerns with health professionals.
儿童免疫是全球儿童预防保健的重要方面，世界卫生组织组织了诸如扩大免疫规划等项目。与其他国家不同，英国的免疫规划不是强制性的，是否为孩子接种疫苗由父母决定。
本研究的目的是探讨选择不给孩子接种疫苗的父母的决策过程。
这是一项定性研究，通过在父母家中或工作场所进行半结构化访谈。研究在一个贫困程度较高的市中心地区进行。该地区的地区免疫协调员和健康访视员将父母推荐给研究人员。随后使用目的最大变异抽样法选择父母。数据采用一致和系统的审查进行分析。从最初的几份转录本中得出的初始编码框架通过应用于后续转录本进行修订和完善。分析的最后阶段涉及使用修订后的编码框架比较数据以得出结论并进行验证。
对13名父母进行了访谈。父母们讨论了他们对儿童疾病和免疫的看法，以及两者之间的风险效益分析。所有父母都将副作用风险作为选择不接种疫苗的一个原因。提出了一个代表本研究中父母经历的决策过程模型。在回答免疫问题时，父母描述了三种行为：常规反应、情感反应以及通过进入质疑阶段然后进行信息寻求和评估的循环过程来推迟决策。该模型的关键是一个反思阶段，大多数父母无论对免疫问题的最初反应如何都描述了这一阶段。父母们还讨论了他们在决策后果方面的责任。健康专业人员被认为提供了不平衡的信息，这是决策的一个障碍。
本研究中的父母选择不给至少一个孩子接种疫苗。大多数父母认为他们是在对免疫的风险和益处进行评估并接受该决策责任的基础上做出了明智的决定。健康专业人员未被视为提供平衡信息的人。因此重要的是，父母能够轻松获取有关治疗利弊的准确信息，并有机会与健康专业人员讨论他们的担忧。
