Taylor James A, Darden Paul M, Brooks Dennis A, Hendricks J W, Wasserman Richard C, Bocian Alison B
Department of Pediatrics, University of Washington, Seattle, Washington, USA.
Pediatrics. 2002 Dec;110(6):1110-6. doi: 10.1542/peds.110.6.1110.
To assess the association between parents' perceptions of various barriers to vaccination and their preferences regarding specific strategies designed to reduce missed vaccination opportunities and the immunization status of their children and to estimate the overall contribution of the perception of barriers on underimmunization among children who are vaccinated in pediatricians' offices.
As part of a nationwide study on the immunization status of children followed by practicing pediatricians, parents of children who were 8 to 35 months of age and seen consecutively at 177 participating practice sites completed a survey on health beliefs regarding the vaccination process. In addition to demographic information, parents were asked to identify the most difficult thing about obtaining immunizations, as well as their preferences regarding the maximum number of vaccine injections that should be administered to their child at 1 visit and for receiving a needed immunization during an office visit for a mild illness. Immunization data on study children were abstracted from the practice medical record, and specific survey responses for each parent were compared with the immunization status of his or her child at 8 months of age using chi2 tests. For parental health beliefs associated with immunization status by bivariate analyses, the relative risks for underimmunization and population-attributable risk percentages of each belief were calculated after potentially confounding variables were adjusted for.
Immunization data were collected on 13 520 children; 13 516 parents responded to at least 1 question regarding vaccination health beliefs. Two thirds of the responding parents indicated that their child should receive no more than 2 immunizations at 1 visit. However, there was no difference in the preferred maximum number of vaccines between parents of children who were fully immunized at 8 months of age and those of underimmunized children. Similarly, there was no difference in a stated preference for receiving a needed immunization during an illness visit. Overall, 74% of respondents indicated that there was "nothing" difficult about obtaining vaccines for their children. The most commonly cited barrier was concern about the side effects of vaccines, identified by 22.6% of parents. However, this barrier was not associated with immunization status. Each of the remaining barriers-including the confusing vaccination schedule, expense of vaccines, the inconvenience of the vaccination process, having a child who was often too ill to receive vaccines, religious objections, and other identified barriers-was statistically associated with immunization status, with adjusted relative risks for underimmunization ranging from 1.42 to 3.04. However, because each of these barriers was identified as important by <5% of parents, the population-attributable risk percentage for each was < or =2.5%. Overall, it was estimated that parental perception of barriers associated with immunization status accounts for 8.0% of the underimmunization observed among children who are vaccinated in the offices of primary care pediatricians.
Parental preferences regarding vaccination practices designed to reduce missed opportunities were not associated with the immunization status of their children. Although several barriers to vaccination were associated with immunization status, individual barriers were identified by a small minority of parents. Overall, parental perceptions of barriers to vaccination do not seem to be a significant cause of underimmunization in this population of children.
评估父母对各种疫苗接种障碍的认知与他们对旨在减少错过疫苗接种机会的特定策略的偏好之间的关联，以及他们孩子的免疫状况，并估计在儿科医生办公室接种疫苗的儿童中，障碍认知对未充分免疫的总体影响。
作为一项全国性的关于执业儿科医生随访儿童免疫状况研究的一部分，在177个参与研究的医疗机构连续就诊的8至35个月大儿童的父母，完成了一项关于疫苗接种过程健康观念的调查。除人口统计学信息外，父母还被要求指出获取免疫接种最困难的事情，以及他们对孩子每次就诊应接种的最大疫苗针数的偏好，以及孩子患轻度疾病就诊时接受所需免疫接种的偏好。研究儿童的免疫接种数据从医疗机构病历中提取，使用卡方检验将每位父母的具体调查回答与其孩子8个月大时的免疫状况进行比较。对于通过双变量分析与免疫状况相关的父母健康观念，在对潜在混杂变量进行调整后，计算未充分免疫的相对风险和每种观念的人群归因风险百分比。
收集了13520名儿童的免疫接种数据；13516名父母至少回答了1个关于疫苗接种健康观念的问题。三分之二的受访父母表示，他们的孩子每次就诊接种疫苗不应超过2针。然而，8个月大时已完全免疫儿童的父母与未充分免疫儿童的父母在偏好的最大疫苗针数上没有差异。同样，在患病就诊时接受所需免疫接种的明确偏好方面也没有差异。总体而言，74%的受访者表示为孩子获取疫苗“没有”困难。最常提到的障碍是对疫苗副作用的担忧，22.6%的父母提到了这一点。然而，这一障碍与免疫状况无关。其余每个障碍——包括令人困惑接种时间表、疫苗费用、接种过程不便、孩子经常病得太重无法接种疫苗、宗教反对意见以及其他确定的障碍——在统计学上均与免疫状况相关，调整后的未充分免疫相对风险范围为1.42至3.04。然而，由于这些障碍中每一个被认为重要的父母比例均<5%，因此每种障碍的人群归因风险百分比均≤2.5%。总体而言，估计父母对与免疫状况相关障碍的认知占在初级保健儿科医生办公室接种疫苗儿童中观察到的未充分免疫情况的8.0%。
父母对旨在减少错过接种机会的疫苗接种做法的偏好与他们孩子的免疫状况无关。尽管几种疫苗接种障碍与免疫状况相关，但只有一小部分父母提到了个别障碍。总体而言，在这群儿童中，父母对疫苗接种障碍的认知似乎不是未充分免疫的重要原因。
