Benin Andrea L, Wisler-Scher Daryl J, Colson Eve, Shapiro Eugene D, Holmboe Eric S
Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA.
Pediatrics. 2006 May;117(5):1532-41. doi: 10.1542/peds.2005-1728.
BACKGROUND: The high visibility of controversies regarding vaccination makes it increasingly important to understand how parents decide whether to vaccinate their infants. OBJECTIVE: The purpose of this research was to investigate decision-making about vaccinations for infants. DESIGN: We conducted qualitative, open-ended interviews. PARTICIPANTS: Subjects included mothers 1 to 3 days postpartum and again at 3 to 6 months. RESULTS: We addressed 3 topics: attitudes to vaccination, knowledge about vaccination, and decision-making. Mothers who intended to have their infants vaccinated ("vaccinators," n = 25) either agreed with or did not question vaccination or they accepted vaccination but had significant concerns. Mothers who did not intend to vaccinate ("nonvaccinators," n = 8) either completely rejected vaccination or they purposely delayed vaccinating/chose only some vaccines. Knowledge about which vaccines are recommended for children was poor among both vaccinators and nonvaccinators. The theme of trust in the medical profession was the central concept that underpinned all of the themes about decision-making. Promoters of vaccination included trusting the pediatrician, feeling satisfied by the pediatrician's discussion about vaccines, not wanting to diverge from the cultural norm, and wanting to adhere to the social contact. Inhibitors included feeling alienated by or unable to trust the pediatrician, having a trusting relationship with an influential homeopath/naturopath or other person who did not believe in vaccinating, worry about permanent side effects, beliefs that vaccine-preventable diseases are not serious, and feeling that since other children are vaccinated their child is not at risk. CONCLUSION: Trust or lack of trust and a relationship with a pediatrician or another influential person were pivotal for decision-making of new mothers about vaccinating their children. Attempts to work with mothers who are concerned about vaccinating their infants should focus not only on providing facts about vaccines but also on developing trusting and positive relationships.
背景：疫苗接种争议的高度曝光使得了解父母如何决定是否为婴儿接种疫苗变得越发重要。 目的：本研究旨在调查婴儿疫苗接种的决策过程。 设计：我们进行了定性的开放式访谈。 参与者：受试者包括产后1至3天以及3至6个月时的母亲。 结果：我们探讨了三个主题：对疫苗接种的态度、疫苗接种知识以及决策过程。打算为婴儿接种疫苗的母亲（“接种者”，n = 25）要么赞同疫苗接种，没有疑问，要么接受疫苗接种，但存在重大担忧。不打算接种疫苗的母亲（“未接种者”，n = 8）要么完全拒绝接种，要么故意推迟接种/只选择部分疫苗。接种者和未接种者对哪些疫苗推荐给儿童的知识都很匮乏。对医疗行业的信任主题是支撑所有决策主题的核心概念。疫苗接种的推动者包括信任儿科医生、对儿科医生关于疫苗的讨论感到满意、不想背离文化规范以及想要遵守社交接触。阻碍因素包括感觉被儿科医生疏远或无法信任儿科医生、与有影响力的顺势疗法医生/自然疗法医生或其他不相信疫苗接种的人有信任关系、担心长期副作用、认为疫苗可预防疾病不严重，以及觉得既然其他孩子接种了疫苗，自己的孩子就没有风险。 结论：信任或缺乏信任以及与儿科医生或其他有影响力的人的关系对于新妈妈为孩子接种疫苗的决策至关重要。与担心为婴儿接种疫苗的母亲合作的努力不仅应侧重于提供疫苗相关事实，还应侧重于建立信任和积极的关系。
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