Levi Benjamin H
Department of Pediatrics, Penn State College of Medicine, 500 University Dr, Room C1743, Hershey, PA 17033, USA.
Pediatrics. 2007 Jul;120(1):18-26. doi: 10.1542/peds.2006-2627.
Despite the dangers of vaccine-preventable infections and efforts by health care professionals to promote immunization, parents' resistance to routine childhood immunizations continues to grow. This phenomenon can give rise to frustration among health care providers, as well as create barriers in providing medical care to children in need. In response, we developed a CD-ROM-based tutorial that (1) explains the nature and origins of parents' concerns, (2) addresses clinical implications of resistance to immunization, (3) explores ethical and professional obligations that physicians have toward children and their parents, and (4) discusses how physicians can effectively address parents' concerns.
Our goals were to evaluate the tutorial's effectiveness in improving physicians' (1) general knowledge about parents' resistance to childhood immunizations, (2) knowledge of adverse effects of immunization, and (3) attitudes toward parents' resistance to childhood immunization.
DESIGN/METHODS: After pretesting, expert review, and revision, the 45-minute Penn State Immunization Project tutorial was pilot tested with pediatric and family medicine residents at 7 training programs in 4 states (Pennsylvania, New York, Maryland, and Iowa). Knowledge and attitudes were assessed by using a 26-item pretest/posttest, the results of which were then analyzed by using standard statistical methods.
A total of 122 residents completed the pretest/posttest. Statistically and clinically significant improvements were seen in residents' general knowledge, knowledge of adverse events, and all 5 attitudinal measures regarding childhood immunizations.
The tutorial Addressing Parents Concerns About Childhood Immunizations: A Tutorial for Primary Care Providers is effective in improving resident physicians' general knowledge, knowledge of adverse events, and attitudes. As such, this tutorial has the potential to enhance communication between parents and primary care providers and, more generally, improve clinicians' response to the growing resistance toward routine childhood immunizations.
尽管疫苗可预防感染存在危险，且医疗保健专业人员努力推广免疫接种，但家长对儿童常规免疫接种的抵触情绪仍在增加。这种现象可能会让医疗保健提供者感到沮丧，也会在为有需要的儿童提供医疗服务时造成障碍。作为回应，我们开发了一个基于光盘的教程，该教程：（1）解释家长担忧的性质和根源；（2）阐述抵制免疫接种的临床影响；（3）探讨医生对儿童及其家长的伦理和专业义务；（4）讨论医生如何有效解决家长的担忧。
我们的目标是评估该教程在提高医生方面的有效性：（1）关于家长对儿童免疫接种抵触情绪的一般知识；（2）免疫接种不良反应的知识；（3）对家长抵制儿童免疫接种的态度。
设计/方法：经过预测试、专家评审和修订后，时长45分钟的宾夕法尼亚州立大学免疫项目教程在宾夕法尼亚州、纽约州、马里兰州和爱荷华州4个州的7个培训项目中，对儿科和家庭医学住院医师进行了试点测试。通过一份包含26个条目的预测试/后测试来评估知识和态度，然后使用标准统计方法对结果进行分析。
共有122名住院医师完成了预测试/后测试。住院医师在一般知识、不良事件知识以及关于儿童免疫接种的所有5项态度指标方面，在统计学和临床上都有显著改善。
《解决家长对儿童免疫接种的担忧：初级保健提供者教程》在提高住院医师的一般知识、不良事件知识和态度方面是有效的。因此，本教程有可能加强家长与初级保健提供者之间的沟通，更广泛地说，改善临床医生对日益增长的儿童常规免疫接种抵制情绪的应对。
