Department of Pediatrics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Wash.
Department of Pediatrics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Wash.
Acad Pediatr. 2018 May-Jun;18(4):430-436. doi: 10.1016/j.acap.2017.12.009. Epub 2018 Jan 8.
Presumptive formats to initiate childhood vaccine discussions (eg, "Well, we have to do some shots") have been associated with increased vaccine acceptance after one visit compared to participatory formats (eg, "How do you feel about vaccines?"). We characterize discussion format patterns over time and the impact of their repeated use on vaccine acceptance.
We conducted a longitudinal prospective cohort study of children of vaccine-hesitant parents enrolled in a Seattle-based integrated health system. After the child's 2-, 4-, and 6-month visits, parents reported the format their child's provider used to begin the vaccine discussion (presumptive, participatory, or other). Our outcome was the percentage of days underimmunized of the child at 8 months old for 6 recommended vaccines. We used linear regression and generalized estimating equations to test the association of discussion format and immunization status.
We enrolled 73 parent-child dyads and obtained data from 82%, 73%, and 53% after the 2-, 4-, and 6-month visits, respectively. Overall, 65% of parents received presumptive formats at ≥1 visit and 42% received participatory formats at ≥1 visit. Parental receipt of presumptive formats at 1 and ≥2 visits (vs no receipt) was associated with significantly less underimmunization of the child, while receipt of participatory formats at ≥2 visits was associated with significantly more underimmunization. Visit-specific use of participatory (vs presumptive) formats was associated with a child being 10.1% (95% confidence interval, 0.3, 19.8; P = .04) more days underimmunized (amounting to, on average, 98 more days underimmunized for all 6 vaccines combined).
Presumptive (vs participatory) discussion formats are associated with increased immunization.
与参与式格式相比（例如，“您对疫苗有何看法？”），在一次就诊后，假设性的疫苗讨论启动格式（例如，“我们必须打一些疫苗”）与疫苗接种率的提高有关。我们描述了随时间推移讨论格式模式的特征，以及它们的重复使用对疫苗接种接受率的影响。
我们对西雅图一家综合性医疗系统中接种疫苗犹豫不决的父母的孩子进行了一项纵向前瞻性队列研究。在孩子 2 个月、4 个月和 6 个月大时，父母报告了孩子的提供者用来开始疫苗讨论的格式（假设性、参与性或其他）。我们的结果是孩子在 8 个月大时未接种推荐疫苗的天数百分比。我们使用线性回归和广义估计方程来检验讨论格式和免疫状态的相关性。
我们共纳入了 73 对父母-孩子二人组，在 2 个月、4 个月和 6 个月的随访后分别获得了 82%、73%和 53%的数据。总体而言，65%的父母在至少一次就诊中收到了假设性格式，42%的父母在至少一次就诊中收到了参与性格式。与未收到任何假设性格式相比，父母在至少一次就诊中收到假设性格式（而不是未收到）与孩子的免疫接种率显著降低相关，而在至少两次就诊中收到参与性格式与孩子的免疫接种率显著降低相关。与假设性格式（而不是参与性格式）相比，每次就诊中使用参与性格式与孩子多 10.1%（95%置信区间，0.3，19.8；P=.04）未接种疫苗天数相关（总共，所有 6 种疫苗的平均免疫接种率降低了 98 天以上）。
假设性（而不是参与性）讨论格式与增加免疫接种率有关。
