Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
University of Pennsylvania, Philadelphia, PA, USA.
Hum Vaccin Immunother. 2020 May 3;16(5):1145-1154. doi: 10.1080/21645515.2019.1654352. Epub 2019 Sep 30.
In response to the increase in non-medical vaccine exemptions (NME), many states have adopted education mandates (EM), required vaccine education for parents requesting NMEs for their school-age children, but these EMs vary greatly in implementation. In order to learn about the administrative aspects of each state's EM, we interviewed fourteen health department officials from nine states with EMs. Interviews were conducted over the phone, transcribed by a professional transcription service, and double-coded using NVivo 12 by two members of the study staff. The coding resulted in 3698 comments overall, 98.5% inter-coder reliability, and a κ statistic of 0.691. We found no consistent format for content delivery, and methods used included in-person dialogs, web-based education, and video modules. Content of the education is not standardized, and education length ranges from 15 to 60 minutes. Four major themes about the EM policies emerged: (1) the use of EMs to eliminate "convenience exemptions;" (2) the importance of health department communication with health-care providers; (3) facilitators and barriers to implementation; and (4) the positive recommendation for other states to adopt EM policies. We concluded that current EM implementation varies greatly, but officials in states which have adopted EMs for parents requesting NMEs for school-entry vaccinations overwhelmingly recommend other states to adopt them as well. Key features of successful programs may include conversations with parents requesting NMEs and strong communication channels with health-care providers. Systematic tracking of vaccine status after exemption requests and education is necessary to quantitatively determine the effectiveness of EM programs.
针对非医学疫苗豁免（NME）的增加，许多州都采取了教育要求（EM），要求要求为学龄儿童申请 NME 的家长进行疫苗教育，但这些 EM 在实施方面差异很大。为了了解每个州 EM 的行政方面，我们采访了九个州的 14 名卫生部门官员，这些州都有 EM。采访通过电话进行，由专业转录服务转录，并由两名研究人员使用 NVivo 12 进行双重编码。编码总共产生了 3698 条评论，编码者间的可信度为 98.5%，κ 统计量为 0.691。我们没有发现内容传递的一致格式，所使用的方法包括面对面的对话、基于网络的教育和视频模块。教育内容没有标准化，教育时长从 15 分钟到 60 分钟不等。关于 EM 政策出现了四个主要主题：（1）使用 EM 消除“方便豁免”；（2）卫生部门与医疗保健提供者沟通的重要性；（3）实施的促进者和障碍；以及（4）强烈建议其他州采用 EM 政策。我们的结论是，目前 EM 的实施差异很大，但已经为申请学校入学疫苗接种 NME 的家长采用 EM 的州的官员强烈建议其他州也采用 EM 政策。成功计划的关键特征可能包括与申请 NME 的家长进行对话，以及与医疗保健提供者建立强大的沟通渠道。在豁免请求和教育之后，有必要对疫苗接种状况进行系统跟踪，以定量确定 EM 计划的效果。
