Strobino D, Keane V, Holt E, Hughart N, Guyer B
Department of Maternal and Child Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD, USA.
Pediatrics. 1996 Dec;98(6 Pt 1):1076-83.
This article describes the results of a community-based study to determine the effect of family knowledge and attitudes on the immunization rates of a random sample of children younger than 2 years in the poorest census tracts of Baltimore.
The two sources of data were (1) parent interviews that provided data on knowledge, attitudes, and beliefs related to immunization and sociodemographic characteristics, and (2) medical record audits from which data on immunization status were obtained. The protection motivation theory, a model of behavioral change, was used to select the variables to assess the relation of parental attitudes with immunization status. A multivariate logistic regression analysis included only variables found to be significantly associated with immunization outcome in the preliminary analysis.
Mothers were well informed and generally had favorable attitudes toward immunizations. Immunization status was more strongly associated with the sociodemographic characteristics of the children than with the protection motivation theory variables. Only two protection motivation theory variables were associated with more than one immunization outcome. The children of mothers who perceived that timing of vaccination did not matter were less likely to be immunized than children of care takers who thought that it did matter and children whose parents believed in the safety of multiple immunizations were less likely to be immunized than children whose parents did not hold this belief.
In this study, parents' attitudes and beliefs had little effect on their children's immunization levels. Interventions intended to heighten parental awareness about immunization may have little impact. In poor urban neighborhoods, African-American children whose mothers are young, have multiple siblings, and do not use the Women, Infants and Children program may be at highest risk for delayed immunization.
本文描述了一项基于社区的研究结果，该研究旨在确定家庭知识和态度对巴尔的摩最贫困普查区随机抽取的2岁以下儿童免疫接种率的影响。
数据来源有两个：（1）对家长的访谈，提供了与免疫接种以及社会人口学特征相关的知识、态度和信念的数据；（2）病历审计，从中获取免疫接种状况的数据。采用行为改变模型——保护动机理论来选择变量，以评估父母态度与免疫接种状况之间的关系。多变量逻辑回归分析仅纳入在初步分析中发现与免疫接种结果显著相关的变量。
母亲们了解情况良好，并且总体上对免疫接种持积极态度。免疫接种状况与儿童的社会人口学特征的关联比与保护动机理论变量的关联更强。只有两个保护动机理论变量与不止一种免疫接种结果相关。认为接种疫苗时间无关紧要的母亲的孩子比认为时间重要的照料者的孩子更不可能接种疫苗，并且父母相信多次免疫接种安全性的孩子比父母不持此信念的孩子更不可能接种疫苗。
在本研究中，父母的态度和信念对其子女的免疫接种水平影响甚微。旨在提高父母对免疫接种认识的干预措施可能影响不大。在贫困的城市社区，母亲年轻、有多个兄弟姐妹且未参加妇女、婴儿与儿童项目的非裔美国儿童可能面临免疫接种延迟的最高风险。
