FPs' Personal Touch Can Persuade Doubting Parents to Vaccinate Their Children

Respect for Parents' Perspective Is Key

August 04, 2009 04:25 pm Barbara Bein

Although immunization rates among infants and young children are at an all-time high, some parents still are reluctant to vaccinate their children. According to CDC immunization experts, however, family physicians are in a prime position to educate reluctant parents because of their ongoing relationship with those parents.

"Many parents have never seen a case of a vaccine-preventable disease, so they don't understand how serious these diseases can be," said Kris Sheedy, Ph.D., associate director of communication science for the CDC's National Center for Immunization and Respiratory Diseases, or NCIRD. "(Health care) providers are the most trusted sources (of information) for parents. A recommendation from a physician goes a long way."

The NCIRD has noted some differences in the results of its 2003 and 2008 HealthStyles surveys of parents, she said. In 2003, 63 percent of the 649 parents surveyed said immunizations were "very important" for keeping children healthy. In 2008, 48 percent of the 608 parents surveyed characterized immunizations as very important.

In addition, more parents in 2008 said they believed that vaccines aren't tested enough for safety; that children get too many vaccines during the first two years of their lives; that vaccines may cause developmental disabilities, such as autism; and that vaccines are given to children to prevent diseases they are not likely to get.

"Pain of the shots was the most common concern for parents in both 2003 and 2008," said Allison Kennedy, M.P.H., an epidemiologist and health services researcher for the NCIRD, who presented this information during the CDC's 2009 National Immunization Conference in Dallas. "Additionally, the 2008 survey showed that they're concerned about the ingredients in vaccines and the number of shots."

According to another recent study, "Parental Refusal of Pertussis Vaccination Is Associated With an Increased Risk of Pertussis Infection in Children,"(pediatrics.aappublications.org) evidence suggests that the number of parents who refuse immunizations has steadily increased during the past decade, and the consequences can be distressing. In this case, children of parents who refused pertussis immunizations were at increased risk for pertussis compared with children of parents who accepted the vaccinations.

"These findings stress the need to further understand why parents refuse immunizations and to develop strategies for conveying the risks and benefits of immunizations to parents more effectively," said the study, which was published in the June issue of Pediatrics.

The CDC has developed various online resources physicians can download and hand out to concerned parents, including Vaccine Information Statements(www.cdc.gov), or VISs, that describe each vaccine's risks, benefits and possible adverse reactions. The VISs also provide information about the National Vaccine Injury Compensation program, a no-fault alternative to the traditional tort system for resolving vaccine injury claims. The program provides compensation to people who have been injured by certain vaccines.

According to Sheedy, NCIRD researchers currently are working on new educational materials that are expected to be posted to the CDC Web site portal for health care professionals(www.cdc.gov) later this summer. In addition to information on vaccine-preventable diseases, the new materials will include the stories of people who have been affected by these ailments.

"It's important that we continue to communicate to every new cohort of parents," Sheedy said. "It may be old news to us (health care professionals), but it's new news to them. They're looking at the Internet, and what they find may be alarming."

Carrie Nelson, M.D., of Aurora, Ill., is the program director of the Rush-Copley Family Medicine Residency Program in Aurora, Ill., and an assistant professor at Rush Medical College in Chicago. She's also a member of the AAFP Commission on Health of the Public and Science.

During her 17 years of practicing family medicine -- much of it in private practice -- Nelson said that parents have asked her about the safety of immunizations and any possible links to autism. Typically, she said, the questions come during well-child visits and appointments for school vaccinations. The parents who were most concerned had the youngest children -- from newborns to 2-year-olds, she said.

"They'll say they watched a show or saw something on the Internet about alleged links between immunization and autism," Nelson told AAFP News Now. "They want my point of view on it."

Nelson said she is respectful of these parents' concerns and gives them the CDC's VISs so they can make informed decisions. She also said she avoids being judgmental.

"As a physician, I believe in vaccines, and I may believe it's irresponsible not to vaccinate your children," said Nelson. "But I can't convey that to such parents, or I risk alienating them and losing the opportunity to influence them in favor of vaccination."

She said that in her years of practice, only a half-dozen families have refused all vaccinations. However, even some of those family members changed their minds when they saw someone with pertussis or mumps during outbreaks.

More frequently, Nelson said, parents would ask about allowing longer intervals between some series of vaccinations, such as the vaccine against hepatitis B, which is given at birth and again at ages one month and six months. She said she has accommodated these requests, although it has meant making time for extra office visits.

"There's no harm done if there's a longer interval, if that's what they (parents) want to do," said Nelson. "I've generally been very successful at reassuring them. The trick is the personal relationship that allows me to allay their fears."

In focus groups the NCIRD has conducted, parents who are inclined to refuse vaccines or to spread them out can't be persuaded to change their opinions by physicians who use heavy-handed tactics. Such parents, said Sheedy, "want to feel like they are partners in the decision-making process. They want a provider who will work with them. So providers have to take the time to listen and understand the parents' concerns."