No improvement in maternal vaccine hesitancy with physician-targeted intervention


1. There was no significant improvement in overall maternal vaccine hesitancy following an intervention aimed at improving physician communication with parents.

2. No significant difference in reported physician confidence while communicating with parents about vaccine related issues was appreciated between the intervention and control groups.

Evidence Rating Level: 1 (Excellent)      

Study Rundown: As public concerns regarding vaccination persist, parental vaccination refusal rates place United States children at risk for vaccine-preventable diseases. Many physicians may feel unprepared to address this issue with parents directly, and there is little research regarding how best to approach families. In the current study, researchers sought to explore the consequences of establishing a novel, physician-targeted, communication intervention to address maternal vaccine hesitancy. Results demonstrated no significant difference between maternal hesitancy in the intervention and control groups after 6 months. The intervention was not associated with an improvement in physician confidence in discussing vaccines with parents. Study data may be limited as researchers did not directly measure vaccine behavior for participants. In addition, data were collected during a statewide pertussis outbreak, which may have resulted in the lower-than-anticipated rate of vaccine hesitancy. In addition, at the time of data collection, new evidence found efficacy in physician use of presumptive rather than participatory verbiage when discussing vaccinations with parents. Despite these limitations, the findings of this study encourage researchers and physicians to establish multiple-level interventions in order to improve the overall vaccination rate.

Click to read the study, published today in Pediatrics

Relevant Reading: Parents with doubts about vaccines: Which vaccines and reasons why

Study Author, Dr. Nora Henrikson, PhD, MPH, talks to 2 Minute Medicine: Group Health Research Institute Research Associate.

“Physicians are a major influence on parents’ decisions about childhood vaccines; but doctors may lack confidence in addressing concerns about vaccines. It’s hard to say how our study may affect future physicians’ practice. We proved that this particular intervention didn’t reduce parents’ hesitancy about childhood vaccines. But more research is needed before we can say what will actually be effective. In the meantime, vaccines are children’s best protection from infectious diseases, including ones that can cause death. And delaying or refusing vaccines can lead to outbreaks of vaccine-preventable diseases, as recently happened with measles at Disneyland. Many parents are continuing to hesitate to vaccinate their children, so it’s worthwhile for doctors in training to start thinking about how they’ll talk with their patients about this important issue.”

In-Depth [randomized controlled trial]: Researchers included 347 mothers and 47 pediatric clinics from March 2012 to December 2013 in Washington State for data analysis. A total of 25 clinics (173 mothers) were randomized to receive the intervention, and the 22 remaining clinics (174 mothers) served as the control group. Intervention sites were instructed about the “Ask, Acknowledge, Advise” strategy from Vax Northwest, which was adapted to vaccine conversations. The “Ask” component invited parental questions, “Acknowledge” aimed to establish respect and trust for parental concerns, and the “Advise” portion prompted physicians to recommend immunizations. Each intervention physician was offered training, study paper materials, and email updates for links to webinar versions of the training. Maternal vaccine hesitancy was measured using the Parental Attitudes on Childhood Vaccines survey. Mothers were surveyed at 4-6 weeks of infant age and again at 6 months. Physician confidence pertaining to communication with parents about vaccines was assessed at baseline and again at 6 months. A total of 9.8% of mothers in the intervention group and 12.6% in the control group were vaccine hesitant at baseline (p = 0.43). At 6 months there was no significant difference between groups (7.5%-intervention vs. 8.0%-control, p = 0.78). At follow-up, there was no significant difference in physician self-efficacy when discussing risks, providing information, and answering difficult questions about vaccines between intervention and control groups.

Image: PD

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