Despite being recognized as one of the most successful public health measures, vaccination is perceived as unsafe and unnecessary by a growing number of individuals. Lack of confidence in vaccines is now considered a threat to the success of vaccination programs. Vaccine hesitancy is believed to be responsible for decreasing vaccine coverage and an increasing risk of vaccine-preventable disease outbreaks and epidemics. This review provides an overview of the phenomenon of vaccine hesitancy. First, we will characterize vaccine hesitancy and suggest the possible causes of the apparent increase in vaccine hesitancy in the developed world. Then we will look at determinants of individual decision-making about vaccination.

https://www.tandfonline.com/doi/pdf/10.4161/hv.24657

Vaccine hesitancy: An overview

A critical factor shaping parental attitudes to vaccination is the parent’s interactions with health professionals. An effective interaction can address the concerns of vaccine supportive parents and motivate a hesitant parent towards vaccine acceptance. Poor communication can contribute to rejection of vaccinations or dissatisfaction with care. We sought to provide a framework for health professionals when communicating with parents about vaccination. Literature review to identify a spectrum of parent attitudes or ‘positions’ on childhood vaccination with estimates of the proportion of each group based on population studies. Development of a framework related to each parental position with determination of key indicators, goals and strategies based on communication science, motivational interviewing and valid consent principles. Five distinct parental groups were identified: the ‘unquestioning acceptor’ (30–40%), the ‘cautious acceptor’ (25–35%); the ‘hesitant’ (20–30%); the ‘late or selective vaccinator’ (2–27%); and the ‘refuser’ of all vaccines (<2%). The goals of the encounter with each group will vary, depending on the parents’ readiness to vaccinate. In all encounters, health professionals should build rapport, accept questions and concerns, and facilitate valid consent. For the hesitant, late or selective vaccinators, or refusers, strategies should include use of a guiding style and eliciting the parent’s own motivations to vaccinate while, avoiding excessive persuasion and adversarial debates. It may be necessary to book another appointment or offer attendance at a specialised adverse events clinic. Good information resources should also be used. Health professionals have a central role in maintaining public trust in vaccination, including addressing parents’ concerns. These recommendations are tailored to specific parental positions on vaccination and provide a structured approach to assist professionals. They advocate respectful interactions that aim to guide parents towards quality decisions.

/pdf/communicating-with-parents-about-vaccination-a-framework-for-2yqksih5s6.pdf

Communicating with parents about vaccination: a framework for health professionals

Objective: This paper aims to systematically review the use and performance of the Brief Illness Perception Questionnaire (Brief IPQ).Design: Electronic databases were searched for papers administering the Brief IPQ published in peer-reviewed journals. Data were extracted from the results for meta-analysis.Main outcome measures: Use by illness population, country, language and study design. The questionnaire’s concurrent validity, predictive validity, sensitivity to change, discriminant validity and mean scores for different populations were summarised.Results: The review included 188 papers. The Brief IPQ has been administered to patients from age 8 to over 80, with a wide range of illnesses, in 26 languages from 36 countries. Pooled correlations between illness perceptions and depression, anxiety, blood glucose levels and quality of life were consistent with previous research and theory (range .25–.49 for consequences, identity and emotional representations; −.12 to −.27 for personal control). All items...

A systematic review and meta-analysis of the Brief Illness Perception Questionnaire

(see Appendix 2, available at [www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.090313/-/DC1][1] for summary of recommendations and clinical considerations)









There are more than 200 million international migrants worldwide,[1][2] and this movement of people has implications for individual and

/pdf/evidence-based-clinical-guidelines-for-immigrants-and-200zq1p7iy.pdf

Evidence-based clinical guidelines for immigrants and refugees

Predictors of HPV vaccine uptake among women aged 19-26: importance of a physician's recommendation.

Predictors of HPV vaccine acceptability: A theory-informed, systematic review

Background: Although cervical cancer rates in the United States are highest in Southern and rural areas, research on human papillomavirus (HPV) vaccine acceptability has focused on other geographic areas. Methods: To address this gap, we surveyed women from a rural area in North Carolina with elevated rates of cervical cancer to identify predictors of HPV vaccine acceptability for themselves and their daughters. Results: One hundred forty-six women completed questionnaires about HPV infection, cervical cancer, and HPV vaccination. The majority (62%) of respondents were African American. Most respondents intended to vaccinate an adolescent daughter against HPV. Older and African American women reported lower vaccination intentions. Higher intentions to vaccinate an adolescent daughter against HPV were associated with knowing more about HPV, believing that HPV infection and cervical cancer are both likely and have negative consequences, and believing that the HPV vaccine is effective against cervic...

HPV vaccine acceptability in a rural Southern area.

Context: Because cervical cancer mortality in the United States is twice as high among black women as white women and higher in rural areas, providing human papillomavirus (HPV) vaccine to rural black adolescents is a high priority. Purpose: To identify racial differences in knowledge and attitudes about HPV, cervical cancer, and the HPV vaccine that may influence uptake of the vaccine. Methods: We interviewed women (91 black and 47 white) living in a rural area of the Southern United States in 2006. Analyses controlled for socioeconomic status, age, and recruitment location. Findings: More white respondents had heard of HPV than had black respondents (57% vs 24%, P < .001), and whites had higher HPV knowledge (42% vs 29% correct responses, P < .05). Blacks were less likely than whites to think that cervical cancer would be a serious threat to their daughters' health (75% vs 96%, P < .001). More blacks than whites thought the ideal age to receive the vaccine was 17 years or older (63% vs 40%, P < .05). Blacks reported lower intentions to vaccinate their daughters than whites (M = 4.14 vs 4.55, P < .05 in unadjusted analyses, but not statistically significant in adjusted analyses). Conclusions: Black and white respondents had different awareness, knowledge, and beliefs related to the HPV vaccine. Communication-based interventions to maximize uptake of the HPV vaccine in the rural, Southern United States may need different messages for black parents of adolescent girls.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1748-0361.2009.00204.x

Racial Differences in HPV Knowledge, HPV Vaccine Acceptability, and Related Beliefs Among Rural, Southern Women

Objective. To inform future human papillomavirus (HPV) vaccination programs, we systematically reviewed studies of HPV-related beliefs and HPV vaccine acceptability, organizing the findings using health behavior theory and cervical cancer risk factors. Methods. We searched Medline, CINAHL, and PsycINFO from 1995 to January, 2007 for studies of HPV beliefs and HPV vaccine acceptability among adolescents, young adults, and parents of adolescents in the United States. Results. We identified 28 studies. Most were small, cross-sectional studies of parents and adults. Most parents reacted positively to the possibility of vaccinating their daughters against HPV. Vaccination acceptability was higher when people believed the vaccine was effective, a physician would recommend it, and HPV infection was likely. Cost and, for 6% to 12% of parents, concerns that vaccination would promote adolescent sexual behavior were barriers to vaccination. African American, Hispanic, and white respondents were equally accepting of the HPV vaccine. Parents with lower levels of education reported higher vaccine acceptability. Many studies inadequately reported on other variables associated with cervical cancer mortality. Conclusions. HPV vaccine programs in the United States should emphasize high vaccine effectiveness, the high likelihood of HPV infection, and physicians' recommendations, and address barriers to vaccination.

Karah I. Fazekas

Papers

Predictors of HPV vaccine acceptability: A theory-informed, systematic review

HPV vaccine acceptability in a rural Southern area.

Racial Differences in HPV Knowledge, HPV Vaccine Acceptability, and Related Beliefs Among Rural, Southern Women

PredictorsofHPVvaccineacceptability:Atheory-informed,systematicreview