«Audience Research: Delayers of Infant Immunisation Prepared for the Ministry of Health FINAL 29 January 2013 AUDIENCE RESEARCH:DELAYERS OF INFANT ...»
Delayers of Infant Immunisation
Prepared for the Ministry of Health
29 January 2013
AUDIENCE RESEARCH:DELAYERS OF INFANT IMMUNISATION
1. Executive Summary 1
1.1 Audience research amongst delayers of
infant immunisation 1
1.2 The world of delayers 1
1.3 Messages to encourage immunisation
1.4 Conclusions 5
2. Introduction 7
2.1 Background 7
2.2 Audience research amongst delayers of infant immunisation 8
3. The World of Delayers 10
3.1 Parents’ attitudes and experiences of immunising infants 10
3.2 Parents’ attitudes and experiences of delaying immunisations 16
3.3 Typologies of parents who delay immunisations 19
4. Messages to Encourage Immunisation Timeliness 23
4.1 Messages tested 23
4.2 Message resonance 24
5. Conclusions 30 Bibliography 32 Appendices 33
1. Information sheet 33
2. Discussion guides 34
1. Executive Summary 1.1 Audience research amongst delayers of infant immunisation In November 2011, the New Zealand Government announced the introduction of a new immunisation health target that seeks to improve immunisation timeliness for young infants.
Specifically, the target for the end of 2014 is 95 percent of all eight-month-olds are fully immunised with the three scheduled vaccinations at six weeks, three months and five months.
The Ministry of Health commissioned audience research with parents who have delayed one or more of their baby or young infant’s primary immunisations.
The research objectives were to explore parents’1 decisions and reasons for delaying primary immunisations, and to test messages to encourage and support parents to immunise their infants on time.
Focus groups and individual interviews were conducted with 68 parents of infants aged eight to 12 months for whom one or more primary immunisations were not administered on time. Fieldwork was conducted in seven district health boards2 between July and August 2012.
1.2 The world of delayers Parents’ attitudes and experiences of immunising infants Parents who have delayed their infants’ primary immunisations have a strong desire to protect them from serious illness and disease and keep them healthy and well. Parents consider serious illness and disease to have a devastating impact on infants, families/whānau and communities. Māori, Pacific and Asian parents have heightened sensitivity to the risk of their infants contracting serious disease, as they are more likely to have had first-hand experience of disease. For example, they may have experience of an infant or child in their family/whānau becoming unwell or dying from a serious disease, or being exposed to disease in developing countries.
Parents generally believe their infants are protected from disease in the home environment and become more vulnerable when they start socialising with other children. Immunisation is believed to provide infants with a ‘protective blanket’ when interacting outside the family/whānau. Most parents consider that getting their infants immunised is a responsible thing to do as it not only protects their child and family/whānau but protects other infants and children in their communities.
Most parents learn or start to think about immunising their infants after they are born. Most parents do their own research on immunisation (mainly around potential risks and side effects) through the Internet, reading brochures and talking to their midwife, Well References to ‘parents’ in this report also includes primary caregivers.
Northland, Counties Manukau, Waitemata, Waikato, Bay of Plenty, Canterbury and Capital and Coast.
Child/Tamariki Ora provider, general practitioner (GP) or practice nurse. However, some parents (particularly Māori and Pacific parents) do not feel well informed about immunisation and often believe it is compulsory to immunise their infants.
While at a rational level, most parents have confidence in the safety of vaccines; at an emotional level, they still have fears. Some Pākehā and Māori parents have specific fears over the safety of the Measles, Mumps and Rubella (MMR) vaccine.
Mothers generally make all decisions and arrangements for their children’s immunisation.
Immunisation is a significant event and most mothers are usually supported by their partner (for the six-week immunisation) or another female family member when their infants are being immunised. These mothers find this support extremely valuable. However, some mothers had little or no support from a child’s father or from family or friends, and these mothers tend to have a history of prolonged delays in immunising their infants.
While parents often have emotional fears over the safety of vaccines, they have real concerns over their potential side effects (eg fever, vomiting, redness, tenderness and swelling), and these concerns are exacerbated if their infant is unwell. Parents who have had low prior exposure to immunisation – first-time parents, parents who were not immunised as children or whose family/whānau tend not to immunise their children have increased anxiety over potential side effects.
Most parents fear the immunisation experience, and around half were not present for at least one of their infant’s immunisations – although they comforted them in the waiting room afterwards.
While most parents find immunising their infants in a clinical setting comforting, in case of reactions to the vaccines, most do not find it suitable comforting their infants in public waiting areas. Some Māori parents have had poor experiences with health providers, both in relation to immunisation and other health matters, which impacts on their confidence to immunise their infants in these settings. There is a strong preference from parents for their infants to be immunised in more family supportive environments, and those who had inhome immunisations found this service particularly valuable.
Parents’ attitudes and experiences of delaying immunisations
Parents are generally aware of the recommended ages to immunise their children, as outlined in the National Immunisation Schedule. All parents spoke of receiving information on key information dates from their midwife, Plunket Nurse or other Well Child Tamariki Ora provider. Parents recall receiving timely letters and emails from their GPs reminding them when their infant’s immunisations were due, text reminders of their appointments and follow up text messages and phone calls when they missed an appointment.
Parents believe they had legitimate reasons for delaying their infant’s primary immunisations (eg their child was unwell; they were not in their home location at the time of the recommended immunisations or they lacked transport to get to an appointment).
Parents are more comfortable delaying their infant’s immunisations in cases where they believe their reasons for delaying were in the best interest of their child (eg. in cases of unwell or premature infants). However, parents often feel guilty for delaying their child’s immunisations where reasons were circumstantial (eg. not having transport to attend an appointment).
While parents are aware of the recommended ages for immunising their infants and children, they have little or no understanding of the importance of immunising at the recommended ages or the consequences of not doing so on time. Consequently, while most parents consider immunisation to be important for the overall health of their child, there is a lack of urgency to get infants immunised on time if they are largely staying within the home environment.
Most parents intend to catch up their infant’s immunisations so they are fully protected from serious disease. The tipping point for getting immunisations up to date is before their infant or child enters early childhood education or school, and starts interacting and socialising with other children.
Typologies of parents who delay primary immunisation events
Although parents who delay their child’s primary immunisations share a set of core values, there is diversity within this group. Three distinct typologies of ‘delayer’ parents have been identified in this research, which reflect parents’ attitudes towards immunisation and their
experiences of delaying:
1. The Compromised – support immunisation but face significant individual, family/whānau and/or environmental barriers to immunising their infant(s) on time.
2. The Considered – support immunisation but are concerned with the timeliness of the schedule. They therefore immunise at times that they feel are more appropriate for their child.
3. The Conflicted – have concerns about immunisation and immunise their infants when they feel there is a heightened risk of disease, or through a sense of pressure from their partner, family/whānau and/or health provider.
1.3 Messages to encourage immunisation timeliness Key messages tested
The following messages, aimed at encouraging parents to immunise their infants on time at
six weeks, three months and five months, were tested on parents:
1. messages on immunising to protect infants and children from serious diseases
2. messages on immunisation timeliness
3. messages to encourage parent/caregiver communication with GP/practice nurse when infants are unwell at times when immunisations are due
4. messages on asking for support from family/whānau
5. messages on convenience, including combining immunisation appointments with other routine appointments
6. messages on fewer disruptions to parents’ work and children’s education, if infants and children are immunised
7. messages on vaccine safety.
Key messages that might encourage or enable timely immunisation uptake amongst parents of infants Overall, messages that will be more effective in encouraging immunisation timeliness tap into parents’ emotions to protect their children. Therefore, messages that have greater relevance remind parents of their infant’s vulnerability to serious illness and disease and that immunisation is a proven and effective way to protect their child and keep them healthy and well.
Immunisation protects infants and children
This message ‘diseases don’t discriminate – anyone can catch them’ and ‘babies are at risk if not fully immunised’ resonates strongly with all parents because it reminds them of the presence of preventable diseases in their communities, and that all infants are vulnerable if they are not fully immunised. It also suggests that other protective factors (breastfeeding and good diet) are not sufficient alone to protect their child from serious illness and disease, and immunisation is therefore an important addition.
The message ‘immunise on time, every time’ makes people feel pressured rather than supported to immunise on time. Parents believe that this message doesn’t acknowledge there are often legitimate reasons (eg. when their child is sick) or events beyond their control (eg. lack of transportation) for not immunising their infants on time.
Communication with GP/practice nurse
The message ‘if your baby is due to be immunised and is unwell, talk to your nurse or doctor before cancelling your appointment’ challenges parents’ assumptions that they cannot and should not immunise their infants unless they are 100% well (feeding, sleeping and playing normally). For many parents, they feel their concerns around immunising an unwell infant are valid, and that their child may get sicker, have a greater risk of side effects from the vaccines and/or that the vaccines may not be as effective. However, their main aversion to immunising a sick infant is they do not want to cause them further discomfort.
While doctors and nurses can advise whether infants can clinically undergo immunisation, only parents can make decisions around the comfort of their child.
Asking for support
All parents were receptive to the message ‘ask family and friends to support you to immunise your baby’. This message acknowledges it is both logistically challenging and emotionally stressful for parents to take their infants to their appointments and get them immunised.
Most parents give their infants 100% focus and attention during and after immunisations.
Therefore, combining their child’s immunisations with other family members’ regular doctor or hospital appointments is not desirable. Parents say they are very unlikely to combine their child’s immunisations with their own appointments (even if routine) as they want to be well when they immunise their infants. However, this message has resonance with parents with large families in the ‘Compromised’ typology who find it challenging to schedule and attend medical appointments.
The message ‘during a disease outbreak, children can sometimes be excluded from daycare, crèche, kindergarten or school if they haven’t been immunised’ resonates with parents. However, it also confronts parents’ perceptions that early childhood education centres require infants and children to be fully immunised before they are enrolled.
The message ‘immunising your baby and children will mean less time away from work as they will be protected if there is a disease outbreak’ is disliked by most parents because it conveys that they should immunise their infants against life-threatening illness and disease out of convenience rather than a desire to protect their child. However, it does resonate with the small group of working parents who have their infants in childcare. These parents are reliant on both parents’ incomes for their daily living and often lack flexible working arrangements and sick leave entitlements.