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Presumptive vaccine recommendations increased acceptance
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Parental vaccine acceptance is linked to how providers initiate and pursue vaccine recommendations, according to recent study findings published in Pediatrics.
Health provider and parent vaccine discussions were evaluated to determine what influence provider communication has on parent resistance to vaccine recommendations. All parents had children aged 1 to 19 months.
Douglas J. Opel, MD, MPH, of the University of Washington School of Medicine and colleagues examined 111 vaccine discussions with 16 providers from nine practices. Recommendations were categorized as presumptive (“Well, we have to do some shots”) or participatory (“What do you want to do about shots?”). Seventy-four percent of providers used presumptive recommendations. Vaccine-hesitant parents were more likely to voice resistance to provider initiation compared with nonvaccine-hesitant parents.
Parents were more likely to resist vaccination if providers used participatory methods for recommendations compared with presumptive methods (adjusted OR=17.5; 95% CI, 1.2-253.5). Fifty percent of providers pursued original recommendations after parent resistance and 47% of parents who were resistant accepted recommendations provider insistence. “How providers initiate their vaccine recommendations at health supervision visits appears to be an important determinant of parent resistance to that recommendation,” the researchers wrote. “Also, if providers continue to pursue their original recommendation after encountering parental resistance, many parents eventually agree to it. These associations require confirmation in longitudinal studies with a more diverse population of parents and providers.”
Disclosure: The study was funded in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of NIH.
Perspective
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Paul Offit, MD
It's a lesson that's apparently been difficult to learn.
In 1995, when the varicella vaccine was first licensed and recommended for routine use in children, uptake was slow. And it stayed slow until caretakers became more accepting and took a stronger stance in recommending it for their patients.
Similarly, in 2006, when the HPV vaccine was licensed and recommended for routine use in adolescent girls, uptake was slow. During the past three years, while uptake of Tdap and the conjugate meningococcal vaccine (MCV-4) has risen, HPV vaccine uptake among girls has stalled. The main reason: lack of enthusiasm from the provider. Ironic, given that HPV causes more deaths in the United States every year than tetanus, diphtheria, pertussis, and meningococcus combined.
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