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Interventions could lead to increased immunization rates among urban families
Open communication with providers, flexibility in scheduling appointments, and individual as well as community education may lead to improved immunization rates among urban families, according to recent study findings.
Melissa S. Stockwell, MD, MPH, Florence Irving assistant professor of pediatrics and population and family health at Columbia University Medical Center and a pediatrician at New York-Presbyterian Hospital, and colleagues surveyed parents of 705 children aged 36 months or younger to determine parental, practice and social factors associated with missed immunization visits by young, urban children. Most families were Latino and publicly insured with a regular provider.
Melissa S. Stockwell
Almost 20% of parents reported a missing immunization visit. Of those, the most commonly reported reason was competing priorities (62.5%), followed by forgetting the appointment (20.5%), and problems with insurance (12.5%).
Parents who thought vaccines were not very important (36.8%) were more likely to miss a visit compared with parents who thought they were important (18.3%). Safety concerns were a reason for delaying immunizations for 46.9% of parents compared with 17.5% of parents who did not delay immunization (P<.001). Immunization visits were more likely to be missed if families had a negative immunization experience as well as putting off an immunization visit because of negative experiences.
Compared with 10.7% of parents who never rescheduled a doctor’s visit, 32.2% of parents who rescheduled a visit missed other visits (P<.0001). Compared with 16.9% of parents who did not have scheduling problems, 44.4% who had scheduling problems missed an immunization visit (P<.0001). When a child’s provider lacked key elements of the medical home, parents were more likely to miss visits.
Friends and families with positive views on immunization led to parents being less likely to miss an immunization visit (adjusted OR=0.030; 95% CI, 0.002-0.41). Vaccine safety concerns led to parents being four times more likely to miss a visit (adjusted OR=3.76; 95% CI, 1.23-11.5). Immunization visits were also more likely to be missed among parents who rescheduled appointments (adjusted OR=3.27; (95% CI, 1.76-6.09) and parents who had problems scheduling appointments (adjusted OR=4.00; 95% CI, 1.49-10.75). Problems with communicating freely with providers about concerns led to a two times greater risk of missing a visit (adjusted OR=2.38; 95% CI, 1.05-5.36). Missed immunization visits were more common among African American children (adjusted OR=9.40; 95% CI, 1.16-75.94) and children who were not the first born (adjusted OR=2.40; 95% CI, 1.27-4.55).
“In conclusion, this study highlights factors that future interventions could target to help urban families keep immunization visits,” the researchers wrote. “These include open lines of communication between family and providers, flexibility in scheduling appointments, and individual and community-wide education regarding the importance of immunizations and their safety.”
Disclosure: The study was funded in part by the CDC.
