Published: Nov 4, 2013 | Updated: Nov 4, 2013
By Chris Kaiser

Full Story:  http://www.medpagetoday.com/PrimaryCare/Vaccines/42689

Pediatricians who told parents their child needed a vaccination rather than asked if they wanted one met less parental resistance, researchers found.

Three-quarters of providers brought up the issue of vaccination by using a “presumptive” approach, which assumes parents will immunize their child, according to Douglas J. Opel, MD, MPH, of the University of Washington School of Medicine in Seattle, and colleagues.

Only 26% of parents were resistant to vaccine recommendations when providers used the presumptive approach. However, 83% resisted when providers used a “participatory” approach, which invites parental involvement, researchers noted in the study published online Nov. 4 in Pediatrics.

“I think we’ve known for sometime that … we have to be careful in our language when we broach the subject of vaccines with parents, and especially now when more and more parents are resistant to vaccines,” Robyn Strosaker, MD, a pediatrician at University Hospitals Rainbow Babies & Children’s Hospital in Cleveland told MedPage Today. She was not involved in the study.

When the researchers controlled for parental hesitancy status, parent and child demographics, and visit characteristics, they found that the participatory approach was associated with a significantly increased odds of parental resistance to the physician recommendation, but the confidence interval was very wide (OR 17.5, 95% CI 1.2–253.5).

This is the first study to “address the existing gap in evidence for provider communication behaviors that are effective in increasing parental acceptance of childhood vaccines,” researchers wrote. And as such, the results can “help guide the development of quality improvement interventions aimed at increasing vaccination rates among vaccine-resistant parents.”

Opel and colleagues cited studies that demonstrated the value parents place in their pediatrician for trusted vaccine recommendations.

Parents initially resistant to vaccine recommendations have cited their pediatrician’s reassurance and vaccine information as reasons for changing their minds. In the current study, when pediatricians persisted in recommending vaccinations (50% persisted when initially met with resistance), 47% of the resistant parents eventually accepted the recommendation for vaccination.

“There is a lot of information out there and it can be really confusing to parents who mean well, but not all sources are credible,” Jay Homme, MD, a pediatrician at the Mayo Clinic in Rochester, Minn., who was not involved with the study, told MedPage Today.

“I feel like we have to build on a trust relationship. I’ve seen their children since they were infants. I’ve seen other children of theirs and really work on developing a trusting relationship,” he said.

Opel and colleagues enrolled 16 pediatric providers from nine primary care practices in the Seattle area. They videotaped and analyzed 111 vaccine discussions during a child’s check-up visit.

Parents also filled out a questionnaire that assessed their level of hesitancy toward vaccines — 55 were vaccine-hesitant parents and 56 were vaccine-receptive parents.

The children ranged in age from 1 to 19 months and 77% of parents were older than 29. Most of the parents were married or living with a partner, most had better than a high school education, and most were white.

More than half (57%) the participants had one child, 62% of the eligible children were the first born, and it was the first immunization discussion for 26%.

A total of 38% of providers explicitly solicited questions or concerns about shots — a percentage that did not differ between vaccine-hesitant (36%) and vaccine-receptive (39%) parents.

A little more than half (55%) of providers gave a rationale for shots, with no difference among the two groups of parents (55% each). Slightly more than half (55%) the providers discussed side effects, again with no difference between the resistant and receptive parents (51% versus 59%).

Several experts contacted by MedPage Today said because parents don’t see the diseases that these vaccines help to prevent, they don’t think they are real anymore.

“I’ve seen whooping cough and we’ve had whooping cough in Arkansas and certainly in other parts of the country. So I try to tell the parents why that particular disease is so dangerous and potentially dangerous for their child, and try to address their concerns in that way,”Eddie Ochoa, MD, a pediatrician at Arkansas Children’s Hospital in Little Rock, told MedPage Today.

The study was limited because of the potential for the Hawthorne effect, the heterogeneity of the parents, and because the categorization of vaccine-resistant parents was not based on immunization records and was merely a proxy of immunization behavior, researchers said.