Parents’ and Health Professionals’ Attitudes to Advancing Primary MMR Vaccine Administration from Fifteen to Six Months of Age—A Qualitative Thematic Analysis Embedded in a Randomized Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.1.1. Parents
2.1.2. Healthcare Providers
2.2. Data Collection
2.3. Data Analysis
3. Results
3.1. Parental Attitudes about MMR and Advancing MMR1 Administration
3.1.1. Unquestioning Trust
That’s just like such a thing that she [the child] has to wear shoes and diapers, she also has to go to the doctor and be weighed and measured and vaccinated.(Parent 19)
That’s how I was raised. I’ve also gotten it myself. So that is what you do [get the child vaccinated].(Parent 4)
If anyone says this [recommending vaccines], then it must be because it is true.(Parent 13)
We haven’t even discussed that she shouldn´t have it.(Parent 5)
I trust enormously the professionalism that is in our, what is it, our health board, which has worked on this for many years.(Parent 19)
I think when the health authorities also recommend that this, it´s what you do. Then, I think that, then the risk of getting it is probably not as great in relation to what, what else you get out of it [the vaccination].(Parent 17)
If there is evidence for it, then that is what we follow. Then, there is no reason to ask too many other critical questions. The professionals who know something guide us in the right direction.(Parent 2)
3.1.2. Acceptance after Careful Consideration
I just like to go into it [NBH home page]. I thought it was very clear, and you can look up the vaccines separately.(Parent 9)
I think that the side effects from a vaccine are, uh, relatively much less than having to go through these disease courses.(Parent 18)
So, that makes it an easy decision for us. We will not expose our children to this [the MMR diseases] if we can avoid it.(Parent 14)
For us, it’s a lot about the practical because uh, if they [the children] get side effects when would it fit in. We try like to put it like that uh the MMR vaccine such a week before we even went on holiday (…) if it so was at 6 months, so just see we need something practical there, but not so much beyond that.(Parent 14)
Let’s now say it had been a new vaccine with MMR, so not just the old vaccine, but a new vaccine they tested, then I would have been more in doubt.(Parent 13)
But I think it’s mostly because people are not properly informed. I also think that people have come so far away from the disease flourishing in society that now they do not think about it. It is almost a given that it is not a risk anymore.(Parent 8)
3.1.3. Challenging Indecisiveness
But it’s just a little annoying to start out with such a skepticism. I would much rather just be able to blindly trust it [the NBH].(Parent 12)
I was just very much in doubt and in the end, I actually felt that I really only chose to vaccinate him because I actually didn’t know what else to do. It was a choice in powerlessness. It sounds a bit wrong, but then it was a ‘non-choice’.(Parent 12)
Then I cannot trust that the National Board of Health gives me objective information because they have an interest together with the Serum Institute to sell vaccines.(Parent 12)
So, I actually think I’m a bit in between […] yes to both camps. Then there’s not really room for me anywhere in either.(Parent 12)
I wish his [her child’s] immune system was allowed to develop without being disturbed. If I had to vaccinate them [the children] at all, I would at least like them to be more than 3 years old, so their system was a little more well developed so we do not disturb it too much.(Parent 20)
…that it [the MMR] should be given earlier, in the middle of the childhood vaccination program with the three vaccines there, I think it’s just completely in the wrong direction. If it is at 6 months you want to give it, then it is also only 1 month after the second vaccine. Yeah, so it just seems very careless, I think.(Parent 21)
3.1.4. Defensive Rejection
Doctors have been given kind of God status in Denmark… right? When the doctor says: “it’s good”, then it’s good, you know… I just wonder: why are you not able to be a little more critical?(Parent 20)
I just think in reality… it must be the right to a fucking free choice and respect around that choice. From the entire system.(Parent 23)
And I do not see that the diseases you are vaccinated against in Denmark are so horrible that you can’t just deal with it, again with a few exceptions.(Parent 23)
I really wish they [the children] had some of the childhood diseases because I think it helps to mature and develop them, and there is a sense that we should have the childhood diseases while we are children well and truly.(Parent 20)
I have seen hours of lectures. I have more than 12–15 books [about the subject] written by scientists and doctors.(Parent 22)
Well, that [advancing MMR-1] sounds so awful. I really thought we should not disturb the little people too soon in their little bodies. It makes me really sad, that that is what you are aiming at.(Parent 20)
Well, we [the healthcare system] are trying to make the weak stronger by weakening the strong. It is wrong. You don’t have to. The strong who are made stronger, they want to lift the weak and they should probably do it, I’m 100 on that. The good genes go on and the bad ones disappear. That’s how it is. Whether you like it or not.(Parent 23)
And I also think it’s striking that when I compare my unvaccinated kids with children vaccinated, oh my God! The amount of sick days—it’s striking. It is! It’s crazy the difference. The kids are all ailing.(Parent 23)
So I just found it interesting that many of those I know, who do not vaccinate their children, none of our children have anything at all with the immune system or allergies or eczema or anything. And pretty much everyone else I know [vaccinated children] gets sick.(Parent 12)
3.2. Low Mutual Tolerance between Vaccine Supporters and Opponent
…if I think too much about it, I become sort of really angry with those, who don’t do it [vaccinate], if they can.(Parent 5)
If you choose not to vaccinate, then you can’t go to daycare and school—then you can’t get any public subsidy.(Parent 7)
If you don’t vaccinate, you are just an “idiot”, right? [……] instead of just maybe ask about my thoughts about it.(Parent 20)
Just the fact that you ask questions makes you unscientific, a “tinfoil hat”, you know, almost illiterate and worse.(Parent 23)
So, it is not okay to question what order the doctor puts out or what order the National Board of Health puts out, it is just not!(Parent 20)
3.3. Lifelong Unresolved Feelings of Guilt
We said it must have been the vaccination, but the doctor said no, no, no, no. That can’t be right. I wouldn’t say that I that I feel looked down upon. However, I have felt that they didn’t believe me.(Parent 24)
I don’t know when I started to think that it was my fault.(Parent 21)
I afflicted my completely smart, healthy, bright little child with an injury for life, and I can’t redo it. A small healthy child, whom I voluntarily gave a medication which harmed him. That is the worst. For me, it would have been a million times easier to accept, if he had had the same injuries from measles, or mumps, or rubella or something else. Because this is something that I have done.(Parent 21)
The younger brother he has felt ignored,—and he still does.(Parent 24)
When the fever disappeared, it was that HE also disappeared. Then, the light in his eyes was simply turned off. He disappeared completely, and just looked confused.(Parent 22)
I can be a little worried about whether side effects are discovered in children who do not have those developments (…) Well, our girl could walk, and she could talk, she could sing. That is, when she got the injuries. If you do this [vaccinate at 6 months] … will you then discover those side effects?(Parent 24)
3.4. HCPs Support MMR Vaccination and Are Careful Not to Lose Contact with Reluctant Parents
When they say almost aggressively: ‘We have taken a stand on it. We will not discuss it’. Then I don’t give it many attempts.(HCP 2)
When you sort of avoid the discussion, that is with a total vaccination opponent, then it is to keep the good relationship.(HCP 1)
We [the employees in his general practice] will not choose on behalf of people, but we like to express our clear attitude and at the same time respect their attitude. The thing about simply not wanting to vaccinate at all—we just question that.(HCP 10)
Parents in his practice rarely rejected the MMR vaccine; he could only recall one family among his 9000 patients that had ultimately rejected the vaccine. When asked what people might fear, he mentioned that they often worried whether the vaccine might inhibit the natural immune system. He hypothesized that rejecting the vaccine might be an attempt to create a “a type of false security, about something that you actually can’t be so sure about”.(HCP-10)
But uh, they cannot remember any epidemics or seriously ill or deaths. So, you know more about vaccination injuries than you know about diseases.(HCP-10)
I tell [the parents] what it’s like to have mumps, rubella and measles. I can remember them all.(HCP 4)
Then you say sort of… ‘there can be a local reaction, and they might get a little fever in the evening’.(HCP 8)
I don´t hand out the pamphlet [about vaccination] to everybody. Only the ones who have doubt concerning dates and so on. The…need to have it in writing, right?(HCP 3)
It is a good window [at six months] to do it. There is even greater compliance in the very first part when the mother has just given birth, she has been here [at the GP] so frequently and the family is still preoccupied with this new [child] in very new ways…(HCP 10)
They become more careless about showing up and stuff like that. …I think it could promote compliance that the child is so small [at six months].(HCP 10)
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Number | Gender | Age (Years) | Age of Child | Number of Children in Family/ Gender of the Child | MMR Trial Participant | Interview Format |
---|---|---|---|---|---|---|
1 | F | 37 | 5 mo. | 3/M | Yes | Face-to-face |
2 | F | 34 | 6 mo. | 2/F | Yes | Face-to-face |
3 | M, F | 37, 33 | 5 mo. | 1/F | Yes | Face-to-face |
4 | F | 43 | 5 mo. | 3/M | Yes | Face-to-face |
5 | F | 30 | 6 mo. | 2/F | Yes | Face-to-face |
6 | F | 26 | 5 mo. | 1/F | Yes | Face-to-face |
7 | F | 32 | 7 mo. | 1/F | No | Online |
8 | M | 34 | 15 mo. | 1/M | No | Face-to-face |
9 | F | 40 | 22 mo. | 3/M | No | Telephone |
10 | M, F | 30, 32 | 6 mo. | 2/M | Yes | Face-to-face |
11 | F | 36 | 12 mo. | 2/M | No | Telephone |
12 | F | 29 | 16 mo. | 1/M | No | Face-to-face |
13 | F | 34 | 11 mo. | 2/F | Yes | Telephone |
14 | F | 32 | 17 mo. | 2/M | No | Online |
15 | F | 24 | 20 mo. | 1/M | No | Online |
16 | M | 31 | 8 mo. | 1/F | No | Face-to-face |
17 | F | 33 | 14 mo. | 1/M | No | Online |
18 | F | 35 | 2 mo. | 4/M | No | Face-to-face |
19 | F | 28 | 11 mo. | 1/F | No | Telephone |
20 | F | 41 | 12 mo. | 3/M | No | Telephone |
21 | F | 67 | 28,* 33, 38 years | 2 */M | No | Telephone |
22 | F | 59 | 5, 7, 19, 27 years | - | No | Telephone |
23 | M | 49 | 4, 9 years | - | No | Face-to-face |
24 | M | 49 | 13, 18 *, 21 years | 2 */F | No | Telephone |
Number | Gender | Profession | Interview Format |
---|---|---|---|
1 | F | HVN | Individual |
2 | F | HVN | Individual |
3 | F | HVN | Individual |
4 | F | HVN | Individual |
5 | F | HVN | Dyad |
6 | F | HVN | Dyad |
7 | F | GP | Focus group |
8 | F | GP | Focus group |
9 | F | GP | Focus group |
10 | M | GP | Individual |
11 | F | GP nurse | Individual |
Parental Attitudes about MMR Vaccines | Unquestioning Trust | Acceptance after Careful Consideration | Challenging Indecisiveness | Rejecting in A Defensive Way |
---|---|---|---|---|
Parent trust in the healthcare system | Unlimited | Nuanced and informed | Limited | Absent, with tendencies toward conspiracy theories |
Sources of information | Do not seek information Family history GP Leave it to experts | National Board of Health Serum Institute Danish Medicines Agency | Questioning information from: National Board of Health; Serum Institute; Danish Medicines Agency. | Mistrust towards: National Board of Health and Serum Institute. Uses: Alternative sources International literature |
Challenges | None | None | Feeling bewildered, lonely, and not belonging. Difficulty making decisions on behalf of one’s child | Feeling overruled and confronted |
Parental attitudes about advancing MMR1 administration | Positive | Positive due to known vaccine Expect sufficient information | Negative due to child’s immature immune system | Highly negative due to child’s immature immune system and difficulty of discovering side effects in young children |
HCP response to parent attitude | Supportive | Supportive, emphasizing that forgotten disease severity may impede the ability to weigh for and against | Challenge reluctance HVNs cautious because parents still need their service GP stresses that avoiding vaccines is also a choice | HVNs avoid arguing with parents who have made their decision in a defensive way |
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Kirkedal, A.-B.K.; Møller, J.E.; Stensballe, L.G.; Zoffmann, V. Parents’ and Health Professionals’ Attitudes to Advancing Primary MMR Vaccine Administration from Fifteen to Six Months of Age—A Qualitative Thematic Analysis Embedded in a Randomized Trial. Vaccines 2023, 11, 67. https://doi.org/10.3390/vaccines11010067
Kirkedal A-BK, Møller JE, Stensballe LG, Zoffmann V. Parents’ and Health Professionals’ Attitudes to Advancing Primary MMR Vaccine Administration from Fifteen to Six Months of Age—A Qualitative Thematic Analysis Embedded in a Randomized Trial. Vaccines. 2023; 11(1):67. https://doi.org/10.3390/vaccines11010067
Chicago/Turabian StyleKirkedal, Ann-Britt Kiholm, Julie Elkjær Møller, Lone Graff Stensballe, and Vibeke Zoffmann. 2023. "Parents’ and Health Professionals’ Attitudes to Advancing Primary MMR Vaccine Administration from Fifteen to Six Months of Age—A Qualitative Thematic Analysis Embedded in a Randomized Trial" Vaccines 11, no. 1: 67. https://doi.org/10.3390/vaccines11010067
APA StyleKirkedal, A. -B. K., Møller, J. E., Stensballe, L. G., & Zoffmann, V. (2023). Parents’ and Health Professionals’ Attitudes to Advancing Primary MMR Vaccine Administration from Fifteen to Six Months of Age—A Qualitative Thematic Analysis Embedded in a Randomized Trial. Vaccines, 11(1), 67. https://doi.org/10.3390/vaccines11010067