What Influences Health Professionals’ Recommendations for Non-Scheduled Childhood Vaccinations? A Qualitative Study of Health Professionals’ Perspectives in Three Provinces of China
2.1. Study Design
2.2. Research Questions
- What are HPs working in China perspectives and experiences of recommending non-EPI vaccines?
- What influences interactions with parents and caregivers for HPs in China?
- What is the relationship between economic incentives and HPs working in China recommendation behaviors for vaccines not included in the national routine childhood immunization schedule?
2.3. Study Setting
2.4. Participant Recruitment
2.5. Data Collection
2.6. Data Analysis
3.1. Participant Characteristics
3.2. Analytical Themes
3.3. Negative Connotations of ‘Recommending’ Non-EPI Vaccines
“That’s not recommendation, it’s just notification. It’s our job to clearly tell parents, we must tell, the information about non-EPI vaccine, such as the pros and cons of non-EPI vaccine, what disease it prevents, etc. But we cannot say that you have to choose non-EPI vaccines. It’s their own choice to get their children vaccinated non-EPI vaccines.”P12, Sichuan province.
3.4. Influences of Location and Workload on Non-EPI Vaccine Recommendations
“Most people consider that vaccines are free. When you recommend non-EPI vaccines to them, they can’t understand the difference between EPI and non-EPI vaccines and can’t accept these self-paid vaccines. It will cause financial burden for caregivers and also misunderstanding for ourselves, so I don’t recommend non-EPI vaccines unless caregivers take initiate to ask for them.”P04, Henan province.
“The uptake of varicella vaccine is higher. Parents’ knowledge of varicella vaccine is more sufficient, and they are more concerned about it, which is easier for us to recommend.”P03, Henan province.
“Nowadays most caregivers’ knowledge is very rich and their awareness of vaccination is very high, sometimes I think they are more professional than me.”P20, Guangdong province.
“During the peak season, we are busy with vaccinating from morning to noon. Our centre is supposed to be closed at 12:00 p.m., but sometimes we even can’t have lunch until 1:00 p.m. because we have to get the children who have already come to be vaccinated. The waiting area was crowded and noisy. It is very uncomfortable. Sometimes when I am too busy, I just give them the consent forms and tell them to read it by themselves. To tell the truth, I don’t want more people come because we are too tired.”P18, Guangdong province.
“The non-EPI vaccine is voluntary and self-paid. I recommend it and caregivers choose to get their children vaccinated by themselves. I think caregivers in our area have strong compliance and the uptake of non-EPI vaccines is quite high. Most people generally accept non-EPI vaccines...our publicity about vaccination starts from the newborn. When the vaccination card is established and the vaccination starts, I start to introduce the pneumonia vaccine, the five-unit vaccine, and so on. Now, young parents are more than happy to pay for non-EPI vaccines.”P13, Sichuan Province.
“We have six doctors here, so we are not particularly busy. We always inform them of the pros and cons of the non-EPI vaccines regardless whether these vaccines are in stock. We also tell them what kind of disease these vaccines can prevent... Our non-EPI vaccination volume can reach half of the total vaccination volume”P05, Sichuan Province.
3.5. Influences of Economic Incentives on Non-EPI Vaccine Recommendations
“Take the varicella vaccine recommendation for example, when it’s time for varicella vaccine, we tell caregivers varicella vaccine is preventable. And we will explain how much it costs. Then we will call caregivers make the appointment for varicella vaccine. Nearly half or more parents will get their children vaccinated after recommendation.”P03, Henan province (High 8 Yuan bonus).
“It’s not much money if there are extra non-EPI services and I am very busy. It’s unnecessary to recommend non-EPI vaccines for that money. We must spend time focusing on EPI vaccination because it’s related to government assessment for Category I vaccines coverage.”P11, Sichuan province (Low 2 Yuan bonus).
“We can only get 0.7 yuan per non-EPI injection, but we are so tired. I would rather leave work on time than work overtime for such a small amount of money.”P18, Guangdong province (Low 0.70 Yuan bonus).
“I don’t recommend non-EPI vaccines. There is no difference from the aspect of income whether I recommend non-EPI vaccines and provide more non-EPI vaccination or not. Sometimes there are parents who come to consult me about vaccination and are willing to pay for it, then I will tell them the information about non-EPI vaccines.”P01, Henan province (no bonus).
“I only recommend EPI vaccines. I can’t get income from non-EPI vaccination. It doesn’t matter for me whether I provide more non-EPI vaccination or not. If parents ask for non-EPI vaccines, I would provide non-EPI services.”P02, Henan province (no bonus).
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|Provider Characteristics||Henan Province|
|Male||5 (62.5)||0 (0)||3 (37.5)||8|
|Female||2 (16.7)||6 (50)||4 (33.3)||12|
|Rural||5 (45.4)||3 (27.3)||3 (27.3)||11|
|Urban||2 (22.2)||3 (33.3)||4 (44.5)||9|
|<35||0 (0)||1 (50)||1 (50)||2|
|35–45||3 (27.3)||5 (45.5)||3 (27.3)||11|
|>45||4 (57.1)||0 (0)||3 (42.9)||7|
|Junior college or below||3 (33.3)||2 (22.2)||4 (44.5)||9|
|Undergraduate||1 (20)||1 (20)||3 (60)||5|
|Missing||3 (50)||3 (50)||0 (0)||6|
|Clinical medicine||5 (100)||0 (0)||0 (0)||5|
|Nursing||1 (12.5)||4 (50)||3 (37.5)||8|
|Preventive medicine||0 (0)||0 (0)||3 (100)||3|
|Others||1 (100)||0 (0)||0 (0)||1|
|Missing||0 (0)||2 (100)||0 (0)||2|
|Working years in immunization|
|<10||2 (50)||1 (25)||1 (25)||4|
|10–20||2 (33.3)||2 (33.3)||2 (33.3)||6|
|>20||2 (33.3)||0 (0)||4 (66.6)||6|
|Missing||1 (25)||3 (75)||0 (0)||4|
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Cheng, J.; Lin, S.; Wu, C.; Howard, N.; Zou, J.; Sun, F.Y.; Sun, M.; Chantler, T. What Influences Health Professionals’ Recommendations for Non-Scheduled Childhood Vaccinations? A Qualitative Study of Health Professionals’ Perspectives in Three Provinces of China. Vaccines 2021, 9, 1433. https://doi.org/10.3390/vaccines9121433
Cheng J, Lin S, Wu C, Howard N, Zou J, Sun FY, Sun M, Chantler T. What Influences Health Professionals’ Recommendations for Non-Scheduled Childhood Vaccinations? A Qualitative Study of Health Professionals’ Perspectives in Three Provinces of China. Vaccines. 2021; 9(12):1433. https://doi.org/10.3390/vaccines9121433Chicago/Turabian Style
Cheng, Jiejie, Shiyu Lin, Chaoqi Wu, Natasha Howard, Jiatong Zou, Fiona Yueqian Sun, Mei Sun, and Tracey Chantler. 2021. "What Influences Health Professionals’ Recommendations for Non-Scheduled Childhood Vaccinations? A Qualitative Study of Health Professionals’ Perspectives in Three Provinces of China" Vaccines 9, no. 12: 1433. https://doi.org/10.3390/vaccines9121433