Parents' Decision-making Experience in Choosing the MMR Vaccine in Banten, Indonesia
Abstract
Research has extensively studied parental vaccination decision-making drivers and barriers. The most powerful predictors of vaccination actions include the understanding of the risks posed by the disease; and the side effects of vaccination; vaccine beliefs and attitudes; and their effectiveness and safety concerns. Thus, this study aimed to explore the parents decision-making experience in choosing MMR vaccine in Banten, Indonesia. In qualitative study, a purposeful sampling process was used to identify parents with a variety of expected MMR decisions: (1) accept MMR on time, (2) accept MMR late, (3) receive one or more individuals, (4) obtain no MMR or individuals. A qualitative quality analysis was used to interpret the transcribed text. A total of 25 participants from 5 different FGDs were included in this study. This qualitative interview resulted in 4 themes, namely: healthy life, own health perceptions, disease history, perceived severity, and susceptibility of vaccine-preventable illnesses. Research on the MMR vaccination should move a step forward and include studies looking at similarities and differences in the factors predicting parents’ intention to follow MMR vaccination recommendations by comparing parents of very young children, being the primary target group of MMR vaccination campaigns and interventions, with parents of adolescent children.
Keywords: decision process, MMR vaccine, qualitative study
References
[1] Organization WH. Decade of vaccines — Global Vaccine Action Plan 2011-2020 [Internet]. Available from: https://www.who.int/immunization/ global_vaccine_action_plan/DoV_GVAP_2012_2020/en/
[2] WHO. WHO Coronavirus (COVID-19) Dashboard | WHO Coronavirus (COVID- 19) Dashboard With Vaccination Data [Internet]. 2021. Available from: https://covid19.who.int/
[3] Betsch C, Sachse K. Dr. Jekyll or Mr. Hyde?(How) the Internet influences vaccination decisions: Recent evidence and tentative guidelines for online vaccine communication. Vaccine. 2012;25(30):3723–3726.
[4] Yaqub O, Castle-Clarke S, Sevdalis N, Chataway J. Attitudes to vaccination: a critical review. Soc Sci Med. 2014;112:1–11.
[5] Tarrant M, Thomson N. Secrets to success: A qualitative study of perceptions of childhood immunisations in a highly immunised population. J Paediatr Child Health. 2008;44(10):541–547.
[6] Gilkey MB, Magnus BE, Reiter PL, McRee AL, Dempsey AF, Brewer NT. The vaccination confidence scale: A brief measure of parents’ vaccination beliefs. Vaccine. 2014;32(47):6259–6265.
[7] Roberts RE, Phinney JS, Masse LC, Chen YR, Roberts CR, Romero A. The structure of ethnic identity of young adolescents from diverse ethnocultural groups. J Early Adolesc. 1999;19(3):301–322.
[8] Andreae MC, Freed GL, Katz SL. Safety concerns regarding combination vaccines: the experience in Japan. Vaccine. 2004;22(29–30):3911–3916.
[9] Larson HJ, Smith DMD, Paterson P, Cumming M, Eckersberger E, Freifeld CC, et al. Measuring vaccine confidence: analysis of data obtained by a media surveillance system used to analyse public concerns about vaccines. Lancet Infect Dis. 2013;13(7):606–613.
[10] Smailbegovic MS, Laing GJ, Bedford H. Why do parents decide against immunization? The effect of health beliefs and health professionals. Child Care Health Dev. 2003;29(4):303–311.
[11] Pebody RG, Paunio M, Ruutu P. Measles, measles vaccination, and Crohn’s disease. Crohn’s disease has not increased in Finland. BMJ. 1998;316(7146):1745–1746.
[12] Zingg A, Siegrist M. Measuring people’s knowledge about vaccination: developing a one-dimensional scale. Vaccine. 2012;30(25):3771–3777.
[13] Borràs E, Domínguez À, Fuentes M, Batalla J, Cardeñosa N, Plasencia A. Parental knowledge of paediatric vaccination. BMC Public Health. 2009;9(1):1–7.
[14] Luman ET, McCauley MM, Shefer A, Chu SY. Maternal characteristics associated with vaccination of young children. Pediatrics. 2003;111(Supplement_1):1215–1218.
[15] Prislin R, Dyer JA, Blakely CH, Johnson CD. Immunization status and sociodemographic characteristics: the mediating role of beliefs, attitudes, and perceived control. Am J Public Health. 1998;88(12):1821–1826.
[16] Taylor JA, Darden PM, Brooks DA, Hendricks JW, Wasserman RC, Bocian AB. Association between parents’ preferences and perceptions of barriers to vaccination and the immunization status of their children: A study from Pediatric Research in Office Settings and the National Medical Association. Pediatrics. 2002;110(6):1110– 1116.
[17] Casiday RE. Children’s health and the social theory of risk: Insights from the British measles, mumps and rubella (MMR) controversy. Soc Sci Med. 2007;65(5):1059– 1070.
[18] Kriwy P. Similarity of parents and physicians in the decision to vaccinate children against measles, mumps and rubella. Int J Public Health. 2012;57(2):333–340.
[19] Freed GL, Clark SJ, Butchart AT, Singer DC, Davis MM. Sources and perceived credibility of vaccine-safety information for parents. Pediatrics. 2011;127(Supplement_1):S107–S112.
[20] Head GA, Mihailidou AS, Duggan KA, Beilin LJ, Berry N, Brown MA, et al. Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure: prospective cohort study. Bmj. 2010;340.
[21] Lewis J, Speers T. Misleading media reporting? The MMR story. Nat Rev Immunol. 2003;3(11):913–918.
[22] Fadda M, Galimberti E, Fiordelli M, Romanò L, Zanetti A, Schulz PJ. Effectiveness of a smartphone app to increase parents’ knowledge and empowerment in the MMR vaccination decision: A randomized controlled trial. Hum Vaccin Immunother [Internet]. 2017 Nov 2;13(11):2512–2521. Available from: https://doi.org/10.1080/21645515.2017.1360456
[23] Camerini AL, Diviani N, Fadda M, Schulz PJ. Using protection motivation theory to predict intention to adhere to official MMR vaccination recommendations in Switzerland. SSM-population health. 2019;7:100321.
[24] Prevention C for DC and. Vaccine excipient and media summary. CDC gov February. 2015.
[25] Lippke S, Ziegelmann JP. Theory based health behavior change: Developing, testing, and applying theories for evidence based interventions. Applied Psychol. 2008;57(4):698–716.
[26] Larson HJ, Jarrett C, Eckersberger E, Smith DMD, Paterson P. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007-2012. Vaccine. 2014 Apr;32(19):2150–2159.
[27] Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–112.
[28] Venkatesh V, Brown SA, Bala H. Bridging the qualitative-quantitative divide: Guidelines for conducting mixed methods research in information systems. MIS quarterly. 2013;21–54.
[29] van den Berg M, Timmermans DRM, Leo P, van Vugt JMG, van der Wal G. Informed decision making in the context of prenatal screening. Patient Educ Couns. 2006;63(1–2):110–117.
[30] Brunson EK. How parents make decisions about their children’s vaccinations. Vaccine. 2013;31(46):5466–5470.
[31] Betsch C, Renkewitz F, Betsch T, Ulshöfer C. The influence of vaccine-critical websites on perceiving vaccination risks. J Health Psychol. 2010;15(3):446–455.
[32] Brunson EK. The impact of social networks on parents’ vaccination decisions. Pediatrics. 2013;131(5):e1397–e1404.
[33] Downs JS, de Bruin WB, Fischhoff B. Parents’ vaccination comprehension and decisions. Vaccine. 2008;26(12):1595–1607.
[34] Haase N, Betsch C, Renkewitz F. Source credibility and the biasing effect of narrative information on the perception of vaccination risks. J Health Commun. 2015;20(8):920–929.
[35] Haase N, Betsch C. Parents trust other parents: Lay vaccination narratives on the Web may create doubt about vaccination safety. Medical Decision Making. 2012;32(4):645.
[36] Harmsen IA, Ruiter RAC, Paulussen TGW, Mollema L, Kok G, de Melker HE. Factors that influence vaccination decision-making by parents who visit an anthroposophical child welfare center: A focus group study. Adv Prev Med. 2012;2012.
[37] Lehmann BA, de Melker HE, Timmermans DRM, Mollema L. Informed decision making in the context of childhood immunization. Patient Educ Couns. 2017;100(12):2339–2345.
[38] Montano DE, Kasprzyk D. Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. Health behavior: Theory, research and practice. 2015;70(4):231.
[39] Schmidt AL, Zollo F, Scala A, Betsch C, Quattrociocchi W. Polarization of the vaccination debate on Facebook. Vaccine. 2018;36(25):3606–3612.
[40] Tickner S, Leman PJ, Woodcock A. ‘It’s just the normal thing to do’: exploring parental decision-making about the ‘five-in-one’vaccine. Vaccine. 2007;25(42):7399–7409.
[41] Benin AL, Wisler-Scher DJ, Colson E, Shapiro ED, Holmboe ES. Qualitative analysis of mothers’ decision-making about vaccines for infants: the importance of trust. Pediatrics. 2006;117(5):1532–1541.
[42] Betsch C, Renkewitz F, Haase N. Effect of narrative reports about vaccine adverse events and bias-awareness disclaimers on vaccine decisions: A simulation of an online patient social network. Medical Decision Making. 2013;33(1):14–25.
[43] Compton J, Jackson B, Dimmock JA. Persuading others to avoid persuasion: Inoculation theory and resistant health attitudes. Front Psychol. 2016;7:122.
[44] Glick M. Believing is seeing: Confirmation bias. J Am Dental Assoc. 2017;148(3):131– 132.
[45] Wolfe RM, Sharp LK. Vaccination or immunization? The impact of search terms on the internet. J Health Commun. 2005;10(6):537–551.
[46] Betsch C, Sachse K. Debunking vaccination myths: strong risk negations can increase perceived vaccination risks. Health psychology. 2013;32(2):146.
[47] Siegrist M, Cvetkovich G. Better negative than positive? Evidence of a bias for negative information about possible health dangers. Risk Analysis. 2001;21(1):199– 206.
[48] Harmsen IA, Ruiter RAC, Kok G, Paulussen TGW, de Melker HE, Mollema L. Child vaccine providers’ experience with the National Immunisation Programme and their consults with parents. Vaccinating: self-evident or not? 2014;99.
[49] Mollema L, Staal JM, van Steenbergen JE, Paulussen TGWM, de Melker HE. An exploratory qualitative assessment of factors influencing childhood vaccine providers’ intention to recommend immunization in the Netherlands. BMC Public Health. 2012;12(1):1–10.
[50] Geelen E, van Vliet H, de Hoogh P, Horstman K. Taming the fear of voice: Dilemmas in maintaining a high vaccination rate in the Netherlands. Soc Sci Med. 2016;153:12–19.