Attitudes and risk perception of parents of different ethnic backgrounds regarding meningococcal C vaccination

Abstract

The aim of the present study is to assess the attitudes of parents toward vaccination as well as their risk perception of disease and vaccination. We interviewed 1763 parents of different ethnic groups (among others, Dutch, Turkish, Moroccan, and Surinamese parents). Results show that there were large differences in knowledge about disease and risk perception of disease and vaccination among parents of different ethnic backgrounds. Generally, people largely overestimated the risk of contracting the disease and the risk of dying after contracting the disease. Dutch parents were best informed, least worried, had the most critical attitude toward the campaign, and the lowest vaccination level compared to other parents. The differences in knowledge about vaccination and the more critical attitude of Dutch parents emphasize the need to take more into account parents’ perspectives when designing information leaflets or other information media.

Introduction

Although the National Vaccination Program in the Netherlands has been successful, and about 95% of Dutch children receive the recommended vaccinations [1], [2], there is some concern that the compliance is decreasing. Some of the larger cities in the Netherlands show a decrease in vaccination level, especially among infants and especially among infants of Dutch descent [1]. This decrease in vaccination level is a worldwide concern [3]. If the vaccination level decreases even further, it is likely that the number of cases of infectious diseases will increase as happened in the past in, for example, the Netherlands (measles) and the UK (pertussis) [4], [5]. Traditionally, opponents of vaccination generally use religious arguments or they base their arguments on anthroposophical ideas [6], [7]. There are also other reasons why parents feel ambivalent toward immunization [8]. The declining incidence of vaccine-preventable diseases has led to a heightened public focus on the issue of vaccine safety, and parents may overestimate the risk of side effects of vaccination or harbor doubts about its effectiveness [9], [10], [11]. Without having any direct experience of the severe consequences of infectious diseases, risks of vaccination are sometimes seen as greater than the risks of non-immunization [9]. Parents’ appraisal of the various risks of vaccination might therefore differ from that of health professionals [12].

As there are ethnic differences in healthcare use in general [13], ethnicity may also play a role in parents’ attitudes toward childhood vaccination and compliance with vaccination. Some studies [14], [15], [16] showed ethnic differences in vaccination coverage, while other studies did not [17]. Streefland et al. [2] noted that immigrants in the Netherlands often see vaccination as something self-evident, suggesting that their compliance might be even higher than that of Dutch parents. However, the few studies that have been done about attitudes toward vaccination of parents with different ethnic backgrounds (e.g. [18]) did not reveal any differences. In the Netherlands, many people from ethnic minority groups live in the four largest cities (about 30% of the total population), while in other parts of the Netherlands 10% of the population, at most, is from the ethnic minorities [19]. The largest ethnic minority groups are Turkish, Moroccan, Surinamese people and people from the Antilles. Surinam is a former part of the Netherlands and many people moved from Surinam to the Netherlands when Surinam became independent. The Antilles is still a part of the Netherlands. People from Morocco and Turkey came to the Netherlands (from 1965 onwards) to find employment.

Learning more about parents’ concerns about, and attitude toward vaccination is important when designing more effective informational material. In this study, we focus on the appraisal of vaccination risks of parents with different ethnic backgrounds, and their attitude toward vaccination. We were able to interview parents who enrolled their children for vaccination against meningococcal C during the 2002 large-scale one-time catch-up vaccination campaign for children aged between 14 months and 18 years old in the Netherlands. For this study, we asked parents about their perceptions of the risks of disease, side effects of vaccination, and their evaluation of the vaccination campaign.