Parent and adolescent perspectives about adolescent vaccine delivery: Practical considerations for vaccine communication
Highlights
► We assessed parent and adolescent perspectives on adolescent vaccine delivery. ► Parents who perceived vaccines as very safe were more accepting of adolescent vaccines. ► Most parents were willing to have adolescents vaccinated during a minor illness. ► Participants most preferred medical settings for vaccine receipt.
Introduction
Between 2005 and 2009 there were six new recommendations for adolescent immunization, including new or changed recommendations for meningococcal, tetanus–diphtheria-acellular pertussis (Tdap), hepatitis A, human papillomavirus (HPV), varicella, and influenza vaccines. Much has been published about the implementation of the HPV vaccine recommendation [1], [2], [3], [4], [5], [6] for adolescents due to the intricacies of introducing a vaccine to prevent a sexually transmitted infection, and because its multi-dose schedule obligates multiple visits [7], [8], [9]. It is unknown whether parents’ perspectives of general vaccine delivery for adolescents are similar to their perceptions about HPV vaccine. In addition, several issues related to adolescent vaccine delivery remain unexplored, including (a) how best to communicate about vaccines with parents [10], (b) logistical issues to deliver vaccines in medical homes, and (c) the use of alternative venues for vaccine delivery [11].
Given an increase in vaccine-hesitancy nationwide in recent decades [12], the issue of vaccine communication has become increasingly important. Understanding what vaccine information parents of adolescents want is essential for providers, policymakers and professional societies to develop educational materials that effectively address parental concerns. In addition, understanding the considerations that parents weigh when deciding whether or not to accept vaccine recommendations for their adolescents can give providers a framework for vaccine discussions.
Adolescents do not frequently make preventive office visits [13], and when they do, many issues compete for time during the visit [14]. Taking the time to discuss vaccines may be challenging. Understanding parents’ and adolescents’ attitudes about topics such as finding vaccine information, vaccine safety, and concomitant delivery can help providers plan strategies to help ensure acceptance, despite busy schedules.
One topic of increasing importance involves alternative settings for adolescent vaccinations, including schools, pharmacies, hospital emergency departments, teen clinics, and public health departments [11], [12]. The need for an annual influenza vaccine, in addition to a 3-dose schedule for HPV vaccination for adolescents can significantly burden primary care practices [15], [16], [17], and highlight the potential importance of schools [18], [19] and even pharmacies [20] as possible vaccination sites. While one study in Texas examined the acceptance of adolescent immunization at alternative sites [21], it remains unclear whether parents in other geographic regions would be willing to have their adolescents vaccinated in these alternative settings.
To address these questions, our objectives were to measure parent and adolescent perceptions about new adolescent vaccines, focusing on topics relevant to vaccine communication. We sought to better understand factors associated with vaccine acceptance, and assess their preferences for: specific topics to discuss with healthcare providers, timing, number of simultaneous vaccines, and site of care for vaccine delivery. Since as teens age, they make more autonomous decisions about their own healthcare [22], we assessed opinions of both parents and adolescents. Finally, since opinions may vary by primary care practice, race/ethnicity, and socio-economic factors [23], [24], [25], [26], we assessed parents and teens from a wide spectrum of primary care practices in a major metropolitan area.
Section snippets
Setting and sample
The study was approved by the Research Subjects Review Board at the University of Rochester. As reported elsewhere [27], we recruited subjects when adolescents presented for medical appointments at 9 primary care practices (5 urban, 4 suburban) in Monroe County, NY between March 2007 and April 2008. By design, we recruited a convenience sample of 430 parents of adolescents (50% with children 11–14 years of age, n = 213; 50% with children 15–17 years of age, n = 217), as well as older adolescent
Participants
Most parents accompanying the adolescents and 57% of adolescents were female (Table 1). About half of adolescents were suburban residents, white non-Hispanic, and two-thirds were privately insured. The demographics of the older adolescents were not significantly different from the characteristics of the entire parent sample.
Vaccine perceptions/information
Altogether, 85% of parents but only 71% of adolescents perceived vaccines as generally ‘very effective’ (p < 0.01, Table 2); 83% of parents and 69% of teens perceived vaccines
Discussion
While the vast majority of parents and adolescents in this upstate NY community accepted the new adolescent vaccine recommendations, there was a higher likelihood of acceptance among those who viewed vaccines as very safe. While many teens feel they can decide for themselves about getting a vaccine at an earlier age, most parents prefer to be involved in this decision until adolescents are 18 years old. The majority of parents and teens would accept up to four vaccines in one visit, and most
Conclusions
Our study is one of the first to examine perceptions among parents and adolescents about general vaccine delivery, and specifically, about adolescent vaccines other than HPV vaccine. Parents and teens alike were most concerned about vaccine safety, and most were willing to have the adolescent receive multiple vaccines simultaneously and during minor illnesses. Our study highlights the importance of communication regarding vaccine side effects as well as the importance of addressing logistical
Acknowledgements
This work was supported by Cooperative Agreement U01IP00040 with the Centers for Disease Control and Prevention (CDC). The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding agency. We would like to thank Mary Gaeddart, Ivana Kalanovic and Eric Heintz for their assistance in data collection and entry, the providers and patients of the primary care practices involved in this study for their helpful cooperation, and the input
References (61)
- et al.
A systematic review of measures used in studies of human papillomavirus (HPV) vaccine acceptability
Vaccine
(2010) - et al.
Not just for kids: new paradigms for vaccine delivery in pediatrics
Acad Pediatr
(2009) - et al.
Parents’ views on 3 shot-related visits: implications for use of adolescent vaccines like human papillomavirus vaccine
Acad Pediatr
(2009) - et al.
Understanding the reasons why mothers do or do not have their adolescent daughters vaccinated against human papillomavirus
Ann Epidemiol
(2009) - et al.
Keeping up-to-date on immunizations: a framework and review for pharmacists
J Am Pharm Assoc (2003)
(2006) - et al.
At what sites are parents willing to have their 11 through 14-year-old adolescents immunized?
Vaccine
(2010) - et al.
Parents concerned about vaccine safety: differences in race/ethnicity and attitudes
Am J Prev Med
(2006) - et al.
Parents’ health beliefs and HPV vaccination of their adolescent daughters
Soc Sci Med
(2009) - et al.
Adolescent Tdap vaccine use among primary care physicians
J Adolesc Health
(2009) Race/ethnicity and gender disparities in the utilization of a school-based hepatitis B immunization initiative
J Adolesc Health
(2004)
Determinants of influenza vaccination in hard-to-reach urban populations
Prev Med
Parental vaccine safety concerns: results from the National Immunization Survey, 2001-2002
Am J Prev Med
More vaccines for children? Parents’ views
Vaccine
Access to medical care for adolescents: results from the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls
J Adolesc Health
Middle- and high-school health education regarding adolescent vaccines and human papillomavirus
Vaccine
Factors that are associated with parental acceptance of human papillomavirus vaccines: a randomized intervention study of written information about HPV
Pediatrics
Understanding and overcoming barriers to human papillomavirus vaccine acceptance
Curr Opin Obstet Gynecol
Mothers’ intention for their daughters and themselves to receive the human papillomavirus vaccine: a national study of nurses
Pediatrics
Appropriate use of cervical cancer vaccine
Annu Rev Med
Human papillomavirus vaccine and adolescents
Curr Opin Obstet Gynecol
The promise and challenge of adolescent immunization
Am J Prev Med
How effectively can health care settings beyond the traditional medical home provide vaccines to adolescents?
Pediatrics
Navigating parental vaccine hesitancy
Pediatr Ann
National health care visit patterns of adolescents: implications for delivery of new adolescent vaccines
Arch Pediatr Adolesc Med
Bright futures: guidelines for health supervision of infants, children, and adolescents
Additional health care visits needed among adolescents for human papillomavirus vaccine delivery within medical homes: a national study
Pediatrics
Primary care physician perspectives on reimbursement for childhood immunizations
Pediatrics
Additional visit burden for universal influenza vaccination of U.S. school-aged children and adolescents
Arch Pediatr Adolesc Med
Effectiveness of school-based influenza vaccination
N Engl J Med
Cited by (35)
Childhood and Adolescent Vaccination in Alternative Settings
2021, Academic PediatricsCitation Excerpt :However, a recent survey found that only about half of pharmacies report vaccinations to an IIS,49 an important barrier for this multi-dose vaccine. Additionally, evidence indicates that parents generally prefer having their adolescents receive routine vaccinations at medical provider offices rather than pharmacies.50 Parents need to weigh the accessibility and convenience of pharmacies in comparison to the familiarity and privacy accorded by the PCP's office.51
Barriers and enablers to adolescent self-consent for vaccination: A mixed-methods evidence synthesis
2019, VaccineCitation Excerpt :All used questionnaires to elicit responses from study participants. Participants comprised young people in eight of the studies [27,34,36,39–43], parents of adolescents in four studies [32,39,41,43], healthcare professionals in two studies [37,38], and two studies were related to healthcare organisations [35,44] (Table 1). The majority of the studies reporting mainly qualitative data in relation to self-consent were considered at ‘low’ [20–22,25,27] or ‘moderate’ [23,24,28–30] risk of bias (Table 2).
Pharmacies versus doctors’ offices for adolescent vaccination
2018, VaccineCitation Excerpt :We hypothesized that, compared to doctors’ offices, parents believe pharmacies are superior vaccination settings when considering vaccine delivery features related to patient accessibility (Hypothesis 1a). However, parents and adolescents who prefer going to traditional medical settings to get vaccines [6–10] have expressed safety and privacy concerns about alternative vaccination settings like pharmacies [6,10]. Therefore, we hypothesized that compared to doctor’s offices, parents believe pharmacies are inferior vaccination settings when considering vaccine delivery features related to the health care environment (Hypothesis 1b).
Impact of pharmacists providing immunizations on adolescent influenza immunization
2016, Journal of the American Pharmacists AssociationCitation Excerpt :Pharmacies are playing an increasing role as immunization venues for adults in the United States.15 Yet studies to date have shown mixed results for provider and parent acceptance of pharmacies as immunization venues for children.16-19 The lack of office visit fees and ease of access have the potential to make pharmacies more attractive to payers and parents.20