Elsevier

Vaccine

Volume 29, Issue 44, 13 October 2011, Pages 7651-7658
Vaccine

Parent and adolescent perspectives about adolescent vaccine delivery: Practical considerations for vaccine communication

https://doi.org/10.1016/j.vaccine.2011.08.002Get rights and content

Abstract

We surveyed parents of adolescents (n = 430) and their adolescents ages 15–17 years (n = 208) in 9 primary-care settings in Monroe County, NY to assess perceptions about adolescent vaccine delivery. Parents and adolescents most wanted to discuss vaccine side effects and the diseases prevented with the adolescents’ provider. Those who perceived vaccines as very safe were more accepting of adolescent vaccines. Most participants agreed with vaccinating the teen during a mild illness and with providing multiple vaccines concomitantly. Participants most preferred medical, as opposed to other settings, for receipt of adolescent vaccines. For parents and adolescents who are wary of vaccination, strategies are needed to enhance communication about risks and benefits of vaccinations.

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

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