Rural Parents' Perspectives about Information on Child Immunization

This article details a study carried out in Alberta, Canada, to gain insight into parents' need for information about child immunisation, in order to improve and/or optimise information shared by rural health professionals. The authors were driven by a quest to understand how the availability - and, more recently, the explosion - of information about immunisation impacts parental decision-making. For years, public health nurses in Alberta provided standardised information on routine public-funded child immunisations. However, information calling into question the effectiveness, safety, and long-term effects of vaccines has become readily available on the internet and elsewhere, causing some parents to question the status quo. Although the healthcare community has responded by providing additional sources of information, there is a need to explore, according to the authors, how parents would, themselves, describe what clear, thorough, and unbiased information means to them. Specifically, the researchers explored: (i) whether information contributed to their decision; and, if so, how (ii) what types of information and content parents required; (iii) the sources of information considered helpful and trusted; and (iv) parents' suggestions about how information could be conveyed to them more effectively.

This was a descriptive qualitative study, using semi-structured interviews with legal-aged mothers responsible for decisions about immunising their infant in the past year. The mothers were from the local rural communities south of Calgary, Alberta, Canada. Data were collected using semi-structured interviews of no longer than one hour in length. The content analysis of the 11 participant interviews revealed 5 themes and numerous sub-themes:

1. Factors influencing mothers' decisions - Virtually all participants found that information from a variety of sources played at least one of the following roles in their decisions about immunisation: helping to make the decision; confirming the decision; causing confusion and making the decision difficult; and stimulating more questions. However, other factors were seen at times to have greater influence than information, such as: personal/others experiences; beliefs; perceived risks to the child; lack of awareness of their right in Alberta to make the decision; and relationships with health professionals.
2. Mothers' worries in making their decision - These concerns have been divided as follows: making the right decision; being respected for making a decision; and being given all the information.
3. Mothers' perceptions about "good" information - The majority stated that information should be comprehensive, that is, current, accurate, and balanced in its presentation. Second, information needed to be logical, clear, and understandable. Most participants shared their views on who they perceived to be trusted information providers and why. One powerful factor in establishing credibility was a sense of confidence in information sources they could relate to, whether someone acknowledged their concerns or had walked in their shoes previously.
4. Mothers' information needs - Participants offered key recommendations for future development and distribution of the information on child immunisation, which are detailed in the article. For example, many participants agreed that information on child immunisation should be available well before parents must make a decision. Specific types of content to be covered are outlined, such as the importance of having current scientific information, research, and statistics that addressed all sides of the immunisation issue.
5. Mothers' recommendations to health professionals:
   

   • strive to provide an environment which welcomes questions and open discussion;
   • demonstrate that they are well informed and up-to-date with current research and practices;
   • recognise that parents can by affected by their demeanour and attitude;
   • be clear on where their allegiance lies;
   • be willing to locate resources for parents;
   • use teachable moments to prepare parents for the immunisation process;
   • speak in terms parents can understand;
   • respect parents as the decision makers;
   • provide overviews of diseases and vaccines;
   • point out information specific to immunisation when given at postpartum visits; and
   • work together with alternative health communities in providing information.

In conclusion, the authors note that this study suggests that parents simply wanted to make the right decision for their children. As a result of this study, the nurses recognised that not all parents want to immunise their children and that they may not be receptive to information offered to them. The nurses saw that persuading or intimidating these parents into vaccinating their children was unlikely, and that in Alberta parents have the right to chose. In short, "[t]he nurses were able to gain a better understanding of how important it was to acknowledge parents' concerns, articulate a balanced presentation on the benefits and risks of immunization, encourage questions and thoughtful reflection about the issue, and support parents in the decision they make."