KEYWORD1:
Vaccine safety; risk communication

BACKGROUND:
Childhood immunization coverage rates have been gradually declining in King County, Washington since 1998. The increasing complexity of the vaccination schedule, continual media coverage on vaccine safety issues, and other factors may contribute to parents' hesitancy to vaccinate their children. Primary care providers can play a key role in influencing parents' decisions to vaccinate.

OBJECTIVE:
Identify key factors that potentially could influence hesitant parents' decision to vaccinate.
Describe how providers address parents' vaccine concerns and misconceptions.

METHOD:
Three parent focus groups (n=29)and two provider groups (n=19) were conducted using an independent research firm. Parent participants had children younger than age three years. Emphasis was placed on recruiting parents who devoted "a lot of time and effort" toward researching immunizations. Providers were pediatricians or family physicians. Participants were recruited from an existing database, referrals and flyers.

RESULT:
Parents' hesitancy to vaccinate their children was often based on limited knowledge and misperceptions about vaccines and the diseases they prevent. Parent participants expressed interest in receiving risk/benefit information about immunizations from their health care provider. They responded positively to photographs of vaccine-preventable diseases as an educational tool. Nearly 97% of parents considered their physician's recommendation as trustworthy; over 90% stated that a physician's recommendation influenced their decision to immunize. Physician groups differ in their approaches to addressing parents' vaccine concerns.

CONCLUSION:
Parent participants relied heavily on physicians'recommendations when making decisions about vaccinating their children. A physician's perspective and knowledge about immunizations played a key role in determining whether a child received routine immunizations.
LEARNINGOBJECTIVES:
Identify key messages and useful strategies for handling parents' concerns about immunizations.
Identify preferred sources and types of information for parents who are hesitant about immunizations.
Describe differences in perspectives between pediatricians and family physicians regarding immunizations.