BACKGROUND:
In Hawaii, the immunization rate for children ages 19-35 months dropped significantly over a 3-year period. In fact, between 1999-2001, there was an 8.8% drop in coverage for the 4:3:1:3:3 (4 DTaP, 3 IPV, 1 MMR, 3 HIB, 3 HBV) series in this age group.

OBJECTIVE:
The purpose of this study is to explore the barriers to immunizations in parents whose children are not fully immunized (4:3:1:3:3) by 24 months of age.

METHOD:
This qualitative study used a single category design focus groups sessions. IRB approval was obtained. Purposeful sampling was used to choose parents of 24-59 month old children who are not fully immunized. Transcript based analysis using unabridged transcripts of the focus groups were the basis of analysis. Content analysis was accomplished using the qualitative software.

RESULT:
Thirteen focus groups were conducted in a 6 month period including a total of 64 parents, guardians or foster parents. The mean age of the sample was 33.2 (SD 8.5) and mean number of children in the family was 2.75 (SD 1.5). Thirteen focus groups were conducted with a total of 64 parents, guardians or foster parents. The mean age of the sample was 33.2 (SD 8.5) and mean number of children in the family was 2.75 (SD 1.5).Five categories of barriers were identified: transportation, financial issues, organizational policies, parental issues and child issues.

CONCLUSION:
This study identified potentially all of the parental barriers to immunizations for parents in Hawaii. Different barriers existed in different communities, with different health care systems, and with different health care providers. In order to decrease the barriers to immunizations, one must identify the unique barriers specific to the setting. Once identified, specific intervention can be targeted to reduce the barriers. To achieve this goal, using the rich data from this study, the next step would be to create a Parental Immunization Barriers Survey that could be utilized by health care providers, clinics, and communities to identify specific barriers.

LEARNING OBJECTIVES:
1. Discuss 5 categories of parental barriers to immunizations in Hawaii
2. Discuss strategies to minimize parental barriers to childhood immunizations.