Timely Immunization in Texas and Barriers Parents Face

Background:
Texas has achieved the Healthy People 2010 childhood immunization goal of 90% coverage for all measured vaccines with the exception of the 4th DTaP, for which coverage is only 82%. While many barriers are well-recognized nationally, there may be unrecognized barriers that play a role at state level. To explore this possibility, the Texas Department of State Health Services Immunization Branch interviewed over two thousand parents of children under age three regarding possible barriers.

Objectives:
To identify barriers to on-time DTaP immunization that may be responsible for holding back progress in Texas and to determine which are the most important.

Methods:
Qualitative, exploratory research was followed by quantitative research which was conducted in late May / early June 2008. Children under 3 who were late for DTaP vaccine were identified through the state IIS (ImmTrac). To improve data quality, after the interviews were completed health departments contacted physicians and parents to verify immunization status at time of survey: 56% were up to date and 44% were behind.

Results:
A third of children had experienced a substantial gap in insurance, cost was a problem for half their parents during that time and most did not know about resources available to obtain immunization at little or no cost. For all parents, the leading logistic barriers were time off work and childcare denial of entry to children with fever after immunization, followed by finding a doctor, transportation and proof of income. Almost all parents of children in need of DTaP immunization mistakenly believed the child was up to date. A fifth of parents chose to skip or delay vaccination, and while safety was the leading reason, over a third did so because the child was ill at the time.

Conclusions:
There are opportunities to improve parent's knowledge and access regarding needed resources and information about vaccination.