Identifying Parental Barriers to Age-Appropriate Vaccination for Infants

Background: Many children do not receive potentially life-saving vaccines on time.  Gaps in age-appropriate vaccination allow for disease in under-immunized children, and for subsequent epidemics. The Philadelphia Department of Public Health (PDPH), Immunization Program, Community Based Outreach (CBO) initiative tries to reduce gaps by providing services to bring vaccination-delayed children up-to-date.   

Setting: Immunization Program, CBO Initiative, Philadelphia, Pennsylvania, February - October 2009. 

Population: Parents/Guardians for vaccination-delayed infants living in Philadelphia.  

Project Description: CBO targets infants 10 & 20 months of age, who live in 31 of 46 Philadelphia zip codes, and are assessed as not up-to-date on DTaP, Polio, MMR, Hib and Hepatitis B series in the PDPH Kids Immunization Database/Registry System (KIDS) – approximately 720 children per month.  A health and social service agency subcontracted by PDPH then performs outreach, which includes contacting providers and parents through phone, fax, and home visits. As part of the process, workers educate caregivers on the importance of timely vaccinations per the ACIP schedule, and aid in securing immunization services.  To identify barriers for vaccinating children on-time, CBO began, in February 2009, to survey parents.  Upon completing outreach services, outreach workers administered a nine-question, English-only questionnaire to those parents willing to participate.

Results/Lessons Learned: Of the 1300 parents who accepted outreach in this period, 300 (23%) completed the survey. For the 203 who provided reasons for vaccination-delay, the most common reasons cited were “lack of time” (42%) and “lack of money”  (17%).  There were also associations between certain barriers and socio-economic indicators, such as education level, marital status and income. Information collected will provide further insights about the population served by CBO, barriers to vaccination, and whether any of these barriers can be addressed prior to outreach.