Understanding Parents' and Healthcare Providers' Immunization Knowledge, Attitudes and Behaviors: Research the Foundation for Immunization Communication Strategies, Messages, Materials, and Partner Outreach

Background: Understanding the vaccine knowledge, attitudes, and behaviors of parents and healthcare providers is an essential first step in effective vaccine communication.  CDC’s National Center for Immunization and Respiratory Diseases (NCIRD) conducts ongoing research to inform the development of vaccine communication strategies, messages, and educational materials.

Program background: In 2008-2010, NCIRD conducted several research projects to better understand the current vaccine knowledge, attitudes, and behaviors of parents and physicians including: 1) focus group research with 164 first-time mothers in three cities, 2) a national mail survey of 608 parents (2008) and 475 parents (2009) of children aged six years and under, 3) in-depth interviews with 33 practicing physicians in three cities,  4) focus groups with 102 mothers in two cities to test messages and materials, and 5) a national poll of 1500 parents of children aged six through 23 months.  The results of these studies were used along with additional past and current research to inform the development of new educational resources designed to help healthcare providers discuss vaccines and vaccine-preventable diseases with parents.

Evaluation Methods and Results: Mothers in the initial focus groups reported that while vaccines were important to their children's health, they had many questions and concerns. Similarly, the 2008 mail survey of parents found that while 73% of parents were confident in vaccine safety, concerns such as pain from shots (43%) and the number of shots given at once (40%) were common. Online testing of four draft fact sheets demonstrated that materials developed to address mothers' vaccine questions and concerns were clear, useful, and trusted. In-depth interviews with physicians showed that vaccine safety was a major issue for all physicians; in addition, some physicians reported that vaccine administration was becoming burdensome.  In 2009 mothers in the focus groups generally expressed support for vaccination and most described vaccinating their children according to the recommended schedule. However, some discussed short-term delay or “splitting up” of vaccines into more than one office visit, usually due to concerns over pain or safety. Similar to the 2008 data, the 2009 mail survey of parents found that while 79% of parents were confident or very confident in vaccine safety, concerns such as a child’s pain from vaccines (44%) and number of vaccines children receive at one office visit (34%) were common. Research also reaffirmed parents’ trust in the vaccine information they receive from their child’s healthcare provider.

Conclusions: An understanding of the current vaccine knowledge, attitudes, and behaviors of parents and physicians has helped NCIRD respond effectively to questions and concerns about childhood immunizations.

Implications for research and/or practice: Research is ongoing, and is being used to inform the development of health communication strategies, messages and materials for parents and healthcare providers as part of CDC's Childhood Immunization Campaign including “Provider resources for vaccine conversations with parents,” web and social media, and partner outreach and engagement.