ABSTRACT BACKGROUND: Lack of information has been associated with couples anxiety or concern in a number of healthcare areas. OBJECTIVES: (1) Identify the proportion of parents who agreed, were neutral, and disagreed that they had access to enough information to make a decision about immunizing their child; (2) examine how parents who agreed and disagreed differed with respect to sociodemographic characteristics, and their attitudes about immunizations, their child's healthcare provider, immunization requirements/exemptions, and immunization policymakers; and (3) identify if differences exist in specific immunization concerns. METHODS: A sample of parents with at least one child aged < or =6 years (n=642) was analyzed using data from the Health Styles survey conducted during July and August 2003. Odds ratios and the Mantel-Haenszel chi-square test were used for analysis. RESULTS: Response rate for Health Styles was 69% (4035/5845). The largest proportion of parents agreed they had access to enough information (67%) compared to parents who were neutral (20%) or who disagreed (13%). Compared to parents who agreed, parents who disagreed were more likely to be less confident in the safety of childhood vaccines (odds ratio [OR]=5.4, 95% confidence interval [CI]=3.3-8.9), and to disagree that their child's main healthcare provider is easy to talk to (OR=10.3, 95% CI=3.7-28.1). There was a significant linear trend in the percentage of parents expressing immunization concerns among those who agreed, were neutral, and who disagreed they had access to enough information (p<0.05; df=1). CONCLUSIONS: While most parents agreed that they had access to enough immunization information, approximately a third did not. Perceived lack of information was associated with negative attitudes about immunizations and toward healthcare providers. Basic information about the benefits and risks of vaccines presented by a trusted provider could go a long way toward maintaining and/or improving confidence in the immunization process.
CHAPTER ONE 1.0 INTRODUCTION
Immunization is recognized as a safe and effective method of preventing disease (National Advisory Committee on Immunization, 1998); however, not all parents choose to immunize their children and not all couples choose to maintain or update their own immunization status. The goal of this thesis is to understand why young couples (parents or future parents) make the decisions they do and how they arrive at those decisions. Health scientists need to acquire an understanding of the experience of people in relation to their environments for the purpose of increasing their potential for health. Improved health policies may be developed if we can understand how to serve our populations better as a whole. It is more useful to put into place policy that will be meaningful and followed, than blanket statements that do not put the population's needs first. This study contributes to a better understanding of the thought processes behind persons who choose to delay or refuse immunizations irrespective of the policy environment. The area of immunization is as complex as a mosaic, and true to this metaphor, every tile of information contributes to the overall picture while remaining distinct. This thesis is presented as another tile. Currently in Amuzi community in Obowo L.G.A, mainstream immunization is voluntary, though strongly encouraged and freely dispensed to all citizens. Changes are on-going in mandatory immunization policy provincially. Alberta and Saskatchewan pride themselves in not having moved to mandatory laws due to the public health delivery systems in place. (Personal communication, P. Hasselback, January, 2002). As long as most people comply, the herd immunity remains strong and the risk for developing vaccine reventable diseases remains low. However, certain groups in the population do not agree with immunization for a variety of reasons. Some of these reasons include theological constraints, belief structures that favor "natural" immunity, beliefs that immunization is dangerous to children, mistrust in pharmaceutical companies and a belief in alternative health therapies such as provided by naturopaths and chiropractors.
What about apathy? Funk and Wagnells (1982) describe this as indifference and lack of interest. Do couples feel immunization is important? Do they think about it during their daily lives? What will our future generation of parents do to contribute to herd immunity when they have never seen the diseases the vaccines are designed to prevent? What will happen when the next generation feels overly confident that they will not be touched by these diseases because they are perceived as a "Third World problem" or when they do not understand the ramifications of the diseases? Lack of knowledge of our own immune systems in the general population is high. Because of the complexity of interactions between anatomical structures and biochemistry most laypersons shrug their shoulders when asked how basic immunological functions occur.
Policies encouraging health education may emphasize the importance of citizens taking a pro-active role in understanding their bodies and what they can do to remain healthy. In this day of reduced health care budgets more emphasis needs to be placed on prevention of disease. Immunization is an integral cog to the wheel. An analysis of this issue indicates a need for more knowledge to guide health care workers and policy-makers in contributing to immunization.
DESCRIPTION OF THE PROJECT
The purpose of this project is to ascertain the beliefs of young couples regarding immunization for their children or future children.
The overall objectives of this qualitative study are to:
a. Determine the theological constructs of young couples who refuse or delay immunization among their children or future children for religious beliefs.
b. Determine the beliefs of young couples who engage in alternative health practices and refuse or delay their children's or future children's immunizations.
c. Determine whether youngcouples (non-parents) are thinking ahead regarding immunization.
d. Determine if there are gender differences between perspectives regarding immunization.
e. Determine if there are vocational/academic differences between groups regarding immunization.
f. Determine the relationship between various groups who do not immunize regarding their decision-making.
OBJECTIVES
The main objective of the study was to deepen our understanding of the knowledge, attitudes, practices, fears and beliefs about immunization among children. Specifically the objectives were:
1) To identify myths and misconceptions about immunization among couples.
2) To identify knowledge, attitudes, practices, fears and beliefs (KAPBF) about childhood immunization.
3) To determine motivating and de-motivating factors in parents seeking immunization amoung couples.
RESEARCH QUESTIONS
The aim of this study was to answer the following research questions in order to describe and explain:
a. What are the theological constructs of young couples who choose not to immunize their children or future children? What is the relationship between these beliefs and the young couples' decision-making regarding immunization?
b. What are the beliefs of young couples who engage in alternative health practices and choose not to immunize their children or future children? What is the relationship between these beliefs and the young couples' decision-making regarding immunization?
c. What are the beliefs of young couples who are concerned about vaccine safety and choose not to immunize their children or future children? What is the relationship between these beliefs and the young couples' decision-making regarding immunization?
DEFINITIONS
In the context of this study, the following theoretical definitions were used:
• Understanding is the process of interpreting, knowing and comprehending the meaning that is felt, intended and expressed by another (Denzin, 1989, p. 120);
• Immunization is the process of being immunized against a particular disease;
• Health care workers include individuals from the disciplines of medicine, public health, physical and social science and nursing;
• Health scientists are researchers concerned with aspects of health science and health care from multiple disciplines of medicine, public health, physical and social science, education and nursing; and,
• Informants are defined as the people interviewed in this study who provided information about personal immunization experiences.
