Parents’ experiences and nurses’ perceptions of decision making about childhood immunization

Abstract

The uptake of immunization against infectious childhood diseases such as mumps, measles, rubella, diphtheria, tetanus, and pertussis has resulted in positive global health outcomes. The estimated vaccine coverage for these diseases, however, falls below targets recently set by the World Health Organization. The reviewed literature demonstrated that parents have an active role in making decisions about their children's immunization status informed by contextual, individual, and vaccine-specific influences. Few studies addressed nurses' involvement in parental immunization decisions. No qualitative studies could be found that explored Canadian parents' and nurses' perspectives into this complex, contextually-bound phenomenon. The aim of this qualitative study is to understand parents' and nurses' experiences of decision making about childhood immunization, specifically measles-mumps-rubella and/or diphtheria-tetanus-acellular pertussis. Thorne's interpretative description approach was used to facilitate parents' and nurses' sharing of their experiences and perspectives about childhood immunization to capture the relevancy for nursing practice. Results demonstrate that protection was the unifying goal across all parents and nurses. Motivated by protection of their child, parents searched for information about immunization, deliberated the information and sources to determine the relative benefits and risks of immunization, and assumed responsibility for their decision to accept, delay or decline immunization, and accepted responsibility for the consequences of their decision. Nurses described their role as protectors of child safety and population health. Findings of this study suggested that a tension that exists between nurses’ professional obligation to protect the public against vaccine preventable diseases, promote immunization update, yet, respect individual parental choice. Parents desired encounters with health care providers that were open to acknowledging and addressing their concerns in order to protect the health of their child. Future nursing approaches recommended by this study included nurse-led education sessions within a community environment, nurse-led forums that outreach to the public regarding fears and concerns about childhood immunizations, connecting with parents in the community could facilitate better access and improved engagement with health team members, forming partnerships with existing groups, and adding health literacy to the education curriculum could positively impact individual and community health.