What Happens, Communication-Wise, When a Child is Immunized: Insights from a Three-Year Study Glen Nowak, Ph.D. (Acting) Director of Media Relations Centers for Disease Control and Prevention DEPARTMENT OF HEALTH AND HUMAN SERVICES

Key Project People include. . . Alan Janssen, National Immunization Program Beth Hibbs, Ben Schwartz, Larry Pickering, Walt Orenstein Richard Blizzard, Ph.D., the Gallup Organization Janice Watkins, Ph.D., ORISE Also, NIC presentations based on this data are: Workshop 71 (Allison Kennedy, Deb Gust, et al.) Poster 149 (Lindsay Holcomb, Holly Groom, and Maureen Kolasa)

Ongoing Communication Challenges Immunization environment and recommendations are dynamic; Multitude of media and websites offering immunization information and perspectives; Perspective, and good information, on what is actually happening can be difficult to get; Media stories and websites are highly visible, but often poor barometers.

"42 in Japan die after taking Tamiflu" “Health officials in Japan say 42 people have died after taking Tamiflu, but that only two deaths resulted from taking the anti- influenza  drug. . . The other 40 deaths were believed to be not directly linked to the drug.”

Important to go beyond the Media Critical for obtaining and providing “perspective” Essential for identifying whether and how people (e.g., providers, parents, public) are affected Necessary for identifying needed messages, materials, and resources Helpful for gauging the value and impact of messages, materials, and resources

Parent-Provider Encounter Study Three-year project, conceived in 2002 Data collected by the Gallup Organization from parents of children 9-to-24 months old. Valid, in-depth study of how parents and health care providers interacted when it came to childhood immunization recommendations

Specific Study Objectives included. . . Improving our understanding of what actually happens during an immunization-related office visit: What information is provided to parents/guardians? How is information provided? How many parents/guardians have or ask questions? What are parents’ questions? Are the questions changing over time (e.g., in frequency, topic)? Do questions vary by vaccine?

Study objectives continued. . . Gaining better, more accurate, information regarding: Parents’ beliefs regarding the safety of recommended vaccines; Parents’ vaccine safety-related concerns, and whether those concerns were changing (e.g., in number or type) Parents’ satisfaction with the information provided, and the way it was provided

Research Methods Both parties completed surveys Parent/guardian in waiting area at time of visit Physician or nurse after visit Number of practices participating: 79 in 2003; 81 in 2004; 105 in 2005 Randomly selected from AMA master list and then qualified based on providing 6 or more childhood vaccinations/week 430 physicians in 2003; 433 in 2004; 387 in 2005 Number of parents/guardians surveyed: 749 in 2003; 959 in 2004; 817 in 2005

Key Findings

Almost all children were receiving most recommended vaccinations Of the 2,525 parents/guardians who participated in the study, only 11 said it was “not at all important” or “not important” for children to be vaccinated on schedule. But many parents still declined influenza and varicella vaccinations - with “not necessary” the most frequently cited reason. Study also found number of physicians reporting a parent declined MMR vaccination increased from 2003 to 2005 (i.e., 10 percent more report a declination).

Most reported receiving information. . . Most report receiving information sheets (80-85%) Most received information about side effects and an explanation of what to look for/when to call (80-85%)

. . . But some topics are covered less. . . About one-third of parents didn’t recall being provided an explanation of a child shouldn’t receive a recommended vaccination; Only about half reported receiving information regarding a) how vaccines work and b) the contents of vaccines. Consistent with physician/clinician survey

. . . And perceptions did differ. Physicians/clinics reported providing: Information sheets/VIS for 95% of visits Potential side effect information 99% of the time Information on when to call 98-99% of the time Information on the benefits of vaccination, with that percentage increasing from 79.5 percent in 2003 to 95 percent in 2004 and 2005

Questions are often asked during visits Over course of study, about 35-40 percent of parents/guardians asked questions to provider Questions primarily focused on: Alleviating pain or discomfort to child (about 40%) Number of shots being administered (about 35-40%) Short-term reactions to vaccinations (about 30%) General safety of vaccination (about 25%) Potential long term reactions (about 15%)

And parents often had specific concerns. . . The percentage of parents with specific concerns was constant, but the number of concerns increased from 28% in 2003 to 37.5% in 2005 Primary concerns were: Number of vaccinations per visit (about 7 percent) Previous or potential reactions (about 7 percent) Too many vaccinations by age 2 (about 5 percent) Vaccine additives (about 5 percent)

Thimerosal, autism, and vaccinations Of the 2,525 parents/guardians in the study, 167 expressed specific concerns related to thimerosal (i.e., 66), autism (i.e., 58), or both (i.e., 43). Over the three years, there was an increase in number asking about autism (e.g., about 1 in 10 parents in 2005) or thimerosal (e.g., about 1 in 10 in 2005).

Most providers are effectively communicating Parent satisfaction ratings: “Very satisfied” for Vaccine Information Statements (i.e., about a ‘4’ on a 5-point scale) “Very satisfied” for “Time spent explaining and answering questions” about vaccinations “Very satisfied” for “Answers given in response to questions” “Very satisfied” with overall visit Mean ratings varied little by year

Other notable findings Overall, parents/guardians rated vaccines as “very safe” (i.e., around 4’s on a 5-point scale), with that assessment varying little by year. (They only rated vaccines that their children were to receive.) Nearly all parents with safety-related concerns planned to continue vaccinating their children. Some, however, did delay vaccinations because they disagreed with the recommendation (about 29) or did not believe the vaccination was needed (about 27) Vaccine shortages were very rarely experienced by the parents/guardians in this study (i.e. 5 people).

Initial Conclusions (I) Many parents need information regarding why immunizations are given early in life – and reassurance regarding the benefits of vaccinations. Some of the parents/guardians with concerns or questions have more concerns and questions today than a few years ago. The immunization environment can be a difficult communication environment– parents are often distracted during the office visit, and thus it may be helpful to routinely confirm understanding.

Initial Conclusions (II) Parents do hear what’s in the news (especially if something persists in the news) – and if something is in the news, providers need to be up to speed on it. Things that provide opportunities to discuss the importance and value of vaccination are good (i.e., it shows interest in the issue and in hearing your perspective). Media stories and websites can foster questions and doubts – but interpersonal communication with health care providers is highly effective in addressing those things.

Thank You! DEPARTMENT OF HEALTH AND HUMAN SERVICES