Informing the information – the UK use of communication research Jo Yarwood Head of Immunisation Information Department of Health

Why bother?

Vaccination affects huge numbers of 'readers' or 'viewers'. It is 'political' since it is recommended by Governments. It plays victims against the establishment, and experts against experts. The science element gives it an aura of mystique. Communicable diseases are no longer feared - vaccines are now. The role of the media in reporting on vaccination issues.

Research pre-testing ‘strategic’ research bi-annual tracking

What is the commitment? two waves of ‘parental’ tracking per year one wave of professional tracking per year pre-testing (as appropriate) other ad hoc work (eg MMR work) about £250,000 per annum (a small proportion of the total vaccines budget)

To provide information on the following for strategic planning: parents knowledge of immunisation parents attitudes towards immunisation parents experience of services To monitor advertising over time on key indicators In addition, to examine all of the above in the light of continued publicity surrounding childhood immunisations (esp. MMR) Tracking aims

29 waves of research dating back to October Wave 29 fieldwork: 17 th October – 14 th November Random location sampling design in 152 areas in England (geographically representative) 1004 in-home personal interviews with “primary care givers” (usually parents) of 0-2s in England using Multi-Media CAPI. Tracking survey

Background cont. Sampling can be adapted (or added to) to explore other groups in depth Core questions can be adapted for new concerns Information is used to inform the communication strategy

Advertising and publicity

Spontaneous awareness of advertising, information or publicity in last 12 months Any advertising, information or publicity TV programme Base: All primary care givers of 0 - 2s (W29 n = 1004) Newspaper article TV advertisement Oct 03May 05 Feb 02Sep 02Mar 03 May 04Nov 04 Nov 05 **

What remember most about advertising information or publicity (unprompted) Mention of MMR and Autism / bowel disease Get your child immunised/parents responsibility Debate about MMR/controversy/ whether to have it or not Positive mention of MMR Get children immunised/don’t miss immunisations Base: All who recall seeing/ hearing advertising, information or publicity about immunisation (W29 n=726) About immunisations/vaccinations ** *

Oct 03 May 04 Nov 04 Whether seen advertising, info or publicity that might have persuaded them not to immunise Base: All who spontaneously recall seeing/ hearing advertising, information or publicity (W29 n = 726) Feb 02 Sep 02 Mar 03 May 05 Nov 05 Sep 01 Mar 01 Oct 00 Mar 00 Sep 99 Mar 99 Sep 98 34% of these people had postponed or rejected MMR (compared with 14% of all respondents)

Prompted awareness of other publicity about immunisation for children Reference guidePre-school leaflet

Prompted recall of leaflets Mar 03Oct 03 Old Guide to childhood immunisation May 04 Base: All primary care givers of 0 - 2s (W29 n = 1004) MMR Facts (old v2) Feb 02Sep 02 MMR Facts (V3) MMR Facts (old v1) New guide to immunisation for babies Nov 04 Sep 01May 05 Reference guide Pre-school leaflet Nov 05

Immunisation Information and MMR The Facts Websites

Oct 03 May 04Nov 04 Internet access amongst primary care givers Base: All primary care givers of 0-2s (W29 n = 1004) Sep 02Mar 03 Internet use Internet access May 05Nov 05 Visited MMR: The Facts website

MMR

Perceived safety of MMR by social grade Completely safe Slight risk Moderate risk Don’t Know ABC1C2DE High risk Nov 04 Base: All primary care givers 0 - 2s (W29 n = 1004) May 05 Nov 05

Proportion who consider MMR a greater risk than the diseases it protects against Base: All primary care givers of 0 - 2s (W29 n = 1004) Spontaneous Total Oct 03 Nov 04 May 04 Mar 03 Nov 05 Oct 00 Sep 01 Feb 02 Sep 02 Mar 01

Spontaneous awareness of immunisations Polio Whooping Cough Hib MMR Oct 03 Base: All primary care givers of 0 - 2s (W29 n = 1004) May 04 Men C May 05 5 in 1 vaccine Mar 03 Nov 04 Children’s flu Pneumococcal ** Nov 05

Perceived safety of immunisations Old Polio (by mouth) % completely safe DTaP / IPV 5 in 1 vaccine Men C MMR Nov 05May 05Nov 04May 04Oct 03 Mar 03 Base: All primary care givers of 0 - 2s (W29 n = 1004)

Perceived severity of diseases Meningitis Polio Diphtheria Hib % very serious Oct 03 Base: All primary care givers of 0 - 2s (W29 n = 1004) May 04Nov 04 Rubella Measles Mumps Mar 03 Nov 05

Uptake, Refusals and Delays

Parents generally get their children immunised on trust… –they would not usually question the ‘received wisdom’ to immunise –rationally... they know that vaccinations have been clinically tested and are safe they believe the Government would not deliberately harm children and risk litigation (because it wouldn’t get re-elected) –they know that immunisation is not 100% effective, but believe that it reduces the chances of damage from diseases –awareness and understanding of the need for 95% population coverage is low, but parents are concerned about the threat to their own children if other parents fail to immunise Attitudes to immunisation (from MMR work)

Vaccinations delayed and refused Refused MMR Refused any Mar 03 May 04Nov 04May 05 Oct 03 Base: All primary care givers of 0 - 2s (W29 n = 1004) Delayed MMR Delayed any Nov 05

Delaying & refusing MMR: past and future Base: All primary care givers of 0-2s (W29 n = 1004) Delayed indefinitely, refused or would refuse in the future Postponed for reasons other than safety (since done/intend to do) Postponed for safety reasons (since done/intend to do) Rejected - delayed indefinitely/ refused outright 18% postponed for safety reasons or refuse

Which immunisations would not allow a future child to have (prompted) Base: All primary care givers of 0 - 2s (W29 n = 1004)

The Immunisation Process Information gathering

Sources of information consulted before immunisations were due (prompted) Base: All primary care givers of 0 - 2s (W29 n = 1004) Leaflets Healthcare/childcare magazine articles Immunisation appointment card Books Television adverts Women’s magazines Television programmes Internet Newspaper articles NHS Direct

Whether discussed immunisations with a health professional before the immunisations were due Base: All primary care givers of 0 - 2s (W29 n = 1004) Mar 03 Any Health Visitor GP Midwife May 04Nov 04May 05Sep 02 Practice Nurse Oct 03 Nov 05

Information gaps Information on side effects (7%) (8% at W28) More information in general on all aspects (6%) (6% at W28) The most frequently mentioned requests were for more general information 70% felt they had all the info about immunisation that they wanted before their child’s immunisations were due. No MMR related issue was mentioned by more than 2% of all respondents.

The Immunisation Process The decision process

Consent Base: All who accompanied their child for most recent immunisation (W29 n = 826) In writing Any consent May 04 Verbally Oct 03May 05Mar 03 Nov 04 Nov 05 *

The process of deciding to have child immunised – by age and social grade AGE SOCIAL GRADE Base: All primary care givers of 0 - 2s

The Immunisation Process Satisfaction

Base: All who accompanied their child on most recent visit (W29 n = 826) Satisfaction with most recent visit Some dissatisfaction (net) Not enough time to discuss issues Not given sufficient explanation Not able to ask questions Dissatisfied overall

Trust advice about immunisation given by HPs and government Nov 04 % Strongly Agree Mar 03 Health visitors GPs Practice nurses Oct 03 May 04 May 05 Nov 05 NHS Government Base: All primary care givers of 0 - 2s – Four-fifths sample

Media tracking

Activities of DH Immunisation Information Unit (January 2005 – January 2006) Conferences 11 ( delegates 5,115 ) Health professional seminars 74 Parents seminars 8 Parents research 2,000 interviews Health professionals research 1600 interviews Leaflets, posters, videos and factsheets 8,378,050 (highest month) 35,741 visitswww.immunisation.nhs.uk 19,535 visitswww.mmrthefacts.nhs.uk MMR ‘your questions answered’ 1,460

Immunisation communication - public perspectives. Public acceptability will be of increasing importance, irrespective of scientific virtues. The media provide the interface between immunisation programmes and the public. We cannot assume that the media share our views and we must recognise their independence. The public increasingly seek information on an active basis. The internet, where information is unregulated, contains much that is potentially wrong and harmful. We must compete effectively and dedicate as much effort to communicating on vaccines as we do on providing them.

Child protection