1. Do Sources of Parental Information Outside the Health Care Provider’s Office Vary by Immunization Status? Barbara Bardenheier, MPH MA National Immunization Program Centers for Disease Control and Prevention

2. BACKGROUND

3. Basis for Study
In an increasingly information-oriented world, doctors are being challenged in their offices by patients who come in with information.1
million Americans use Internet to find health information each year2
Increase in non-traditional sources of vaccination information
Source (1) Marco, Phys Exec, 2002.
Source (2) Chatterjee, Clin Inf Dis, 2003.

4. Objective
Identify sources of immunization information parents used outside the health care provider’s office
Determine if sources of information varied by
children’s immunization status

5. METHODS

6. Survey Method
NIS-KAP: National Immunization Survey –Knowledge, Attitudes and Practices
Survey of a sample households participating in the National Immunization Survey (6 quarters)
Quarterly random-digit dialing survey

7. Participants
Parents of children aged months were interviewed by telephone

8. Study Design
Case-Control study with three case (NUTD) / control (UTD) groups
Vaccination Status determined from NIS: provider confirmed
UTD: 4:3:1:3:3:1
Measles containing vaccine (MCV): NUTD: received 0 doses
Diphtheria/Tetanus/Pertussis (DTP/DTaP): NUTD: 0-2 doses
Hepatitis B: NUTD: doses

9. Survey Instrument Questionnaire: Sources of immunization information
Type of information sought
Effect of information from various sources
Reliance on information from these sources
Agreement with information

10. Analysis
Data were weighted using SUDAAN to make results generalizable to the population within the strata sampled
Subgroup analyzed included those who obtained immunization information from source other than doctor or nurse ~33%

11. Analysis
Bivariate Analyses were performed using χ2 test of association and logistic regression
Adjusted Odds ratios were adjusted for race, firstborn status, income, and child’s age

12. Response Rate 2,748 out of 5,760 (47.7%) eligible households responded
12 children were excluded because their providers verified additional immunizations after stratification process which rendered them misclassified

13. RESULTS

14. Vaccination Status: Subpopulation of those who got IZ Info from source other than primary doctor/nurse
MCV
n = 558
DTP/DTaP
n = 447
Hepatitis B
n = 412
NUTD
341 (53%)
265 (50%)
227 (27%)
UTD
217 (47%)
182 (50%)
185 (73%)

15. Sources of Information: MCV

16. Sources of Information: DTP

17. Sources of Information: Hepatitis B

18. Important Source for Immunization Decisions
Newspapers/Magazine #1 source for decisions other than primary doc/nurse for all groups
Followed by family/friends, books
Internet 4th for all groups
No significant differences between NUTD/UTD for any group

19. What type of information did they seek?
MCV/MMR
DTP/DTaP
Hep B
NUTD v UTD %
General info
89 v 95
88 v 91
91 v 95
Disease prevented
90 v 94
90 v 88
97 v 96
Side effects
92 v 91
91 v 90
Vaccine efficacy
81 v 78
82 v 80
86 v 80

20. Information Received Increased Concern about Vaccines
Source of Information
MCV/MMR
DTP/DTaP
Hep B
NUTD v UTD %
NP/Magazines
34 v 28
38 v 38
35 v 37
Family/Friend
33 v 46
28 v 46
23 v 27
Internet
25 v 20
24 v 29
53 v 22
Other
20 v 16
21 v 18
28 v 23

21. Did Parents Rely on the Internet for Immunization information?
MCV/MMR
DTP/DTaP
Hep B
NUTD v UTD %
Agree
23 v 26
23 v 23
25 v 24
Neutral
15 v 21
14 v 23
25 v 20
Disagree
61 v 53
63 v 54
50 v 56

22. Were Parents Likely to Believe Information Obtained from Non-Medical Source?
MCV/MMR
DTP/DTaP
Hep B
NUTD v UTD %
Agree
20 v 22
19 v 21
23 v 19
Neutral
8 v 10
7 v 11
10 v 10
Disagree
73 v 68
74 v 68
67 v 71

23. Adjusted Analyses MCV/MMR DTP/DTaP Hep B Source of information
NUTD v UTD
AOR (95%CI)
AOR (95%CI)
Source of information
Internet
0.6 (0.3, 1.3)
0.4 (0.2,1.0)
0.5 (0.2, 1.3)
Day Care/Sch
27.4 (3.2, 233.8)
5.9 (1.1,31.6)
6.6 (1.0, 43.9)
AOR: adjusted for race, income, child’s age, firstborn status
AOR: adjusted for race

24. Adjusted Analyses MCV/MMR DTP/DTaP Hep B
NUTD v UTD
AOR (95%CI)
Effect from information from Internet
Less Concern
referent
More Concern
0.7 (0.1, 4.1)
0.0(0.0,0.2)
11.3 (1.5,83.9)
AOR: adjusted for race, income, child’s age, firstborn status

25. SUMMARY

26. Summary
Overall, 2/3 of respondents did not report obtaining immunization information outside the provider’s office
Of the 1/3 who obtained outside information, the number 1 source for immunization information was newspaper/magazines, followed by family/friends, books, and the internet

27. Summary After adjusting for confounders
No significant difference between NUTD and UTD in type of information obtained
In MCV and DTP groups, NUTD were more likely to report getting information from day care/school
DTP UTD and HepB NUTD more likely to report the internet increased concern with vaccine safety

28. Summary
About 20% of all respondents believed information obtained from non-medical sources
About 1/4 of NUTD and UTD in all groups reported they relied on the internet for immunization information
For most parents vaccination decisions did not appear to be impacted by sources of information other than primary doc/nurse

29. Limitations/Strengths
Nested design of some questions reduced number of respondents
Limited ability to perform multivariate analysis
No other study has examined sources of vaccination information obtained outside providers’ office with provider-confirmed vaccination status of children, OR on a national level

30. Implications
Primary care visits are good opportunity to convey benefits/risks of vaccinations
Strategies and tools are needed to facilitate communication during primary care visits
Among MCV and DTP groups, NUTD groups reporting getting information from day care/school
Could be to get child in without delay
Further research

31. Implications
One-fourth of all respondents reported they rely on the internet for immunization information
HepB NUTD and DTP UTD reported internet increased concern
Internet is an increasingly popular information source
Future Research: parental internet site selection for immunization information

32. Acknowledgements Abt Associates Jeanne Santoli Kris Sheedy Lawrence Barker Susan Chu