Page 55 - Preventing pertussis in early infancy - Visser

Chapter 4
QuantQituaatinvteitsatuivdeysptuardeynptsarents
FigureFi1g.uTrehe1o.rTehtiecoarleftriacmalefwraomrkefwoorrpkefrotruspseisrtcuoscsoisocnoincogovnaicncginvatcicoinatcicoenpatacncecpetwanitcheawnith an
Figure 1. Theoretical framework for pertussis cocooning vaccination acceptance with an
overvioevwerovfietwheomf tehaesumredasiuteremdsitweimthsinwiinthteintiinotne,nptisoync,hposyochiaolsdoectiaelrmdeintearnmtsinaanndtsatatnitdudatintiatul dinal
beliefbs eliefs
overview of the measured items within intention, psychosocial determinants and attitudinal
voluntary vaccination programme was found in all groups – HCWs and parents – it was
beliefs
particularly explicit among maternity assistants. Maternity assistants associated a
compulsory programme with a loss of individual freedom. This was especially true for those HCWs whose employers had demanded them to get a vaccination quite forcefully during the influenza A H1N1 pandemic (on penalty of no longer being allowed to work), or who felt controlled by clients who phoned their employer to find out whether they were vaccinated. This was experienced as a violation of their privacy, and as disrespectful of their opinion. They expressed a strong feeling that their rights were then violated, and in case of future similar situations will have the tendency to not blindly trust a vaccination offer anymore. Making vaccination mandatory might therefore have a negative influence on future vaccination acceptance. Both the specific support for voluntary vaccination and the potential adverse effects of mandatory vaccination indicate a voluntary setting is the better alternative.
Table 1. Examples of the support for voluntary vaccination in focus group discussions and interviews with parents, maternity assistants, midwives and paediatric nurses
Focus group 3, midwives
BaWsehdaotBnwaRsoeudaldsoynoeRudetahAsicontnkioeondfAcpocpmtiroponuaAlcshpopr(ydroavrakchgcrin(edayat)ri,okpngr?erevyio),upsrqeuvaioliutastqivuearlietasetiavrecrheasneadrlcitheraantdurlietesreaatrucrhe (sleigahrtchgr(eliyg)ht grey) Based on Reasoned Action Approach (dark grey), previous qualitative research and literature search (light grey)
You cannot impose that on somebody.
Quantititatitive study parents
Mandatory versus voluntay
Mandatory versus voluntary
I would not do it.
MeasurMedeaitseumresdwiittehminspweirtshoinapledrestoenraml idneatnetrsmairneansutsmamreasriusmedminarbiseelodwin. below.
Measured items within personal determinants are summarised in below. No, I would not do it either.
Focus group 1, parent
VariableVsariables NumbeNr umRbelriabilRiteyliabEilxitaymplEexqaumepstleioqnusestions
Variables Number Reliability Example questions
You can never make this compulsory. No, if they do not want it (i.e. the vaccination, OV) themselves...... It is a personal
of itemos f items
responsibility that people should take.
of items
IntentioIntention 3
the best intentions, but well, if you take away the choice from people they will say: it is my body into which you want to
5 α .906 α .906If I wereIftIowaecrceptot acpcerptut saspisecrotucsosoisnicnogcvoaocnciingavtiaocncinatthioenfiirnsthmeofnirtsht month
Intention
3 α .926 I were to accept a pertussis cocooning vaccination in the first month after
3 α .926 α .926I were tIowaecrceptot acpcerptut saspisecrotucsosoisnicnogcovaocnciingatviaocncinatthioenfiirnsthmeofnirtsht amftoenrth after
deliveryd,eiflivitewryo,uiflditbweouflfderbeedo. (fdferfeinda.t(edleyfninoatte–lydenfointa–tedleyf)inately)
PsychosPoscyicahl osocial
determdineatnetrsminants
Interview 1, paediatric nurses
delivery, if it would be offered. (definately not – definately) Compulsory, no. (...) because it is important to decide about your own body. I think that’s it. Yes, even though it is done with
Psychosocial
inject something.
determinants
Focus group 3, nurses
AttitudeAttitude 5
Attitude
I think compulsion is very difficult. It is like if you don’t vaccinate yourself then you cannot work with children from 0 to 6
Perceived control
5 α .906 If I were to accept a pertussis cocooning vaccination in the first month
afterdealifvteryd,eIlwiveoruyld,Icwonosuildecrotnhsisid(enrothimisp(noortaimntp–oirmtapnotr–taimntp)ortant)
after delivery, I would consider this (not important – important) months. (...) I would not be in favour of that. I am not ready for that. (...) I think freedom of opinion is very important. This is
SocialnSoormcialnorm 7 7 α.836α.836IthinkmItohsitnpkamreonstspoafreanteswobfoarnewebroerntowaecrceptotacpcerptutsaspisecrotucsosoisnicnogcooning
Social norm 7 α .836 I think most parents of a newborn were to accept a pertussis cocooning
a step too far for me.
vaccinavtiaocnc,inifaotifofenr,eifdoinffethredfiirnsthmeofnirtsht amftoenrtdhealifvteryd(edliovenroyt(adgoreneot–agree –
Focus group 1, maternity assistants
vaccination, if offered in the first month after delivery (do not agree –
(..) what I disliked was the letter (by the employer, OV) PerceivePdercoenivterodlcontrol
agree) agree)
agree)
That came across really coercive, like: you need to get that shot or otherwise you won’t be planned into the work schedule.
PerceivePderccaepivaecditycapac2ity 2 r .801 r .801 If I wereIftIowberoeftfoerbeedoaffpeerretdusaspisecrotucsosoisnicnogcovaocnciningavtiaocncinatthioenfiirnsthmeofnirtsht month Perceived capacity 2 r .801 If I were to be offered a pertussis cocooning vaccination in the first month
It was about families who started to call to ask whether we were vaccinated. They could refuse us. I immediately thought:
after dealifvteryd,eIltivruersyt,IIwtrousldt Ibweoaublldebtoe gaebtlevtaoccgientavteadc.ci(ndaotendo.t(adgoreneot–agree –
after delivery, I trust I would be able to get vaccinated. (do not agree –
that will turn off our colleagues. I would never call a centre of maternity assistants to ask whether the maternity assistants
PerceivePderceived 1 1 Perceived
n.a. n.a. If I wereIftIowberoeftfoerbeedoaffpeerretdusaspisecrotucsosoisnicnogcovaocnciningavtiaocncinatthioenfiirnsthmeofnirtsht month
agree) agree)
agree)
were vaccinated or not. I would never have done that. So if there are people who do that, I don’t want to work there.
1 n.a. If I were to be offered a pertussis cocooning vaccination in the first month I thought it was important that our privacy was at play here.
autonomauytonomy after dealifvteryd,eitliviseuryp, tiot ims ueptotodmeceidteo odnecaidcceeopntaaticocnep(dtaotinoont(adgoreneot–agree – autonomy after delivery, it is up to me to decide on acceptation (do not agree –
affect affect
I think it annoying and they don’t need to know everything (...)
Focus group 2, maternity assistants
affect
agree) agree)
agree)
DecisionDaelcuisniocenratlauintcyertain3ty 3 α .876 α .876The decTishioendeocnisaioccneopntaancceopftanpcerotuf saspisecrotucsosoisnicnogcovaocnciningavtiaocncifneaetlsion feels
Decisional uncertainty 3 α .876 The decision on acceptance of a pertussis cocooning vaccination feels
A little social pressure, team consultation, that is all right. But (....) you should not force your opinion on others.
Not force your opinion, no.
(secure – doubtfull)
AnticipaAtnedticnipeagtaetdivneegative
Anticipated negative
We don’t like ‘have to’, but advice is acceptable.
(secure(–sedcouurbet–fudllo)ubtfull)
Non accNeopntaancceptance3 3 α .756 α .756ImagineImyoaugidniedynoutdaicdcenpotacpcerptutsaspisecrotucsosoisnicnogcovaocnciingatviaocnciannadtioynouarnd your Non acceptance 3 α .756 Imagine you did not accept a pertussis cocooning vaccination and your
Acceptance 4
Effort to make an informed and deliberate choice
child falclshildl wfaitllhs pillewrtuitshspise, rhtouwssiws,ohuoldwywoouufledeyl?o(unfoetegl?ui(lntyot–guiillty)– guilty)
child falls ill with pertussis, how would you feel? (not guilty – guilty)
AcceptaAncceptance 4 4 α.846α.846ImagineImyoaugidniedyaocucedpidtacpcerptutsaspisecrotucsosoisnicnogcvoaocnciingavtiaocnc,inhaotwiown,ohuoldwywoouuldyou
α .846 Imagine you did accept a pertussis cocooning vaccination, how would you
feel? (nfoetecl?on(nceortnceodnc–ecronnecde–rnceodn)cerned)
feel? (not concerned – concerned)
Respondents in the focus group meetings and interviews experienced difficulties in 55 55 54 making an informed and deliberate choice (examples are shown in Table 2). Some
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