Page 63 - Preventing pertussis in early infancy - Visser

Chapter 4
Quantitative study parents
comparable to other Public Health vaccination information. This would also be offered when pertussis cocooning vaccination would really be implemented in the Netherlands.
Second, generalisability and possible selection bias are issues in this study. We were unable to determine the response rate due to our inclusion strategy, in which it was not possible to determine how many questionnaires were actually handed out to the parents. We were also unable to send parents a reminder to fill in the questionnaire and to perform a non-response analysis. However, we chose the advantage of personal contact with a trusted health provider over the security of knowing the exact response rate and the possibility to send reminders.. This trust in the relationship with a known healthcare provider could also lead to selection bias. However, in the Netherlands almost all parents visit their neighbourhood CWC with their child to monitor growth and development (Statistics Netherlands 2009). Therefore, selection as a result of the matching beliefs of health providers and patients is not likely to be a real issue here. As the instruction to the CWC was to ask all parents (either one or four weeks postpartum, as stated in the methods section) in the research period, and participants originated from different geographical locations throughout the Netherlands, the inclusion method should have had limited selective influence. Furthermore, the relatively long and wordy questionnaire could have led to selection of better educated respondents. As our study sample shows a minor overrepresentation of participants that completed higher education (51.8% vs 45% in the general population between 25-35 years of age (Statistics Netherlands 2016)), therefore our results need to be interpreted with more caution for the low educated Dutch parents.
Third, some psychosocial determinants were measured with only one item. Therefore the measurement specificity might have been reduced, influencing the real relationship between these determinants and intention. However, all the different determinants were still strongly related to intention. Also, we had to exclude some determinants from the analysis since they showed little variability.
Finally, this study only focused on the personal and psychosocial determinants of potential vaccine recipients. It is clear that the context in which the vaccination is offered is of equal importance in the design of an effective intervention. For example, the attitude of healthcare workers towards pertussis cocooning, and logistical or financial barriers can also influence the actual vaccination uptake (Goins et al. 2007, Miller et al. 2011, Beel et al. 2013, Wiley et al. 2013, Rossmann Beel et al. 2014, Hayles et al. 2015, O'Leary et al. 2015). By using a theory- and evidence-based structural method such as Intervention Mapping, it is possible to take factors on all ecological levels into account in the design of an effective vaccination programme (Kok et al. 2016).
Conclusion
We conclude that the intention to accept a pertussis cocooning vaccination amongst parents responding to this study is high. It is important to secure that intention is translated into actual uptake upon implementation of pertussis cocooning by addressing the determinants that influence acceptance. This study presents a robust theoretical framework,
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