Evaluating interventions to stimulate acceptance of NIP vaccinations: the role of deliberation on experiences and values.
Twijfel over vaccinatie
De twijfel van ouders over de acceptatie van vaccinatie van hun kind(eren) staat in de top-10 van bedreigingen voor de gezondheid van de Wereldgezondheidsorganisatie (WHO). Op dit moment hebben we in Nederland onvoldoende zicht op de groep ouders die twijfelt over het accepteren van vaccinatie van hun kinderen. Dit onderzoek brengt deze situatie in kaart.
Ons eerdere onderzoek toonde aan dat reflectie op waarden en ervaringen voor ouders belangrijk is voor het besluiten tot wel of niet vaccineren van hun kind(eren). Omdat effectieve interventies om deze twijfel te verminderen schaars zijn, zijn vernieuwende interventies nodig. In dit onderzoek ontwikkelen we 2 interventies waarin reflectie op waarden en ervaringen wordt gestimuleerd. Eén aanpak omvat een online reflectie-instrument. De andere gaat over een specifieke wijze van gespreksvoering tijdens het informatiegesprek over vaccinatie van hun kind(eren). Het effect van deze interventies op de mate van twijfel en het vertrouwen van en de acceptatie van de vaccinatie(s) door ouders wordt gemeten en geëvalueerd.
Samenvatting van de aanvraag
Since several years, an increasing reluctance to accept vaccinations in general is noted.. This has led to renewed risks of morbidity and mortality by infectious diseases. In the Netherlands the national vaccination coverage also shows a decreasing trend line. According to the WHO SAGE Working Group on Vaccine Hesitancy, vaccine hesitancy refers to ‘delay in acceptance or refusal of vaccination despite availability of vaccination services’. Up to now, in response to the growing vaccine hesitancy, attempts to increase vaccination uptake have mainly focused on making the information provided about vaccination easier accessible and attuning it more to the information needs of the public. However, these adjustments have been insufficient to change the tide. Our previous research results provide a potential explanation for this. We demonstrated that decisional uncertainty is an important, so far not recognized, determinant and provides important cues for interventions. Further we observed that deliberation on experiences and values are important influential themes for parents in addition to factual information. An intervention aiming to reduce decisional uncertainty and to support parents in their decision making should therefore include, besides factual information, the possibility to share experiences and reflect on values. The interventions which we will develop in this study incorporate these elements, but still need an thorough scientific evaluation. Although we know there is an increase in vaccine hesitancy in the Netherlands, we have no baseline information on how hesitant the Dutch parent population is, how hesitancy is distributed among this population and which socio-demographic characteristics are related to hesitancy. This project will therefore perform the following two sub studies among parents who are offered a first National Immunisation Programme (NIP) vaccination for their child, aiming: 1. To determine how parents visiting the Child Health Clinic (CHC) in the Netherlands are distributed among the vaccine hesitancy spectrum, and to explore the relation between the socio-demographic characteristics of the parents and their position in the vaccine hesitancy spectrum. 2. To determine, in a proof-of-concept study, the estimated impact of interventions that include reflection on facts, values and experiences on informed decision making, decisional uncertainty, trust and vaccination uptake in parents who have to decide on acceptance of NIP vaccination for their child. In a first study we will perform a cross-sectional study in parents. Through a subset of Dutch CHCs parents will be asked to fill out a questionnaire on: intention to fully or partially vaccinate their child, level of hesitancy which they experience and socio-demographic characteristics. After the first study we will determine, in a proof-of-concept study, the estimated impact of interventions that include reflection on facts, values and experiences on informed decision making, decisional uncertainty, trust and uptake in parents who have to decide on acceptance of NIP vaccination for their child, by the following steps: develop the interventions; perform a proof-of-concept effect study; and perform a process evaluation. The interventions entail; A. an online deliberative tool, B. a structured individual consultation of a youth health professional (YHP), and C. a structured group consultation of a YHP with parents. All interventions will include reflection on experiences, facts and values. Intervention A and B will be tested in parents who are offered a first NIP vaccination for their child, and who indicate to be either hesitant in deciding about this issue or indicate to have the intention to refuse (part of) NIP vaccinations and compared to regular care. Through an inclusion protocol, which mimics real-life CHC practice, thereby taking in account (non)attendance to extra (study) consultations and (not) having used the online tool, we will be able to estimate the effects on informed decision making, decisional uncertainty, trust and uptake of: intervention A, intervention B, and of regular extra consultation as compared to regular care; of the additional effect of intervention A; and of intervention B as compared to the regular extra vaccination consultation. If during the preparation of study 2 developments at CHCs have progressed as such that as part of regular care group centered consultations on child health are offered to parents, we will evaluate intervention C. We aim to include 30 group consultations performing regular structure and 30 performing intervention C structure and compare group medians of informed decision making, decisional uncertainty, trust and uptake. A process evaluation study will be performed to assess actual uptake of each intervention. For both parents as well as YHP we will measure their opinion on feasibility, acceptance and satisfaction.