Sage Journals: Discover world-class research

Abstract

Recent increases in childhood vaccine exemption rates are a source of concern within the public health community. Drawing from the health belief model and in-depth interviews with 50 mothers (n = 50) who refused one or more vaccine, the aim of this study was to identify the specific reasons and the broader decision context(s) that underscored participants’ vaccine refusal. Results indicate that the vast majority of participants supported vaccination until a particular cue motivated them to consider otherwise, and qualitative analysis identified three main categories into which these cues fell: perceived adverse reactions, endorsements from health care professionals, and perceived contradiction among expert-endorsed messages. These categories point to the central role of health communication in motivating vaccine refusal. Better understanding these cues can inform vaccine communication scholarship and practice, and also lend theoretical insight into the intertextual nature of controversial health messages and decisions.

Keywords

vaccination vaccine refusal health belief model interviews mothers qualitative United States of America North America North Americans thematic analysis research strategies qualitative methods

Get full access to this article

View all access options for this article.

References

Allen

(2007). Vaccine: The controversial story of medicine’s greatest lifesaver. New York: W.W. Norton.

Atwell

J. E.

Van Otterloo

Zipprich

Winter

Harriman

Salmon

D. A.

. . . Omer

S. B.

(2013). Nonmedical vaccine exemptions and pertussis in California, 2010. Pediatrics, 132, 624–630.

Bee

(Writer). (2014, June 2). An outbreak of liberal idiocy. On The Daily Show [Television series episode]. Retrieved http://thedailyshow.cc.com/videos/g1lev1/an-outbreak-of-liberal-idiocy

Birnbaum

M. S.

Jacobs

E. T.

Ralston-King

Ernst

K. C.

(2013). Correlates of high vaccination exemption rates among kindergartens. Vaccine, 31, 750–756.

Bowen

G. A.

(2008). Naturalistic inquiry and the saturation concept: A research note. Qualitative Research, 8, 137–152.

Brown

J. B.

Stewart

Ryan

B. L.

(2003). Outcomes of patient provider interaction. In Thompson

T. L.

Dorsey

Miller

K. I.

Parrot

(Eds.), Handbook of health communication (pp. 141–162). New York: Routledge.

Brown

K. F.

Kroll

J. S.

Hudson

M. J.

Ramsay

Green

Long

S. J.

Sedvalis

(2010). Factors underlying parental decisions about combination childhood vaccinations including MMR: A systematic review. Vaccine, 28, 4235–4248.

Burke

L. A.

Miller

M. K.

(2001). Phone interviewing as a means of data collection: Lessons learned and practical recommendations [30 paragraphs]. Forum Qualitative Sozialforschung/Forum: Qualitative Social Research, 2(2), Article 7. Retrieved from http://www.qualitative-research.net/index.php/fqs/article/view/959/2094

Centers for Disease Control and Prevention. (2016). Measles, mumps, and rubella (MMR) vaccination: What everyone should know. Retrieved from https://www.cdc.gov/vaccines/vpd/mmr/public/

10.

Centers for Disease Control and Prevention. (2017a). Immunization schedules. Retrieved from http://www.cdc.gov/vaccines/schedules/

11.

Centers for Disease Control and Prevention. (2017b). Influenza vaccination information for health care workers. Retrieved from https://www.cdc.gov/flu/healthcareworkers.htm

12.

Champion

V. L.

Skinner

C. S.

(2008). The health belief model. In Glazz

Rimer

B. K.

Viswanath

(Eds.), Health behavior and health education: Theory, research, and practice (4th ed., pp. 45–66). San Francisco: Jossey-Bass.

13.

Chen

M. F.

Wang

R. H.

Schneider

J. K.

Tsai

C. T.

Jiang

D. D. S.

Hung

M. N.

Lin

L. J.

(2011). Using the health belief model to understand caregiver factors influencing childhood influenza vaccinations. Journal of Community Health Nursing, 28, 29–40.

14.

Corbin

J. M.

Strauss

A. L.

(2008). Basics of qualitative research: Techniques and procedures for developing grounded theory (3rd ed.). Los Angeles: Sage.

15.

Devault

M. L.

(2004). Talking and listening from women’s standpoint: Feminist strategies for interviewing and analysis. In Hesse-Biber

S. N.

Yaiser

M. L.

(Eds.), Feminist perspectives on social research (pp. 227–250). New York: Oxford University Press.

16.

Donadiki

E. M.

Jiménez-García

Hernández-Barrera

Sourtzi

Carrasco-Garrido

de Andrés

A. L.

. . . Velonakis

E. G.

(2014). Health belief model applied to non-compliance with HPV vaccine among female university students. Public Health, 128, 268–273.

17.

Feemster

Offit

(2013). Delaying vaccination is not a safer choice. JAMA Pediatrics, 167, 1097–1098.

18.

Feikin

D. R.

Lezotte

D. C.

Hamman

R. F.

Salmon

D. A.

Chen

R. T.

Hoffman

R. E.

(2000). Individual and community risks of measles and pertussis associated with personal exemptions to immunization. Journal of the American Medical Association, 284, 3145–3150.

19.

Freed

G. L.

Clark

S. J.

Butchart

A. T.

Singer

D. C.

Davis

M. M.

(2010). Parental vaccine safety concerns in 2009. Pediatrics, 125, 654–659.

20.

Gahr

DeVries

Wallace

Miller

Kenyon

Sweet

. . . Lynfield

(2014). An outbreak of measles in an undervaccinated community. Pediatrics, 134, e220–e228.

21.

Gellin

B. G.

Maibach

E. W.

Marcuse

E. K.

(2000). Do parents understand immunizations? A national telephone survey. Pediatrics, 106, 1097–1102.

22.

Guest

Bunce

Johnson

(2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18, 59–82.

23.

Harmsen

I. A.

Doorman

G. G.

Mollema

Ruiter

R. A.

Kok

de Melker

H. E.

(2013). Parental information-seeking behaviour in childhood vaccinations. BMC Public Health, 13, Article 1219.

24.

Hays

(1996). The cultural contradictions of motherhood. New Haven, CT: Yale University Press.

25.

Hochbaum

G. M.

(1958). Public participation in medical screening programs: A sociopsychological study. Washington, DC: U.S. Government Printing Office.

26.

Hotez

P. J.

(2017, February 8). How the anti-vaxxers are winning. The New York Times, p. A25.

27.

Institute of Medicine. (2013). The childhood immunization schedule and safety: Stakeholder concerns, scientific evidence, and future studies. Washington, DC: The National Academies Press. doi:10.17226/13563

28.

Janz

N. K.

Becker

M. H.

(1984). The health belief model: A decade later. Health Education Quarterly, 11, 1–47.

29.

Kaiser Family Foundation. (2005). Women and health care: A national profile. Retrieved from http://www.kff.org/womenshealth/7336.cfm

30.

Kata

(2010). A postmodern Pandora’s box: Anti-vaccination misinformation on the Internet. Vaccine, 28, 1709–1716.

31.

Kennedy

A. M.

Brown

C. J.

Gust

D. J.

(2005). Vaccine beliefs of parents who oppose compulsory vaccination. Public Health Report, 120, 252–258.

32.

Kluger

(2010, April 15). Lady Madonna. Time. Retrieved from http://www.time.com/time/specials/packages/article/0288041982175_1982185_198220700.html

33.

Kodish

(2014, June 26). The ethical negligence of parents who refuse to vaccinate their children. The Washington Post. Retrieved from http://www.washingtonpost.com/news/to-your-health/wp/2014/06/26/the-ethical-negligence-of-parents-who-refuse-to-vaccinate-their-children/

34.

Larson

Leask

Aggett

Sevdalis

Thompson

(2013). A multidisciplinary research agenda for understanding vaccine related decisions. Vaccines, 1, 293–304. doi:10.3390/vaccines1030293

35.

Lindlof

T. R.

Taylor

B. C.

(2002). Qualitative communication research methods (2nd ed.). Thousand Oaks, CA: Sage.

36.

Luthy

K. E.

Beckstrand

R. L.

Callister

L. C.

Cahoon

(2012). Reasons parents exempt children from receiving immunizations. Journal of School Nursing, 28, 153–160.

37.

Mackendrick

(2014). More work for mother: Chemical body burdens as a maternal responsibility. Gender & Society, 28, 705–728.

38.

Mattson

(1999). Toward a reconceptualization of communication cues to action in the health belief model: HIV test counseling. Communications Monographs, 66, 240–265.

39.

May

Silverman

R. D.

(2003). “Clustering of exemptions” as collective action threat to herd immunity. Vaccine, 21, 1048–1051.

40.

Merck. (2013). MMRII. Retrieved from http://www.merck.com/product/usa/pi_circulars/m/mmr_ii/mmr_ii_pi.pdf

41.

Mnookin

(2011). The panic virus: A true story of medicine, science, and fear. New York: Simon & Schuster.

42.

Morse

J. M.

(1995). The significance of saturation. Qualitative Health Research, 5, 147–149.

43.

Nyhan

Reifler

Richey

Freed

G. L.

(2014). Effective messages in vaccine promotion: A randomized trial. Pediatrics, 133, e835–e842.

44.

O’Leary

S. T.

Allison

M. A.

Fisher

Crane

Beaty

Hurley

. . . Kempe

(2015). Characteristics of physicians who dismiss families for refusing vaccines. Pediatrics, 136, 1103–1111.

45.

Omer

S. B.

Richards

J. L.

Ward

Bednarczyk

R. A.

(2012). Vaccination policies and rates of exemption from immunization, 2005-2011. New England Journal of Medicine, 367, 1170–1171.

46.

Omer

S. B.

Salmon

D. A.

Orenstein

W. A.

deHart

M. P.

Halsey

(2009). Vaccine refusal, mandatory immunization, and the risks of vaccine preventable diseases. New England Journal of Medicine, 360, 1981–1988.

47.

Petts

Niemeyer

(2004). Health risk communication and amplification: Learning from the MMR vaccination controversy. Health, Risk, and Society, 6, 7–23.

48.

Poland

B. D.

(1995). Transcription quality as an aspect of rigor in qualitative research. Qualitative Inquiry, 1, 290–310.

49.

Porter

(1988). The politics of prevention: Anti-vaccinationism and public health in nineteenth-century England. Medical History, 32, 231–252.

50.

Rosenstock

I. M.

(1974). Historical origins of the health belief model. Health Education Monographs, 2, 328-335.

51.

Santoli

J. M.

Szilagyi

P. G.

Rodewald

L. E.

(1998). Barriers to immunization and missed opportunities. Pediatric Annals, 27, 366–374.

52.

Shoenfeld

Agmon-Levin

(2011). “ASIA”—Autoimmune/inflammatory syndrome induced by adjuvants. Journal of Autoimmunity, 36, 4–8.

53.

Smith

P. J.

Chu

S. Y.

Barker

L. E.

(2004). Children who have received no vaccines: Who are they and where do they live? Pediatrics, 114, 187–195.

54.

Smith

P. J.

Humiston

S. G.

Marcuse

E. K.

Zhao

Dorell

C. G.

Howes

Hibbs

(2011). Parental delay or refusal of vaccine doses, childhood vaccination coverage at 24 months of age, and the health belief model. Public Health Reports, 126(Suppl. 2), 135–146.

55.

Sugarman

S. D.

(2007). Cases in vaccine court: Legal battles over vaccines and autism. New England Journal of Medicine, 357, 1275–1277.

56.

Tayloe

(2015, February 2). When vaccines are refused, what doctors must do. The News & Observer. Retrieved from http://www.newsobserver.com/opinion/op-ed/article10246412.html

57.

Tomljenovic

Shaw

C. A.

(2011). Do aluminum vaccine adjuvants contribute to the rising prevalence of autism? Journal of Inorganic Biochemistry, 105, 1489–1499.

58.

U.S. Department of Health and Human Services, Healthy People 2020. (2011, June 29). Immunization and infectious diseases. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicId=23

59.

Vardeman

J. E.

Aldoory

(2008). A qualitative study of how women make meaning of contradictory media messages about the risks of eating fish. Health Communication, 23, 282–291.

60.

Winett

L. B.

Wulf

A. B.

Wallack

(2016). Framing strategies to avoid mother-blame in communicating the origins of chronic disease. American Journal of Public Health, 106, 1369–1373.

61.

Witte

(1992). Putting the fear back into fear appeals: The extended parallel process model. Communication Monographs, 59, 329–349.

62.

World Health Organization, UNICEF, World Bank. (2009). State of the world’s vaccines and immunization (3rd ed.). Geneva, Switzerland: World Health Organization.

An Ounce of Prevention: Identifying Cues to (In)Action for Maternal Vaccine Refusal

Abstract

Keywords

Get full access to this article

References