Abstract
BACKGROUND: The uptake of the combined measles, mumps and rubella immunisation (MMR) in Britain has fallen since 1998, when a link was hypothesised with the development of bowel disorders and childhood autism. Despite reassurances about the safety of MMR, uptake levels remain lower than optimal. We need to understand what influences parents' decisions on whether to accept MMR or not so that health professionals can provide a service responsive to their needs. AIM: To investigate what influences parents' decisions on whether to accept or refuse the primary MMR immunisation and the impact of the recent controversy over its safety. DESIGN: Qualitative study using focus group discussions. SETTING: Forty-eight parents, whose youngest child was between 14 months and three years old, attended groups at community halls in six localities in Avon and Gloucestershire. METHODS: Purposive sampling strategy was used to include parents from a variety of socioeconomic backgrounds. Three groups comprised parents who had accepted MMR and three groups comprised parents who had refused MMR. Data analysis used modified grounded theory techniques incorporating the constant comparative method. RESULTS: All parents felt that the decision about MMR was difficult and stressful, and experienced unwelcome pressure from health professionals to comply. Parents were not convinced by Department of Health reassurances that MMR was the safest and best option for their children and many had accepted MMR unwillingly. Four key factors influenced parents' decisions: (a) beliefs about the risks and benefits of MMR compared with contracting the diseases, (b) information from the media and other sources about the safety of MMR, (c) confidence and trust in the advice of health professionals and attitudes towards compliance with this advice, and (d) views on the importance of individual choice within Government policy on immunisation. CONCLUSIONS: Parents wanted up-to-date information about the risks and benefits of MMR to be available in advance of their immunisation appointment. Many parents did not have confidence in the recommendations of health professionals because they were aware that GPs needed to reach immunisation targets. Most parents would, however, welcome more open discussion about immunisation with health professionals.
Full Text
The Full Text of this article is available as a PDF (81.3 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bedford H., Elliman D. Concerns about immunisation. BMJ. 2000 Jan 22;320(7229):240–243. doi: 10.1136/bmj.320.7229.240. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bond L., Nolan T., Pattison P., Carlin J. Vaccine preventable diseases and immunisations: a qualitative study of mothers' perceptions of severity, susceptibility, benefits and barriers. Aust N Z J Public Health. 1998 Jun;22(4):441–446. doi: 10.1111/j.1467-842x.1998.tb01411.x. [DOI] [PubMed] [Google Scholar]
- DeWilde S., Carey I. M., Richards N., Hilton S. R., Cook D. G. Do children who become autistic consult more often after MMR vaccination? Br J Gen Pract. 2001 Mar;51(464):226–227. [PMC free article] [PubMed] [Google Scholar]
- Duffell E. Attitudes of parents towards measles and immunisation after a measles outbreak in an anthroposophical community. J Epidemiol Community Health. 2001 Sep;55(9):685–686. doi: 10.1136/jech.55.9.685. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Elliman D. A., Bedford H. E. MMR vaccine--worries are not justified. Arch Dis Child. 2001 Oct;85(4):271–274. doi: 10.1136/adc.85.4.271. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Elwyn G., Edwards A., Gwyn R., Grol R. Towards a feasible model for shared decision making: focus group study with general practice registrars. BMJ. 1999 Sep 18;319(7212):753–756. doi: 10.1136/bmj.319.7212.753. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fleming P. J., Blair P. S., Platt M. W., Tripp J., Smith I. J., Golding J. The UK accelerated immunisation programme and sudden unexpected death in infancy: case-control study. BMJ. 2001 Apr 7;322(7290):822–822. doi: 10.1136/bmj.322.7290.822. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fombonne E. Inflammatory bowel disease and autism. Lancet. 1998 Mar 28;351(9107):955–955. doi: 10.1016/S0140-6736(05)60608-3. [DOI] [PubMed] [Google Scholar]
- Kaye J. A., del Mar Melero-Montes M., Jick H. Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis. BMJ. 2001 Feb 24;322(7284):460–463. doi: 10.1136/bmj.322.7284.460. [DOI] [PMC free article] [PubMed] [Google Scholar]
- King S. Vaccination policies: individual rights v community health. We can't afford to be half hearted about vaccination programmes. BMJ. 1999 Dec 4;319(7223):1448–1449. doi: 10.1136/bmj.319.7223.1448. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kitzinger J. Qualitative research. Introducing focus groups. BMJ. 1995 Jul 29;311(7000):299–302. doi: 10.1136/bmj.311.7000.299. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Meszaros J. R., Asch D. A., Baron J., Hershey J. C., Kunreuther H., Schwartz-Buzaglo J. Cognitive processes and the decisions of some parents to forego pertussis vaccination for their children. J Clin Epidemiol. 1996 Jun;49(6):697–703. doi: 10.1016/0895-4356(96)00007-8. [DOI] [PubMed] [Google Scholar]
- Pareek M., Pattison H. M. The two-dose measles, mumps, and rubella (MMR) immunisation schedule: factors affecting maternal intention to vaccinate. Br J Gen Pract. 2000 Dec;50(461):969–971. [PMC free article] [PubMed] [Google Scholar]
- Peltola H., Patja A., Leinikki P., Valle M., Davidkin I., Paunio M. No evidence for measles, mumps, and rubella vaccine-associated inflammatory bowel disease or autism in a 14-year prospective study. Lancet. 1998 May 2;351(9112):1327–1328. doi: 10.1016/S0140-6736(98)24018-9. [DOI] [PubMed] [Google Scholar]
- Petrovic M., Roberts R., Ramsay M. Second dose of measles, mumps, and rubella vaccine: questionnaire survey of health professionals. BMJ. 2001 Jan 13;322(7278):82–85. doi: 10.1136/bmj.322.7278.82. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pope C., Ziebland S., Mays N. Qualitative research in health care. Analysing qualitative data. BMJ. 2000 Jan 8;320(7227):114–116. doi: 10.1136/bmj.320.7227.114. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Simpson N., Lenton S., Randall R. Parental refusal to have children immunised: extent and reasons. BMJ. 1995 Jan 28;310(6974):227–227. doi: 10.1136/bmj.310.6974.225. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Thomas D. R., Salmon R. L., King J. Rates of first measles-mumps-rubella immunisation in Wales (UK) Lancet. 1998 Jun 27;351(9120):1927–1927. doi: 10.1016/s0140-6736(98)24026-8. [DOI] [PubMed] [Google Scholar]
- Wakefield A. J., Murch S. H., Anthony A., Linnell J., Casson D. M., Malik M., Berelowitz M., Dhillon A. P., Thomson M. A., Harvey P. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998 Feb 28;351(9103):637–641. doi: 10.1016/s0140-6736(97)11096-0. [DOI] [PubMed] [Google Scholar]
