Responding to parents who request NMEs

1. How many times per month would you say the health department receives a request for a nonmedical exemption?

2. What are the most common reasons for this request?

3. What are some difficulties your organization faces when trying to respond to parents requesting nonmedical exemptions?

Implementation of Mandated Education

1. To get us started, can you please provide a general description of your educational mandate program?

2. Who oversees creation of the educational programs that you deliver?

3. What information is provided regarding the risks and benefits of vaccines? a. Probe: Where do you get the information?

4. Can you describe how your organization delivers the education? a. Probe: Who delivers the education, location, and time usually spent? b. Probe: What formats do you use to deliver education – verbal (over the phone, face-to-face), written, graphics, web-based?

5. How long has this program been in effect? a. Have there been any major changes to the information provided, or format in which it is provided, since the start of this program? i. Probe: How have previous infectious disease outbreaks in your state or nationwide affected this education policy? Is there anything else affecting this policy?

6. What is the biggest challenge in the implementation of the educational mandate? a. How does your organization plan to address these challenges?

7. (For states in which health-care professionals are mandated to deliver education) I understand that your state uses health-care professionals as part of the education process. What is their role? a. What kind of contact do you have with the health-care professionals delivering vaccine education?

8. How do you work with other groups to deliver education? a. Can you describe other groups that you think should be responsible for delivering education?

State Vaccination and Exemption Rates

1. How do you think the educational mandate has affected vaccination and exemption rates in your state? a. How are exemption rates measured by your organization? b. What proportion of parents would you estimate change their mind about obtaining a nonmedical exemption after receiving this education? c. What are other outcomes that you track to measure the impact of the educational mandate? d. How has this data been used to modify your state’s educational mandate? For example, have you changed the content of the educational materials?

2. In your opinion, how effective has the educational mandate been in influencing parents to have their child vaccinated? a. (If believed to be effective) Why? b. (If not believed to be effective) Why not? What policy changes or other factors have influenced these exemption rates? Obtain names of laws or specificdocuments. c. Probe: What seems to work well to increase vaccination rates (facilitator)? What is not working (barrier)?

Interviewee Beliefs about EM

1. Would you recommend an educational mandate for other states as a strategy to address requests for nonmedical exemptions? a. Why or why not?

2. What other activities, policy recommendations or other interventions, does your organization carry out to address exemption rates?

3. If you could change the mandate in any way, what would you change?

4. What other interventions or policies do you think would help address requests for nonmedical exemptions?