Vaccine Refusal in Pediatric Practice: A Focus Group Study of Provider Knowledge, Attitudes, and Experiences

Background: Vaccine hesitancy is a growing public health problem in the United States. An increasing number of parents are choosing to decline or delay vaccination for their children. It is unclear if pediatricians have adequate resources to deal with this complex problem. Purpose/Objective: To assess attitudes, perceptions, and experiences of pediatricians who care for children whose parents decline or delay vaccination. Methods: Four focus groups comprising Kaiser Colorado pediatricians were convened (n = 17). Pediatricians practiced in four clinics with variable immunization rates among their patients. Participant responses were audio-recorded, transcribed, and coded using open coding methods and grounded theory. We identified commonalities among provider risk communication strategies to address parental concerns. Preliminary Results: All pediatricians recognized vaccine refusal as a problem in their practices (1%–15% of their patients). Physicians reported using various communication methods to interact with concerned parents. Some physicians used prepared risk communication messages, others negotiated the vaccination schedule with parents, and some physicians accepted the parental decision to decline or delay vaccination. Providers acknowledged that parents have a wide range of concerns about vaccinations. Some providers did not believe they were adequately prepared to address questions regarding vaccine ingredients (e.g. aluminum) or alternative schedules. Providers tended to customized messages and information according to the needs of each patient. Providers also expressed a need for additional resources to help address parental vaccination concerns. Conclusion: Provider experiences with parental vaccination concerns have created a need for effective risk-communication strategies that help parents make informed decisions about vaccinating their children. To help convey the risks and benefits of vaccination, a multifaceted intervention using customized messages might be the most effective approach. On the basis of provider feedback, additional resources might include an interactive Internet site, a formal risk-communication tool, and an educational, prenatal group visit devoted to vaccinations.