Pediatric vaccination beliefs and practices of health care providers in Oregon

Context: Vaccines are a crucial public health achievement, saving up to 3 million lives annually. Many states mandate pediatric vaccination as a public health measure. State-mandated pediatric vaccinations are a key component of this effort. However, in the state of Oregon, as elsewhere, exemptions for elementary school-aged children have risen and outbreaks of pertussis and measles periodically occur. Objective: Health care providers (HCPs) influence parental decisions to vaccinate children. We conducted a qualitative study to identify social and psychological influences on HCP attitudes toward and recommendations for pediatric vaccinations. Design: A semi-structured interview was conducted with traditional (physicians and nurses) and nontraditional (chiropractors and midwives) HCPs (n=15). Data analysis was conducted using Nvivo and standard qualitative methods. Main independent variables: Professional norms, communication style, personal salience, and beliefs concerning vaccine efficacy/risk. Dependent variable: The level of opposition to recommending childhood vaccines (fully opposed, conditionally opposed, or supportive). Results: HCPs, including nontraditional HCPs, occupy a range of positions from full vaccine opposition to full support. Key relationships between the outcome measure and the dependent variables were identified for personal salience, professional group norms, and perceived vaccine efficacy/risk. Providers who had personally nursed a sick child or patient through a vaccine-preventable disease were more likely to support vaccination. But vaccine efficacy trumped personal salience. If a vaccine was perceived as particularly efficacious, even providers whose family members had died from a vaccine side effect would accept the vaccine anyway.