Community Health Improvement for Milwaukee's Children: Assessing Clinical and Administrative Support Staff Attitudes about Immunizations to Inform Health Behavior Change Intervention

Background: Immunization disparities are well documented and community-based approaches show promise. Theory driven health behavior change interventions also demonstrate efficacy. Research to assess and intervene with support staff is a recommendation of the IOM to reduce healthcare disparities.

Methods: This sub-study was part of a larger NIMHHD CBPR project focused on increasing immunization completion rates among urban children, 0-14 years old. Survey data from staff at 2 healthcare and 2 social-services CBO's was analyzed and considered in the development of health behavior change interventions for parents in the larger study.

Results: Sixty-eight staff completed the survey. Compared to parents (n=353), staff were more likely to have greater than a high school education (78% vs 36%). Fifty-two percent of staff were African-American compared to 90% of parents. Confidence in the safety of routine childhood vaccinations was similar across staff and parents (85% vs 83%). Among staff, 89% of all children and 75% of children <4 years were documented as up-to-date via the state registry. In contrast, 72% of all children and 53% of children <4 years in the larger study of parents were documented as up-to-date.

Conclusions: Confidence in childhood vaccinations was similar among staff and parents, though documented completion rates were higher among staff. According to the Theory of Planned Behavior, behavioral beliefs are important factors in health behavior change. Study findings contributed to the creation of a video-based component of a multi-session intervention for parents to increase skills and confidence in communicating with the health-care system, including support staff.