Identifying Knowledge-Attitude-Practice Gaps in Parental Acceptance of Adolescent Vaccinations in Appalachian Kentucky: Implications for Communication Interventions

Rural Appalachian Kentucky adolescents are disproportionately less likely to receive age-appropriate vaccinations compared with other populations, and low vaccination rates in any population presents a major public health risk. This study investigates parental acceptance of adolescent vaccinations by examining their knowledge, attitudes, and normative influences related to vaccinating their adolescents with both state required and recommended vaccines. Using the integrated behavior model (IBM) as a guiding framework to identify what knowledge-attitude-practice gaps (KAP-gaps) may exist for this parent population related to adolescent vaccination, the researchers conducted 21 in-depth interviews with parents of 11 to 18 year old children in Appalachia. Three salient findings emerged: a) knowledge was not related to a parent’s behavior, with both vaccinating and non-vaccinating parents expressing little to mixed knowledge about disease and vaccination, b) parents’ attitudes emerged as either pro-preventive health (leading to valuing vaccinations) or anti-vaccination and lack of valuing preventive health (leading to low vaccination rates), and c) opinion leaders in the community served as important motivators for parents vaccinating their children, contributing to the KAP-gap in that their influence seemed to be enough to drive behavior.  In light of these findings, the authors discuss appropriate communication strategies to use with parents of adolescents and local healthcare providers in order to improve both state required and recommended vaccination rates in Appalachian Kentucky, including one intervention currently under development. The implications from this study could provide insights for designing similar interventions in other underserved, rural areas.