Barriers to Immunization in a Relatively Affluent Community
Barriers to Immunization in a Relatively Affluent Community
Background: Although Healthy People 2000 calls for the complete immunization of at least 90% of children by age 20 months, few communities can claim such success. We wanted to determine the parent-reported barriers associated with underimmunization of infants in a relatively affluent midwestern population.
Methods: We undertook a case-control study of a population-based sample of parents and guardians of children who were either fully immunized or underimmunized at 20 months of age in Olmsted County, Minn.
Results: In this study, 596 of 1,216 parents (46%) of both immunized and underimmunized children participated. Of these participants, 281 (47%) reported barriers to immunizations, but only 15 (3%) reported major barriers. Whereas the most commonly reported barriers were barriers of inconvenience (waiting too long, inconvenient office hours), only delays caused by a sick child, fear of reactions, trouble remembering an appointment, not knowing when the next shot was due, and transportation problems were significantly associated with underimmunization when controlling for demographic factors. Fear of reactions, sick child delays, and not knowing when the next shot was due had the highest attributable risk for underimmunization. Taken together, parent-reported barriers and demographic factors explained less than 30% of the underimmunization status of children. Parents' most common recommendations for improving immunization status were the use of a recall or reminder system and a single unified schedule for immunizations.
Conclusions: In this relatively affluent community, barriers to immunization were commonly reported but few (fear of reactions, sick child delays, and not knowing when the next shot was due) were associated with underimmunization. The types of barriers reported were similar to those reported in other communities, but unlike many populations studied, cost was not reported as an important barrier.
Healthy People 2000 calls for the complete immunization of at least 90% of children by age 20 months. Although some managed care populations have attained this goal, few communities can claim such success.
The reasons for this shortfall in infant immunizations have been studied, evaluated, and discussed for decades. In 1991 the common community barriers to immunization of infants were listed as missed opportunities, organizational failures in the health care delivery system, inadequate access to care, and incomplete public awareness of the importance of immunizations and the morbidity of vaccine preventable diseases. The following family characteristics are associated with lower likelihood of completed immunizations by the age of 2 years: completing less formal education, large family size, lower socioeconomic status, being nonwhite, receiving services through a public health department, living in a single-parent family, getting a late start on immunizations, and inadequate insurance. Practice barriers have been reported by private and public health clinicians as high cost of vaccine to providers, inadequate insurance coverage of families, inadequate use of immunization opportunities, and lack of community-based registries or tracking systems across communities.
Parent-perceived barriers have also been studied, primarily in inner-city parents, parents receiving medical assistance, and rural parents. Most studies have focused on the delivery of immunizations by the public health system. The most common parent-reported barriers were cost, safety concerns, lack of health care access, and inconvenience. Four published studies included parents that were not economically stressed but only one examined the association between parent-reported barriers and the actual immunization status of the child. A second compared the health beliefs of parents in an affluent community with their child's immunization status. Although all barriers deserve attention, the most important barriers to recognize and address are those associated with incomplete immunizations by age 2 years.
Previous reports of parent-perceived barriers have encouraged the development of immunization registries and recall and reminder systems that have been shown to be associated with increased immunization in a clinic population.
Middle-class communities, as well as economically stressed communities, also fall short of the Healthy People 2000 goal of 90% immunization by age 24 months. Barriers reported in the studies of more distressed communities and public health systems might not predict barriers experienced by parents in more affluent or less underserved areas. We report and compare the parent-perceived barriers for fully immunized and underimmunized children found in a population-based birth cohort of children in a relatively affluent community. We also report the solutions suggested by parents.
Background: Although Healthy People 2000 calls for the complete immunization of at least 90% of children by age 20 months, few communities can claim such success. We wanted to determine the parent-reported barriers associated with underimmunization of infants in a relatively affluent midwestern population.
Methods: We undertook a case-control study of a population-based sample of parents and guardians of children who were either fully immunized or underimmunized at 20 months of age in Olmsted County, Minn.
Results: In this study, 596 of 1,216 parents (46%) of both immunized and underimmunized children participated. Of these participants, 281 (47%) reported barriers to immunizations, but only 15 (3%) reported major barriers. Whereas the most commonly reported barriers were barriers of inconvenience (waiting too long, inconvenient office hours), only delays caused by a sick child, fear of reactions, trouble remembering an appointment, not knowing when the next shot was due, and transportation problems were significantly associated with underimmunization when controlling for demographic factors. Fear of reactions, sick child delays, and not knowing when the next shot was due had the highest attributable risk for underimmunization. Taken together, parent-reported barriers and demographic factors explained less than 30% of the underimmunization status of children. Parents' most common recommendations for improving immunization status were the use of a recall or reminder system and a single unified schedule for immunizations.
Conclusions: In this relatively affluent community, barriers to immunization were commonly reported but few (fear of reactions, sick child delays, and not knowing when the next shot was due) were associated with underimmunization. The types of barriers reported were similar to those reported in other communities, but unlike many populations studied, cost was not reported as an important barrier.
Healthy People 2000 calls for the complete immunization of at least 90% of children by age 20 months. Although some managed care populations have attained this goal, few communities can claim such success.
The reasons for this shortfall in infant immunizations have been studied, evaluated, and discussed for decades. In 1991 the common community barriers to immunization of infants were listed as missed opportunities, organizational failures in the health care delivery system, inadequate access to care, and incomplete public awareness of the importance of immunizations and the morbidity of vaccine preventable diseases. The following family characteristics are associated with lower likelihood of completed immunizations by the age of 2 years: completing less formal education, large family size, lower socioeconomic status, being nonwhite, receiving services through a public health department, living in a single-parent family, getting a late start on immunizations, and inadequate insurance. Practice barriers have been reported by private and public health clinicians as high cost of vaccine to providers, inadequate insurance coverage of families, inadequate use of immunization opportunities, and lack of community-based registries or tracking systems across communities.
Parent-perceived barriers have also been studied, primarily in inner-city parents, parents receiving medical assistance, and rural parents. Most studies have focused on the delivery of immunizations by the public health system. The most common parent-reported barriers were cost, safety concerns, lack of health care access, and inconvenience. Four published studies included parents that were not economically stressed but only one examined the association between parent-reported barriers and the actual immunization status of the child. A second compared the health beliefs of parents in an affluent community with their child's immunization status. Although all barriers deserve attention, the most important barriers to recognize and address are those associated with incomplete immunizations by age 2 years.
Previous reports of parent-perceived barriers have encouraged the development of immunization registries and recall and reminder systems that have been shown to be associated with increased immunization in a clinic population.
Middle-class communities, as well as economically stressed communities, also fall short of the Healthy People 2000 goal of 90% immunization by age 24 months. Barriers reported in the studies of more distressed communities and public health systems might not predict barriers experienced by parents in more affluent or less underserved areas. We report and compare the parent-perceived barriers for fully immunized and underimmunized children found in a population-based birth cohort of children in a relatively affluent community. We also report the solutions suggested by parents.
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