Understanding Perceptions And Beliefs About Childhood Vaccination Among Parents

Study Purpose/Question

Complete all of the questions in the template below in reference to the article that you have selected. Ensure that you have selected the correct template (quantitative or qualitative) to match the research method in the article that you have selected.

Where there is a Yes/No option in the question, delete the option that does not apply.

Word count of the template = 550

Question 1: Study Purpose/Question

• Did the study have a clearly stated purpose/research question?      

• Explain your response below: The purpose of this study is clear and distinct. It provides an account of the perception of the parents towards vaccination as there are very limited studies to identifying the patient’s perception towards the vaccination of their child. The research question as quite clear from the themes and the sub-themes that state the factors that promotes the vaccination uptake, the factors, impending the vaccination compliance and the supportive roles of the parent. The research question is about the factors that are responsible for the different perception of the adults regarding vaccination (Zhang et al. 2014). 

Question 2: Relevance to nursing/midwifery practice

• Explain how this question was relevant to nursing/midwifery practice.

Vaccination has contributed to the major reduction in the global mortality and morbidity hence there are several gaps that are still required to be addressed (Kagone et al. 2018). A discreet knowledge regarding the interplay between the population and the health system about the vaccination and about the health staffs organisation at the time of the immunisation sessions are important for improving the effectiveness of vaccination (Kagone et al. 2018). It is necessary in the field of nursing and the midwifery practice because nurses are involved in community practices and health awareness program and a well organised vaccination program is essential for improving the health of the child (Munhall 2012). In order to conduct the health awareness programs regarding vaccination and convincing the people belonging to diversified cultural background to opt for vaccination, the nurses and the midwives needs to understand the logic behind the refusal of vaccines by some parents. McKee and Bohannon (2016) have stated that one of the most common reasons to refuse vaccination is the religious beliefs (MacDonald 2015). Other personal and philosophical reasons are also behind the ‘vaccine hesitancy in the parents, as some thinks that natural immunity is better than that acquired through immunisation. The nurses who work in frontline with the doctors needs to understand  the various perceptions in order to bring the issues in front of the professional heads to take appropriate measures (Munhall 2012).

• What were the possible risks of participating in the study?

The probable risk of participating in the study is that health related information can be disclosed during the interview and hence proper confidentiality is necessary. According to Taylor  (2014), confidentiality is arguably most important in any kind of research. The respondents provide information in a relationship of trust. () have suggested that one of the easiest ways to protect confidentiality is to collect anonymous data. () have refuted this fact as in a qualitative research one needs to collect information from a known sample population and in this study the sample population is quite large. MacDonald (2015) have stated that breaching of confidentiality can be done only if there is an imminent risk of self destruction or a case of substance abuse.  

Relevance to Nursing/Midwifery Practice

Furthermore the parents might not want to participate in the survey after knowing the reason of the survey. Health care information may contain information of diseases that can be stigmatised in the society. For example information about mental health is stigmatised in various cultures.

• Were these risks clearly identified by the authors?                                   

• If risks were identified by the authors, how did they propose to minimise risk?

In order to minimise the risks, the researchers obtained ethical approval from a repudiated Institutional review board, before recruiting the participants. Written consent was taken from all the participants and emphasis was given on confidentiality of the data and voluntary participation of the parents.  Some of the core ethical principles that have to be considered in qualitative research is respect for the person, beneficence and minimizing the risks (Sadaf  et al.2013).  In order to minimise the breaching of the ethics, a pilot interview was conducted in order to test the interview process, but these were not included in the data analysis part. One of the ethical approaches by the researchers is that the interview was conducted as per the time and place convenient for the participants.

• Did the authors state that they had approval from an ethics committee to undertake the study?

It is the responsibility of the review boards to review a report and ensure that informed consent are applied in an ethical way without hampering the safety, rights and the wellbeing of the humans (Faden et al. 01).  Muthuswamy (2013) have argued that ethics committee is often paternalistic in their approach to medical research. They have argued that it should be left entirely to the research subjects to decide about the harms and benefits of the research and hence it is not the legitimate role of the ethics committee.                                                                                                                                                                

• How did the authors obtain informed consent from participants?

Informed consent was taken in a written form. As per the regulations and guidelines regarding the conduction of the clinical research, informed consent should be taken from each of the human subjects (Gupta 2013). Muthuswamy (2013) have stated that informed consent should be taken from the participants without imposing any kind of influence on them.

• Did you identify and potential risks associated with the study that were not identified by the authors and if so, what were they?

One of the potential risks is that the researchers did not provide descriptive information about their study. According to Bal and Choma (2012) the participants should be adequately informed about the possible outcomes, benefits and the risks that may be linked with the research. While conducting the interviews, the researchers might have educated the participants about immunization and the role of immunisation. This helps a participant to make informed decision. The participants should never be coerced in to the decision making process (Beecher and Henry 2017).

Potential Risks and Ethical Approaches

Question 4: Study Methodology

• What the chosen methodology for this study?

The study design is a descriptive qualitative design that has been used for exploring the concerns, views and requirements of the patient regarding the vaccination of their children.

• Was this choice suitable for the given research problem/question?   

This choice was suitable for the given research question as

• Explain your response to (b):

Qualitative research is primary and exploratory research and is normally used for gaining an understanding of the underlying reasons, perception (Seidman, I., 2013). A qualitative will provide a better understanding of the misconceptions and the controversies associated with it. Hence in this context the in order to understand the perceptions and the beliefs about the vaccination a qualitative research was necessary (Seidman, I., 2013). The rationale for understanding the viewpoints of the parents is that it is extremely important for maintaining the high vaccination rate and improving the experience of their child during the procedure. It is the perception about the vaccination that would help the researchers to address any misconceptions regarding vaccination.  

• Describe how the data was collected for this study (interview, observation, etc).

The data was collected by the ethnographer who was not involved in the direct care of the children and was only a researcher. Face to face interviews or telephonic surveys were taken at a time and places per the convenience of the participants.

A pilot interview was conducted for testing the interview guide and the interview process. A total of 19 interviews were conducted with audio recordings, each lasting for about 0 – 30 minutes.

• Did the researchers provide the participants with the opportunity to check the collected data

Or research findings?                                                                                                  

• Did the researchers continue recruiting people to the study until data saturation was reached?

The data saturation reached at the 16^th interview and after that three more interviews were taken until the researcher found out that  no new information are actually generating (Kurup et al.2017).

• Did the study use multiple data collection methods (eg collect data from more than one source)?           
• Explain how the points in (b), (c) and (d) contribute to the trustworthiness of the overall research findings.

In a qualitative research it is necessary to perform a member check in order to check the credibility, validity, accuracy of a study. In many member checks the report and the responds are provided to the respondents for checking the authenticity of the work. Their interpretation and evaluation serve as a check on the viability of the interpretation (Birt et al. 2016).

As stated by Birt et al., (2016) member check can be done at the time of the interview process or after the completion of the study for increasing the validity and the credibility of the responds. Birt et al., (2016), have supported member checking as it helps the author to understand what has to be done during the course of the interview. Providing the participants, the opportunity to review through their responds, help in the correction of the errors and the challenges and incorporate additional important information.

Study Methodology

Multiple data collection method increases the validity and the trustworthiness of a paper and the researcher can assess the feasibility of the data collected via various means (Catherine Houghton et al. 2013).

Question 6: Participants

• How many participants were included in the study?

The participants were recruited from a vaccination clinic. The participants were those parents who had healthy child between 0-18 months of age (Kurup et al.2017). Only those parents were taken into account that were able to read and speak English and were the main caregiver of the child. Among 44 parents, about 22 participants were willing to participate, 6 participants did not meet the inclusion criteria and 16 parents actually participated in the study (Kurup et al.2017).

• What were the inclusion and exclusion criteria?

Inclusion criteria- Parents having healthy child between 0-18 months, who were capable of communicating in English and who were the prime care caregivers of the child (Kurup et al.2017).

Parents having visual or cognitive impairment were excluded (Kurup et al.2017).

• Explain how the participants were recruited

Face to face interviews or telephonic interviews were conducted for recruiting the participants and it was done as per the convenient of the participants (Kurup et al.2017).

• Describe the setting in which the study took place (hospital, community, etc)

The participants were selected from a vaccination clinic in Singapore, where they received routined vaccination. Participants belonging to different races were considered consisting of Chinese, Malay, Indian and other participants (Kurup et al.2017).

Question 7: Research Findings (outcomes)

• What were the main findings of this study? (provide a dot point summary)
• One of the main findings of this paper is that most of the participants remained adhered to the vaccination schedule because in Singapore, the education system and different schools have mandated vaccination to get admission in the school settings.
• People trusted the governmental approaches and the recommendations were the main encouragement to the parents adhering to the vaccination schedule (McKee and Bohannon 2016).
• Most of the parents responded positive to the vaccination schedule as they think it as their parental responsibility and understand the importance of vaccination in acquired immunity.

• Another finding was that the accessibility of the vaccinations has improved considerably which is another reason behind the positive perception of the vaccinations.

• The findings were successful in identifying the reasons for delayed vaccinations. The paper had also considered some of the side effects of vaccination that the participants have experienced in the past.

• It was found that some of the parents really had difficult time in keeping up with the vaccination schedule due to work and their children being sick (MacDonald 2015).

• As per the findings many parents did not have sufficient information regarding vaccinations and may parents felt that they do not have sufficient information regarding the vaccination of their child hence had to depend on the additional information.

• Many participants admitted to the fact that they require remainders for helping them to remember the vaccination appointments.

• It was also found that the parents had to continuously focus on their child for managing the adverse outcomes. Some of them resort to homeopathy or other herbal drinks (Kurup et al.2017).

• Surprisingly it was also found that parents exclude the optional vaccinations for the disease that they consider as less severe.
• One of the important points of concern that has been found from thus study is the reluctance of the nurses, as the parents have repeatedly felt that the nurses are not updated enough about the current knowledge of vaccination or sometimes were indifferent to the questions.

Question 8: Study limitations

• What were the limitations of this study stated by the author/s?

Very few limitations are found in this study. The first limitation is that the study has been conducted at a single site (Kurup et al.2017).

Secondly, the study did not take those parents into considerations, who are linguistically different or cannot communicate in English. The last limitation is that parents of 0-18 month’s old children have been included in the study, which might have failed to consider the parents who had missed or delayed the vaccination doses past 18 months of age (Kurup et al.2017).

• Explain why these are study limitations.

Conducting studies considering single sites limits the transferability of the results in other settings. People belonging to linguistically diverse background may have different cultures and may have different perceptions regarding the importance of vaccination, as there can be culture that probably do not rely on vaccination and think that they might cause side effects. Discussing about the last limitation, there can be parents of children above the age of 18 months who have missed or delayed the vaccinations.

• Did the researchers disclose any personal ideas, experiences or knowledge (bias) that might influence the conduct and outcomes of the study?

• Explain why personal ideas, experiences or knowledge (bias) may reduce the validity of the study

Personally held belief may have influence the validity of a research as its may distort the truth. Personal beliefs may be incompatible with the philosophical underpinnings of the quantitative study (Seidman 2013). According to Wieringa (2014), a researcher’s own values and belief always affects a qualitative research as the questionnaire’s used for the interviews are influenced by the personal beliefs. Hence the main concern should be whether the researcher is transparent and reflexive that is capable of self reflecting critically about their own perceptions, dynamics, relationships and analytical focus.

Members Check and Data Collection Methods

• According to the Levels of Evidence pyramid, what level of evidence are the reported results from this paper?

It is a cross sectional study and belongs to the level IV of the evidence based levels.

• Overall, should the outcomes of this study be used to inform evidence-based practice?                

• Explain your rationale for your responses to questions (a) and (b).

Level of evidence has immense importance in finding evidence and using the evidence for making the clinical decisions. In order to find out a research question or a clinical question it is important to find out the highest level of evidence (Burns et al. 2017).. This study is a cross sectional study. Normally the RCTs are considered as the highest level of evidence, but all the RCTs are always not conducted properly. This paper involves a cross sectional study involving a small sample size. The validity of the study was also low that contributed to the level IV evidence (Burns et al. 2017).

Before undertaking the critical analysis of this paper, I had brainstormed through journals and research papers regarding the importance of immunisations in the children and the pregnant women. A baby remains safe inside the mother’s womb due to the prenatal vaccines administered. I have learnt that there are several kinds’ of vaccines that are given to infants, like DTaP vaccine, Hib and PCV vaccines.  I have learnt that vaccine helps to protect both the pregnant mother and the baby from the diseases that can be prevented by the vaccines. Sadaf  et al.(2013) have stated that vaccinated mothers pass on the antibodies to their babies , which are capable of providing immunity from certain diseases, at least  during few months of their life. While conducting research from my learning I have understood that vaccine helps in the prevention of diseases like pneumonia and Diarrhoea that has been one of the leading causes of child hood mortality and morbidity. Vaccine preventable diseases are responsible for the significant, maternal and the neonatal mortality and morbidity.

The safety of immunisation irrefutable hence care should be given on the doses of immunisation. I have understood that each and every vaccine recommended today by the government health officials carries risk for complications, such as brain inflammation (Nyhan et al. 2014). The reports of National Academy of Sciences causes health related problems like chronic nervous system disorder, often small pox and polio, thrombocytopenia, shock and unusual shock like state.

I have found out from various epidemiologic and mechanistic researches suggest that individuals who are vulnerable to vaccine related adverse reactions have pre-existing history of susceptibility. I have understood that these pre-existing predispositions can be due to a number of factors such as the microbiome, environmental exposures, behaviours and any intervening illness. Hence according to me, more testing is required regarding the current vaccine schedule. It has been found that the most of the vaccine related findings mainly focuses on the results of single immunisations. Although each new vaccination is evaluated in the context of the overall immunisation schedule that existed at the time of review of that vaccine, the elements of the schedule are not evaluated once it is adjusted for accommodating a new vaccine (Mishra et al. 2012).

Participants

Some of the studies have shown that vaccination always cannot provide immunity but sometimes fail to provide individuals with short term protection from the infections (Mishra et al. 2012). While conducting the research, I have found that there had been mumps outbreak even in the fully vaccinated areas in U.S, which emphasizes on the fact that more researches are required. All these facts at first aroused confusion in me regarding the effectiveness of the current vaccines, but the positive feedback from the parents and my relevant research had compelled me to believe that vaccination is an important step towards the well being of the neonatal and the new mothers.  Yet it is surprising to find out that there are parents who still oppose vaccine in spite of the significant amount of information via the internet. This proves that effective education is still required for creating awareness regarding vaccination.

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