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NIHR Signal

Views on vaccination education for patients

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Parents want reliable information on the benefits and risks of vaccination, and time to discuss it with health professionals. This summary of an NIHR-funded study includes an online self-assessment to test your understanding of the research


Immunisation is one of the most successful, cost-effective public health measures but England and Wales are below World Health Organization targets for the uptake of several immunisations. Policy makers need to understand the reasons for this uneven uptake. A recent Cochrane review of 38 qualitative studies conducted in 15 countries provides insight into parents’ experiences of information they received.

Over a third of the studies were published before 2010 and settings, populations, vaccination information and practitioner training varied between countries. Ten studies were conducted in the UK.

The authors suggest that parents generally found the amount of vaccination information inadequate, and that they wanted an opportunity to reflect on detailed information and prepare questions before their child was vaccinated. They expected to talk about vaccination with health workers in tailored, non-
judgmental discussions and wanted to have conversations outside of vaccination appointments, including in non-health settings. Some parents spoke of their mistrust of the objectivity of healthcare providers, the mass media and government sources – especially parents who held uncertain or negative attitudes towards vaccination.

Some UK parents remained concerned about the discredited link between the measles, mumps and rubella (MMR) vaccine and autism, and migrants found it difficult to access translated information. These findings were based on a limited number of studies and judged as being of lower quality.

Expert commentary

Pauline MacDonald is independent consultant nurse, Infection Matters Ltd

UK nurses should be proud of the fact that Public Health England’s ‘tracking surveys’ of parents of young children consistently show that ‘my nurse’ is the most trusted source of information when making decisions about vaccinating one’s child.

This review and its findings, while welcome in terms of highlighting the importance of qualitative research in delivering high-quality care are, in my opinion, not generalisable to the UK. 
Of the 38 studies included in this review, 10 were from UK, and nine of these focused on the MMR vaccine.

We all appreciate the impact in the UK of the unfounded claims associating the MMR vaccine with autism; vaccine uptake dropped, parents were confused and frightened, and ultimately, many children were not vaccinated. We subsequently saw disease and deaths caused by measles. Nurses struggled to counter the plethora of inaccurate claims made in the mainstream media.

We have learnt much from that time. The dedication of UK clinicians to garner parents’ attitudes (particularly on MMR) contributed to better sources of information and better communication. They have kept uptake high in these vital vaccination programmes.

Nurses involved in immunisation, or signposting children for immunisation, should receive high-quality education 
on the subject so they can keep their coveted role as the most trusted source of immunisation advice for parents.

Implications for practice

  • Parents need a range of information that covers both the risks and benefits of vaccination
  • Parents can regret vaccination if 
they feel they were not encouraged to make an informed decision
  • ·Parents who have general concerns about vaccinations before their child is due to have them are less likely to trust health professionals and more likely to use other information sources
  • Health professionals should help parents to assess information, and nurses and health visitors need education on how best to have 
these conversations
  • Public health campaigns should use social media and independent, trusted sources to disseminate information to the public

NIHR Dissemination Centre: right evidence, better decisions

The National Institute for Health Research (NIHR) Dissemination Centre aims to put good evidence at the heart of decision making in health and social care. NIHR Signals are summaries of the most relevant and important research, published on the Discover Portal. You can sign up for NIHR Signals tailored to your area of interest and keep up with the latest research by following @NIHR_DC on Twitter. For more information, visit here

  • This article includes commentary from an independent expert that does not necessarily reflect the views of the NHS, the NIHR or the Department of Health

Test your research awareness

To check your understanding of the research methodology in the NIHR Signal summarised above, take a quick self-assessment by clicking here

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