The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits
The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits
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DOI：
10.1542/peds.2013-2037
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发表时间：
2013-12-01
期刊：
影响因子：
8
通讯作者：
Robinson, Jeffrey D.
中科院分区：
文献类型：
--
作者：
Opel, Douglas J.;Heritage, John;Robinson, Jeffrey D.
目的：了解提供者-家长疫苗沟通的特点，并确定特定提供者沟通做法对家长对疫苗推荐的抵抗力的影响。方法：我们进行了一项横断面观察性研究，在卫生监督访问期间录制了提供者-家长疫苗讨论的视频。采用《父母对儿童接种疫苗的态度调查表》对1~19个月龄儿童的父母进行筛查。我们过度抽样了对疫苗犹豫不决的父母(VHP)，定义为得分=50。我们制定了一个包含15个交流练习的编码方案，并将其应用于所有访问。我们使用多元Logistic回归分析提供者沟通行为与家长对疫苗的抵抗力之间的关系，控制父母的犹豫状态以及人口统计和访问特征。结果：我们分析了来自9个实践的涉及16个提供者的111个疫苗讨论，其中50%包括VHP。大多数提供者(74%)在开始推荐疫苗时都是推定的(例如，“好吧，我们得打几针了”)，而不是参与式的(例如，“你想怎么打疫苗？”)格式。在对提供者入会表示抵制的父母中(41%)，VHP明显多于非VHP。如果提供者使用参与性而不是推定的启动形式，父母抵制疫苗推荐的几率明显更高(调整后的优势比：17.5%；95%可信区间：1.2%-253.5)。当父母拒绝时，50%的提供者继续他们最初的建议(例如，他真的需要这些疫苗)，47%的最初抵制的父母后来接受了他们的建议。结论：提供者如何发起和实施疫苗建议与父母对疫苗的接受有关。
OBJECTIVE: To characterize provider-parent vaccine communication and determine the influence of specific provider communication practices on parent resistance to vaccine recommendations.METHODS: We conducted a cross-sectional observational study in which we videotaped provider-parent vaccine discussions during health supervision visits. Parents of children aged 1 to 19 months old were screened by using the Parent Attitudes about Childhood Vaccines survey. We oversampled vaccine-hesitant parents (VHPs), defined as a score >= 50. We developed a coding scheme of 15 communication practices and applied it to all visits. We used multivariate logistic regression to explore the association between provider communication practices and parent resistance to vaccines, controlling for parental hesitancy status and demographic and visit characteristics.RESULTS: We analyzed 111 vaccine discussions involving 16 providers from 9 practices; 50% included VHPs. Most providers (74%) initiated vaccine recommendations with presumptive (eg, "Well, we have to do some shots") rather than participatory (eg, "What do you want to do about shots?") formats. Among parents who voiced resistance to provider initiation (41%), significantly more were VHPs than non-VHPs. Parents had significantly higher odds of resisting vaccine recommendations if the provider used a participatory rather than a presumptive initiation format (adjusted odds ratio: 17.5; 95% confidence interval: 1.2-253.5). When parents resisted, 50% of providers pursued their original recommendations (eg, "He really needs these shots"), and 47% of initially resistant parents subsequently accepted recommendations when they did.CONCLUSIONS: How providers initiate and pursue vaccine recommendations is associated with parental vaccine acceptance.