Failure to Return: Why Families Don't Keep Immunization Appointments

描述(由申请人提供)： 尽管在全国儿童免疫接种覆盖率方面取得了很大进展，但属于种族或少数民族的儿童和生活贫困的儿童的覆盖率仍然低于全国平均水平。这些儿童进一步面临健康状况不佳的风险，因为免疫不足是其他未得到满足的初级保健需求的一个重要和独立的预测因素。这种免疫不足还具有重要的公共卫生影响，因为居住在大城市等大城市地区的大量未得到充分服务的儿童人口可能导致疫苗可预防疾病的暴发。研究着眼于免疫接种的个别障碍，但很少有研究全面了解影响免疫预约的无数相互关联的因素，而不仅仅是获得机会和费用问题。本研究通过考察父母、提供者和社区三个水平的因素对内城区36个月以下儿童父母的免疫预约行为的影响，将医疗院模型应用于父母的预约接种行为。 这项定性和定量的研究将在纽约市哈莱姆和华盛顿高地的社区进行，这两个社区是美国最贫困的两个社区。我们会的。招募有36个月以下孩子并在过去6个月内试图为其孩子接种疫苗的父母进行系统抽样。我们计划招募375个拉美裔、黑人和白人家庭，包括来自三个地点的贫困线以上和贫困线以下的家庭：社区社会服务计划或日托/Head Start计划、社区卫生诊所和私人儿科诊所。首先，我们将对没有和没有错过疫苗接种预约的家长进行单独的焦点小组，以最终确定在家长调查中将衡量的具体变量。可能的调查变量是：父母对获得卫生保健服务的便利性的看法，对卫生保健系统和免疫接种的体验，对疗养院的满意度，上次预约的体验，对免疫接种和预防性护理的信念，以及社会人口信息。调查问卷将经过预先测试和翻译，以确保问卷在文化和语言上在英语和西班牙语中都是相同的。我们还将对社区卫生中心和私人儿科诊所进行调查，以确定实践类型和提供者、VFC状况、可获得性、连续性、文化能力和免疫实践。这些反应将用于在评估家长反应与免疫预约遵守之间的关系时，对实践层面的背景进行控制。分析将包括双变量和多变量模型，以评估父母、实践和社区因素对遵守免疫预约的概率的相对影响。 这项研究将产生关于父母遵守免疫预约的障碍的信息，提供者可以利用这些信息来制定战略，以改善获得护理和提供免疫的机会，以及社区计划，以帮助父母获得卫生保健服务。

DESCRIPTION (provided by applicant): Despite great progress in childhood immunization coverage nationwide, children belonging to a racial or ethnic minority and those living in poverty continue to have coverage rates below the national average. These children are at further risk for poor health since under-immunization is a significant and independent predictor of other unmet primary care needs. This under-immunization also has important public health implications since a large underserved population of children living in close proximity, such as in a large urban area, could lead to an outbreak of a vaccine-preventable disease. Studies have looked at individual barriers to immunizations, yet few have provided a comprehensive look at the myriad, interrelated factors that affect immunization appointment keeping, beyond access and cost issues. This study adapts the medical home model to parental immunization appointments keeping behavior by examining the way in which three levels of factors, parent, provider and community, influence immunization appointment keeping among parents of children under 36 months of age in an inner city community. This qualitative and quantitative study will be conducted in the communities of Harlem and Washington Heights, New York City, two of the most disadvantaged in the nation. We will. recruit a systematic sample of parents who have a child under age 36 months and have attempted to obtain an immunization for their child in the past 6 months. We plan to enroll 375 Latino, Black and White families, including those above and below poverty level from three venues: community social service programs or day care/Head Start programs, community health clinics, and private pediatric practices. First, we will conduct separate focus groups of parents who have and have not missed immunization appointments to finalize the specific variables to be measured in a parental survey. Possible survey variables are: parental perception of ease of accessing health care services, experience with the health care system and immunization delivery, satisfaction with the medical home, experience with last appointment made, beliefs about immunizations and preventive care, and socio-demographic information. The survey will be pre-tested and translated to assure that the questionnaire is culturally and linguistically equivalent in both English and Spanish. We will also conduct surveys of community health centers and private pediatric offices to ascertain type of practice and provider, VFC status, access, continuity, cultural competency, and immunization practices. These responses will be used to control for the practice-level context when assessing the relation between parent responses and immunization appointment keeping. The analyses will include both bi-variate and multivariate models to assess the relative impact of parent, practice, and community factors on the probability of keeping immunization appointments. This study will generate information on parental barriers to immunization appointment keeping that can be utilized by providers to develop strategies to improve access to care and immunization delivery as well as by community programs to help empower parents in obtaining health care services.