kt neck md

Carlos A. Cuello Garcia!MD, PhD(c)!Health Research Methodology Program!Department of Clinical Epidemiology and Biostatistics

analyzing refusal to vaccinate and related behaviours using the theoretical domains framework

Protocol proposal HRM 726

Disclaimer

Paediatrician (vaccinated a lot of kids for more than 10 years)

No support from drug companies (vaccine manufacturer or others)

THE PROBLEM

Vaccines, victims of their own success, are commonly undervalued.

Go to google data

still good…immunization coverage…

GapMinder

world view

the united states

353 cases by

may 25

(11 in Hamilton)

Public Health Agency of Canada, (2013). Elimination of Measles, Rubella and Congenital Rubella Syndrome in Canada: Documentation and Verification Report - Executive Summary -[online] Available at: http://www.phac-aspc.gc.ca/im/vpd-mev/measles-rougeole-mrer-eng.php [Accessed 26 May. 2014].

92% 69%

the Childhood National Immunization Coverage Survey 2009

2-years-olds 7-years-olds

Taylor LE, et al. Vaccines are not associated with autism: An evidence-based meta-analysis of case- control and cohort studies.

Vaccine (2014), http://dx.doi.org/10.1016/j.vaccine.2014.04.085

Taylor LE, et al. Vaccines are not associated with autism: An evidence-based meta-analysis of case- control and cohort studies.

Vaccine (2014), http://dx.doi.org/10.1016/j.vaccine.2014.04.085

•Despite a massive accumulation of

evidence reassuring that vaccines are

safe, effective, and does not cause

any of the autistic spectrum

disorders, a considerable number of

the population still refuses to

vaccinate their kids based on these

and other misconceptions

Omer SB et al. N Engl J Med 2012;367:1170-1171.

www.oahpp.ca

Reasons for exemptions among children 7 years old for ISPA

antigens, 2011/12

18

40 %

25 %20 %

14 %

<2 %

Acceptor Cautious acceptor Hesitant Late vaccinator Refuser

Leask et al. BMC Pediatrics 2012, 12:154

objectives/questions

•To assess the use of the theoretical domains framework in addressing barriers and changing behaviour amongst patients / parents who refuse vaccinations

•To develop a theory-based intervention to support primary care practitioners when confronted with patients or parents who refuse immunizations

Barriers exist in all countries

•No matter the income level.

•Related to knowledge, beliefs or attitudes

‣ misinformation; parental fear about safety; lack of awareness about vaccine schedule, doses, or vaccine-preventable diseases

• Logistical barriers

‣ shortage of vaccines; distance from clinics; cost of vaccines, vaccination service or transportation; lack of time

Kaufman J, Synnot A, Ryan R, Hill S, Horey D, Willis N, Lin V, Robinson P. Face to face interventions for informing or educating parents about early childhood vaccination. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD010038. DOI: 10.1002/14651858.CD010038.pub2.

changing behaviours

•The aim of the Theoretical Domains Framework

(TDF) is “to simplify and integrate a plethora of

behaviour change theories and make theory more

accessible to, and usable by, other disciplines.”

Cane et al. Implementation Science 2012, 7:37 French et al. Implementation Science 2012, 7:38

quick look

Why is this an important topic?

• Low immunization rates combined with other factors (e.g., immigration) could generate increasing numbers of cases of vaccine-preventable diseases (e.g., measles, rubella, diphtheria, polio, etc.) among the unprotected population

•A population with high levels of immunization is a priority for public health authorities

What is the anticipated deliverable?

•A framework and a tailored intervention for its application and testing

•A protocol for the purposes of the 726 course

• It might be possible to run questionnaires and deliver a final product (peer-review publication) by the first quarter of 2015.

Thank you

@CharlieNeck

cuelloca@mcmaster.ca