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TRANSCRIPT
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.
