RANDOMISED CLUSTER TRIAL TO SUPPORT INFORMED PARENTAL DECISION-MAKING FOR THE MMR VACCINE

Monday, 17th of March 2014

[source]BMC Public Health[|source]

A recent systematic review identified the decision support needs of parents making child health decisions (including immunization); these related to three themes: (i) a need for timely, consistent up-to-date evidence based information tailored to the individual child, delivered in a variety of formats from trustworthy sources; (ii) a need to talk with others facing the same decision to share experiences; and (iii) a need to be in control of their level of preferred involvement in the decision-making process. 

In this paper, the authors report the findings of a cluster randomized controlled trial to evaluate a parent-centred, multi-component intervention to support informed decision-making for MMR. The report concludes that “Whilst both the leaflet and the parent meeting reduced parents decisional conflict, the parent meeting appeared to enable parents to act upon their decision leading to vaccination uptake”. Detailed report on methods, results and discussion is accessible at:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144460/

 

ABSTRACT

BACKGROUND: In the UK public concern about the safety of the combined measles, mumps and rubella [MMR] vaccine continues to impact on MMR coverage. Whilst the sharp decline in uptake has begun to level out, first and second dose uptake rates remain short of that required for population immunity. Furthermore, international research consistently shows that some parents lack confidence in making a decision about MMR vaccination for their children. Together, this work suggests that effective interventions are required to support parents to make informed decisions about MMR.

This trial assessed the impact of a parent-centred, multi-component intervention (balanced information, group discussion, coaching exercise) on informed parental decision-making for MMR.

METHODS: This was a two arm, cluster randomized trial. One hundred and forty two UK parents of children eligible for MMR vaccination were recruited from six primary healthcare centres and six childcare organizations. The intervention arm received an MMR information leaflet and participated in the intervention (parent meeting). The control arm received the leaflet only. The primary outcome was decisional conflict. Secondary outcomes were actual and intended MMR choice, knowledge, attitude, concern and necessity beliefs about MMR and anxiety.

RESULTS: Decisional conflict decreased for both arms to a level where an effective MMR decision could be made one-week (effect estimate = -0.54, p < 0.001) and three-months (effect estimate = -0.60, p < 0.001) post-intervention. There was no significant difference between arms (effect estimate = 0.07, p = 0.215). Heightened decisional conflict was evident for parents making the MMR decision for their first child (effect estimate = -0.25, p = 0.003), who were concerned (effect estimate = 0.07, p < 0.001), had less positive attitudes (effect estimate = -0.20, p < 0.001) yet stronger intentions (effect estimate = 0.09, p = 0.006). Significantly more parents in the intervention arm reported vaccinating their child (93% versus 73%, p = 0.04).

CONCLUSIONS: Whilst both the leaflet and the parent meeting reduced parents decisional conflict, the parent meeting appeared to enable parents to act upon their decision leading to vaccination uptake.