CAUSES AND EFFECT OF NEGATIVE ATTITUDE TO IMMUNIZATION AMONG COUPLES

ABSTRACT
BACKGROUND: Lack of information has been associated with couples anxiety or concern in a number of healthcare areas.
OBJECTIVES: (1) Identify the proportion of parents who agreed, were neutral, and disagreed that they had access to enough information to make a decision about immunizing their child; (2) examine how parents who agreed and disagreed differed with respect to sociodemographic characteristics, and their attitudes about immunizations, their child’s healthcare provider, immunization requirements/exemptions, and immunization policymakers; and (3) identify if differences exist in specific immunization concerns.
METHODS: A sample of parents with at least one child aged < or =6 years (n=642) was analyzed using data from the HealthStyles survey conducted during July and August 2003. Odds ratios and the Mantel-Haenszel chi-square test were used for analysis. RESULTS: Response rate for HealthStyles was 69% (4035/5845). The largest proportion of parents agreed they had access to enough information (67%) compared to parents who were neutral (20%) or who disagreed (13%). Compared to parents who agreed, parents who disagreed were more likely to be less confident in the safety of childhood vaccines (odds ratio [OR]=5.4, 95% confidence interval [CI]=3.3-8.9), and to disagree that their child's main healthcare provider is easy to talk to (OR=10.3, 95% CI=3.7-28.1). There was a significant linear trend in the percentage of parents expressing immunization concerns among those who agreed, were neutral, and who disagreed they had access to enough information (p<0.05; df=1). CONCLUSIONS: While most parents agreed that they had access to enough immunization information, approximately a third did not. Perceived lack of information was associated with negative attitudes about immunizations and toward healthcare providers. Basic information about the benefits and risks of vaccines presented by a trusted provider could go a long way toward maintaining and/or improving confidence in the immunization process. INTRODUCTION Immunization is recognized as a safe and effective method of preventing disease (National Advisory Committee on Immunization, 1998); however, not all parents choose to immunize their children and not all couples choose to maintain or update their own immunization status. The goal of this thesis is to understand why young couples (parents or future parents) make the decisions they do and how they arrive at those decisions. Health scientists need to acquire an understanding of the experience of people in relation to their environments for the purpose of increasing their potential for health. Improved health policies may be developed if we can understand how to serve our populations better as a whole. It is more useful to put into place policy that will be meaningful and followed, than blanket statements that do not put the population's needs first. This study contributes to a better understanding of the thought processes behind persons who choose to delay or refuse immunizations irrespective of the policy environment. The area of immunization is as complex as a mosaic, and true to this metaphor, every tile of information contributes to the overall picture while remaining distinct. This thesis is presented as another tile. Currently in Amuzi community in Obowo L.G.A, mainstream immunization is voluntary, though strongly encouraged and freely dispensed to all citizens. Changes are on-going in mandatory immunization policy provincially. Alberta and Saskatchewan pride themselves in not having moved to mandatory laws due to the public health delivery systems in place. (Personal communication, P. Hasselback, January, 2002). As long as most people comply, the herd immunity remains strong and the risk for developing vaccine reventable diseases remains low. However, certain groups in the population do not agree with immunization for a variety of reasons. Some of these reasons include theological constraints, belief structures that favor "natural" immunity, beliefs that immunization is dangerous to children, mistrust in pharmaceutical companies and a belief in alternative health therapies such as provided by naturopaths and chiropractors. What about apathy? Funk and Wagnells (1982) describe this as indifference and lack of interest. Do couples feel immunization is important? Do they think about it during their daily lives? What will our future generation of parents do to contribute to herd immunity when they have never seen the diseases the vaccines are designed to prevent? What will happen when the next generation feels overly confident that they will not be touched by these diseases because they are perceived as a "Third World problem" or when they do not understand the ramifications of the diseases? Lack of knowledge of our own immune systems in the general population is high. Because of the complexity of interactions between anatomical structures and biochemistry most laypersons shrug their shoulders when asked how basic immunological functions occur. Policies encouraging health education may emphasize the importance of citizens taking a pro-active role in understanding their bodies and what they can do to remain healthy. In this day of reduced health care budgets more emphasis needs to be placed on prevention of disease. Immunization is an integral cog to the wheel. An analysis of this issue indicates a need for more knowledge to guide health care workers and policy-makers in contributing to immunization.