September 1, 2011

Can new approaches to talking about vaccines boost childhood immunization rates?

Clean air, forested parks, meandering bike paths—Washington has much to offer a child growing up here. But in our state, there’s a potentially growing threat to childhood health. Washington’s highest-in-the-nation immunization exemption rate may be inviting a full-blown outbreak of vaccine-preventable disease.

Measles and whooping cough are big concerns, with our state already experiencing outbreaks. Remember these diseases? Many of us are simply too young to recall the suffering and fatalities such illnesses caused years ago—one possible factor in today’s increasing numbers of unvaccinated children.

Immunizations currently prevent measles and whooping cough and a host of other highly communicable diseases. But many parents don’t always get the solid information they need to make decisions about the vaccinations that can protect their children, and others: Some adults and children, especially newborns and those with weak immune systems, can’t receive vaccinations but historically have been largely protected because of living in almost entirely immunized communities.

Group Health joined other health organizations to form Vax Northwest—a partnership that’s testing evidence-based communication among parents and their respected physicians and peers about the importance of timely, complete immunizations. Funded by the Group Health Foundation, the project expands on the Group Health Childhood Immunization Initiative begun in 2008. Vax Northwest partners include Group Health, Seattle Children’s Hospital, the Washington State Department of Health, WithinReach, and the Community Pediatric Foundation.

The project’s goals are to develop replicable tools that can be shared in communities nationwide. The partnership will rigorously evaluate two communication interventions—one focused on physician-parent relationships and the other on peer-to-peer conversations among parents. The interventions are based on behavior and social cognitive theory, social psychology, and behavior-change theory. WithinReach, a Seattle-based family resource organization, will implement the community intervention pilot, shaped in part by parent focus-group research Vax Northwest conducted in 2010. The effort’s success will be measured by Group Health Research Institute’s (GHRI) Center for Community Health and Evaluation (CCHE). GHRI Senior Investigator David Grossman, MD, MPH, who is also Group Health’s Medical Director for Preventive Care, is leading the research of the clinical intervention, implemented as a randomized controlled trial.

“We know that doctors are the most frequently cited source of information on immunization,” says Dr. Grossman. “So by developing and evaluating ways to help doctors work with parents on vaccinating, we hope to leverage that trust, and at the same time protect their children’s health and the health of our communities.”

The clinical intervention, designed in part by physicians, encourages doctors to ask parents about vaccinating their children; to acknowledge parents’ safety concerns, if any; and to advise them in plain, respectful language about immunizing their children. It aims to improve physicians’ self-efficacy, even when they’re talking to parents challenging the advice. Physicians trained in the prototype intervention, piloted last year in four Group Health clinics, found the training useful and said it improved their confidence in communicating with hesitant parents.

The clinical intervention will be administered in 50 pediatric and family medicine practices in King, Snohomish, and Pierce counties. Twenty-five clinics will receive the training and 25 will serve as controls. Researchers will survey a sample of 500 parents involved in the study about their decisions to immunize their children. They will also survey participating physicians at six-month intervals about their communication confidence and other perceptions.

The evaluation of the community-based intervention will examine the role of peer-to-peer communication in attitudes and perceptions around vaccination. The Vax Northwest researchers will evaluate the effectiveness of the phased project, which seeks to mobilize trusted parent peers as volunteer health advocates in schools, child care facilities, and other settings; provide community-localized immunization data; and take advantage of social media.

While Vax Northwest aims to discover new ways to share trusted information with parents, its goal of preventing devastating diseases through immunization is one that’s been protecting Washington’s children for decades.

Learn more about immunization efforts in Washington state:

Group Health Foundation Childhood Immunization Initiative

Washington State Department of Health Immunization & Child Profile Office

Learn what's behind the vaccine controversy” from Group Health’s Northwest Health magazine


by Gretchen Konrady