title: Childhood vaccine risk/benefit communication among public health clinics: a time-motion study.
abstract: United States law requires that immunization providers use Centers for Disease Control Vaccine Information Statements (VISs) and inform parents about vaccine risks and benefits prior to every childhood immunization. A recent national survey found that public health clinics (PHCs) reported high compliance with this law. To further investigate these findings, we conducted an immunization time-motion study in two PHCs in Kansas and Louisiana. Research assistants observed a convenience sample of 246 child immunization visits to record distribution of the VISs and content and time of vaccine communication. Thirty percent of parents read below a ninth grade level, 53% had Medicaid insurance, and 56% were Black. VISs were given with every dose of vaccine administered in 89% of visits. Public health nurses (PHNs) frequently discussed potential vaccine side effects (91%), treatment of side effects (91%), and the vaccine schedule (93%). Contraindications were screened in 71% of visits. Benefits were discussed in 48% of visits and severe risks in 29%. The national Vaccine Injury Compensation Program (VICP) was never discussed. The immunization visits lasted for a mean of 20 min. Vaccine communication of side effects, risks, benefits, screening for contraindications, and the next visit lasted for an average of 16 s for all vaccines. PHC compliance with mandated VIS distribution and practical vaccine communication was high. Room for improvement exists in discussion of benefits, serious risks, and the VICP.
authors.affiliation: Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, 71130, USA. tdavis1@lsuhsc.edu
authors.forename: Terry C
authors.initials: TC
authors.lastname: Davis
authors.forename: Doren D
authors.initials: DD
authors.lastname: Fredrickson
authors.forename: Estela M
authors.initials: EM
authors.lastname: Kennen
authors.forename: Connie
authors.initials: C
authors.lastname: Arnold
authors.forename: Eileen
authors.initials: E
authors.lastname: Shoup
authors.forename: Mackey
authors.initials: M
authors.lastname: Sugar
authors.forename: Sharon G
authors.initials: SG
authors.lastname: Humiston
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Bocchini
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004522:Educational Status; D005260:Female; D006266:Health Education / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007615:Kansas; D008145:Louisiana; D008297:Male; D032541:Mass Vaccination / Q000451:nursing* / Q000706:statistics & numerical data*; D010358:Patient Participation; D017060:Patient Satisfaction; D011368:Professional-Family Relations; D011637:Public Health Nursing / Q000379:methods / Q000706:statistics & numerical data*; D018570:Risk Assessment; D013996:Time and Motion Studies