title: Systematically reviewing qualitative studies complements survey design: an exploratory study of barriers to paediatric immunisations.
abstract: OBJECTIVE
  Designing survey questions requires content expertise, awareness of previous qualitative literature, and piloting. We examined surveys addressing parental barriers to vaccinating children to determine if they comprehensively included themes identified in published qualitative studies.
  
  
  METHODS
  We performed a systematic literature search of 12 electronic databases and compared questions asked in eligible surveys identified to issues raised in qualitative studies. Issues included nine themes related to harm, six related to distrust, eight to issues of access, and three other issues.
  
  
  RESULTS
  The 29 eligible surveys failed to adequately address several important themes identified in qualitative studies. The number that failed to address the following themes were as follows: beliefs that vaccines cause diseases (n = 26); painful (n = 25); distrust of medical community (n = 28); communication problems with staff (n = 25); memories of their own or others adverse experiences (n = 28); fear of long-term effects (n = 26); belief the medical community does not understand adverse events associated with vaccines (n = 28); and parent's own lack of knowledge about diseases (n = 29).
  
  
  CONCLUSIONS
  Many surveys of parental barriers to immunization failed to address a number of important themes identified in qualitative studies. To the extent this is true in other areas, ensuring that investigators have conducted an adequate number and variety of qualitative studies, and systematically reviewing those studies, will improve surveys' content validity.
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Health Science Centre, Hamilton, Ontario, Canada. millsej@mcmaster.ca
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.forename: Cory P
authors.initials: CP
authors.lastname: Ross
authors.forename: Beverly
authors.initials: B
authors.lastname: Shea
authors.forename: Kumanan
authors.initials: K
authors.lastname: Wilson
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Guyatt
mesh_terms: D001290:Attitude; D002648:Child; D003469:Culture; D003627:Data Interpretation, Statistical; D016206:Databases, Bibliographic; D003657:Decision Making; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010290:Parents; D036301:Qualitative Research; D014611:Vaccination / Q000523:psychology*