title: Addressing parents' concerns about childhood immunizations: a tutorial for primary care providers.
abstract: BACKGROUND
  Despite the dangers of vaccine-preventable infections and efforts by health care professionals to promote immunization, parents' resistance to routine childhood immunizations continues to grow. This phenomenon can give rise to frustration among health care providers, as well as create barriers in providing medical care to children in need. In response, we developed a CD-ROM-based tutorial that (1) explains the nature and origins of parents' concerns, (2) addresses clinical implications of resistance to immunization, (3) explores ethical and professional obligations that physicians have toward children and their parents, and (4) discusses how physicians can effectively address parents' concerns.
  
  
  OBJECTIVE
  Our goals were to evaluate the tutorial's effectiveness in improving physicians' (1) general knowledge about parents' resistance to childhood immunizations, (2) knowledge of adverse effects of immunization, and (3) attitudes toward parents' resistance to childhood immunization.
  
  
  METHODS
  After pretesting, expert review, and revision, the 45-minute Penn State Immunization Project tutorial was pilot tested with pediatric and family medicine residents at 7 training programs in 4 states (Pennsylvania, New York, Maryland, and Iowa). Knowledge and attitudes were assessed by using a 26-item pretest/posttest, the results of which were then analyzed by using standard statistical methods.
  
  
  RESULTS
  A total of 122 residents completed the pretest/posttest. Statistically and clinically significant improvements were seen in residents' general knowledge, knowledge of adverse events, and all 5 attitudinal measures regarding childhood immunizations.
  
  
  CONCLUSIONS
  The tutorial Addressing Parents Concerns About Childhood Immunizations: A Tutorial for Primary Care Providers is effective in improving resident physicians' general knowledge, knowledge of adverse events, and attitudes. As such, this tutorial has the potential to enhance communication between parents and primary care providers and, more generally, improve clinicians' response to the growing resistance toward routine childhood immunizations.
authors.affiliation: Department of Pediatrics, Penn State College of Medicine, 500 University Dr, Room C1743, Hershey, PA 17033, USA. bhlevi@psu.edu
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Levi
mesh_terms: D001294:Attitude to Health; D016251:CD-ROM; D002648:Child; D026690:Ethics, Clinical; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007114:Immunization / Q000523:psychology*; D033282:Parental Consent / Q000523:psychology; D010290:Parents / Q000523:psychology*; D010372:Pediatrics; D010821:Physicians, Family; D011368:Professional-Family Relations