title: Factors underlying parental decisions about combination childhood vaccinations including MMR: a systematic review.
abstract: Suboptimal childhood vaccination uptake results in disease outbreaks, and in developed countries is largely attributable to parental choice. To inform evidence-based interventions, we conducted a systematic review of factors underlying parental vaccination decisions. Thirty-one studies were reviewed. Outcomes and methods are disparate, which limits synthesis; however parents are consistently shown to act in line with their attitudes to combination childhood vaccinations. Vaccine-declining parents believe that vaccines are unsafe and ineffective and that the diseases they are given to prevent are mild and uncommon; they mistrust their health professionals, Government and officially-endorsed vaccine research but trust media and non-official information sources and resent perceived pressure to risk their own child's safety for public health benefit. Interventions should focus on detailed decision mechanisms including disease-related anticipated regret and perception of anecdotal information as statistically representative. Self-reported vaccine uptake, retrospective attitude assessment and unrepresentative samples limit the reliability of reviewed data - methodological improvements are required in this area.
authors.affiliation: Centre for Patient Safety and Service Quality, Imperial College London, St. Mary's Hospital Campus, London W2 1NY, United Kingdom. Katrina.Brown@imperial.ac.uk
authors.forename: Katrina F
authors.initials: KF
authors.lastname: Brown
authors.forename: J Simon
authors.initials: JS
authors.lastname: Kroll
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hudson
authors.forename: Mary
authors.initials: M
authors.lastname: Ramsay
authors.forename: John
authors.initials: J
authors.lastname: Green
authors.forename: Susannah J
authors.initials: SJ
authors.lastname: Long
authors.forename: Charles A
authors.initials: CA
authors.lastname: Vincent
authors.forename: Graham
authors.initials: G
authors.lastname: Fraser
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
mesh_terms: D002675:Child, Preschool; D002755:Choice Behavior; D003657:Decision Making; D019049:Developed Countries; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage; D010290:Parents / Q000523:psychology*; D014611:Vaccination / Q000523:psychology*; D017778:Vaccines, Combined / Q000008:administration & dosage
chemical_list: D022542:Measles-Mumps-Rubella Vaccine; D017778:Vaccines, Combined