title: How parents' negative experiences at immunization visits affect child immunization status in a community in New York City.
abstract: OBJECTIVE
  Little is known about how families' experiences with immunization visits within the medical home may affect children's immunization status. We assessed the association between families' negative immunization experiences within the medical home and underimmunization.
  
  
  METHODS
  We surveyed parents (n = 392) of children aged 2-36 months about immunization experiences at community health centers, hospital-based clinics, private practices, and community-based organizations in New York City. We used Chi-square tests and odds ratios (ORs) to assess the relationship between medical home elements and parental immunization experience ratings. We used multivariable analysis to determine the association between negative experiences during immunization visits and underimmunization, controlling for insurance, maternal education, and receipt of benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children.
  
  
  RESULTS
  The majority of children were of Latino race/ethnicity and had Medicaid and a medical home. One-sixth (16.9%) of families reported a previous negative immunization experience, primarily related to the child's reaction, waiting time, and attitudes of medical and office staff. Parents' negative immunization experiences were associated with the absence of four components of the medical home: continuity of care, family-centered care, compassionate care, and comprehensive care. In addition, children in families who reported a negative experience were more likely to have been underimmunized (adjusted OR = 2.00; 95% confidence interval 1.12, 3.58).
  
  
  CONCLUSIONS
  In a community in New York City, underimmunization of young children was associated with negative immunization experiences. Strategies to improve family experiences with immunization visits within the medical home (particularly around support for the family), medical and ancillary staff attitudes, and reduced waiting time may lead to improved immunization delivery.
authors.affiliation: Columbia University, Division of General Pediatrics, New York, NY 10032, USA. mstockwell@columbia.edu
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Stockwell
authors.forename: Matilde
authors.initials: M
authors.lastname: Irigoyen
authors.forename: Raquel Andres
authors.initials: RA
authors.lastname: Martinez
authors.forename: Sally
authors.initials: S
authors.lastname: Findley
mesh_terms: D002675:Child, Preschool; D003142:Communication; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D008297:Male; D009519:New York City; D010290:Parents / Q000523:psychology*; D010817:Physician-Patient Relations; D012959:Socioeconomic Factors; D014611:Vaccination / Q000706:statistics & numerical data*