title: Understanding attitudes toward adolescent vaccination and the decision-making dynamic among adolescents, parents and providers.
abstract: BACKGROUND
  With several new vaccine recommendations specifically targeting adolescents, improving adolescent vaccination rates has become a major health priority. Vaccination attitudes are an important, modifiable target for new interventions. Prior research has examined primarily the attitudes and beliefs of adolescents, parents or healthcare providers separately without exploring the decision-making dynamic among these stakeholders. We sought to identify potentially modifiable barriers in the vaccine decision process among adolescents, parents and healthcare providers that could be addressed through interventions implemented within the adolescent's medical home.
  
  
  METHODS
  We conducted a qualitative study of adolescents, their parents and healthcare providers, recruited from four primary care practices in Michigan. For each practice, three separate focus group discussions (adolescents, parents and healthcare providers, for a total of 12 focus groups) were conducted to explore vaccination attitudes, possible interventions to improve vaccine uptake and access to and use of technology for vaccination interventions. Themes that emerged from the focus group discussions were categorized using an inductive, iterative process, and analysis focused on highlighting similarities and differences among the three perspectives.
  
  
  RESULTS
  Participants included 32 adolescents, 33 parents and 28 providers. The majority of parents and adolescents were female. Lack of knowledge about recommended adolescent vaccinations was universally recognized among the three groups and was perceived to be the underlying driver of low immunization rates. Notably, each group did not appear to fully appreciate the challenges faced by the other stakeholders with respect to adolescent vaccination. Adolescents were seen as having a greater role in the vaccine decision-making dynamic than previously suggested. Provider-based interventions such as educational tools and reminder-recall notices were identified as important components of any immunization program. Overall, there was high receptivity among all stakeholders toward integrating technology such as email and Internet into new vaccination interventions.
  
  
  CONCLUSIONS
  We identified potentially modifiable attitudinal barriers to adolescent vaccination among the three key stakeholders. However, there were notable differences in attitudes and preferences across the three perspectives, indicating that for an intervention to be successful it will require a dynamic partnership with the target audiences.
authors: Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, 300 North Ingalls Building, Ann Arbor, MI, 48109-5456, USA. charitha@med.umich.edu
authors: Charitha
authors: C
authors: Gowda
authors: Sarah E
authors: SE
authors: Schaffer
authors: Kevin J
authors: KJ
authors: Dombkowski
authors: Amanda F
authors: AF
authors: Dempsey
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D002648:Child; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008824:Michigan; D010290:Parents / Q000523:psychology*; D014611:Vaccination