title: A description of barriers and facilitators to childhood vaccinations in the military health system.
abstract: OBJECTIVE
  To perform a literature review of barriers to and facilitators of parents' decisions to have their children vaccinated. Both differences and similarities between the civilian sector and the military health system (MHS) were explored.
  
  
  METHODS
  Articles and documents were identified from the following databases: CINAHL, PubMed, Defense Technical Information Center (DTIC), ISI, and Google Scholar. Reference lists from articles were reviewed.
  
  
  CONCLUSIONS
  Common themes identified in the civilian sector and the MHS included an electronic registry, care access issues, provider characteristics, and child illness. Several themes served as a barrier in one system while being a facilitator in the other, such as provider characteristics. Literature addressing the MHS and factors affecting vaccine coverage is scant; however, a large disparity in vaccination coverage exists between the MHS and the civilian sector.
  
  
  CONCLUSIONS
  The theme of provider characteristics was seen as a barrier in both systems; a better understanding of this theme (i.e., provider effectiveness at interacting with parents) would benefit primary care practice. An electronic vaccine registry and targeted education and media campaign used to facilitate vaccinations in the MHS should be piloted in the civilian sector. Additionally, future studies should be performed on identified themes in the MHS.
authors.affiliation: Graduate School of Nursing, Uniformed Services University, Bethesda, Maryland 20841, USA. John.Connors@dm.af.mil
authors.forename: John
authors.initials: J
authors.lastname: Connors
authors.forename: Elena
authors.initials: E
authors.lastname: Arushanyan
authors.forename: Gregory
authors.initials: G
authors.lastname: Bellanca
authors.forename: Ruth
authors.initials: R
authors.lastname: Racine
authors.forename: Andrew
authors.initials: A
authors.lastname: Hoeffler
authors.forename: Allan
authors.initials: A
authors.lastname: Delgado
authors.forename: Susanne
authors.initials: S
authors.lastname: Gibbons
mesh_terms: D002648:Child; D002675:Child, Preschool; D006297:Health Services Accessibility; D006801:Humans; D008889:Military Personnel; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D014611:Vaccination