title: A mixed methods study of parental vaccine decision making and parent-provider trust.
abstract: OBJECTIVE
  To describe parental vaccine decision making behaviors and characterize trust in physician advice among parents with varying childhood vaccination behaviors.
  
  
  METHODS
  Between 2008 and 2011, a mixed methods study was conducted with parents of children aged <4 years who were members of Kaiser Permanente Colorado health plan. Seven focus groups were conducted with vaccine-hesitant parents. On the basis of findings from the focus groups, a survey was developed, pilot tested, and mailed to a stratified sample of 854 parents who accepted (n = 500), delayed (n = 227), or refused (n = 127) vaccinations for one of their children. Survey results were analyzed by chi-square tests and multivariable logistic regression.
  
  
  RESULTS
  Several themes emerged from the focus groups, including: 1) the vaccine decision-making process begins prenatally, 2) vaccine decision making is an evolving process, and 3) there is overall trust in the pediatrician but a lack of trust in the information they provided about vaccines. The survey response rate was 52% (n = 443). Parents who refused or delayed vaccines were 2 times more likely to report that they began thinking about vaccines before their child was born and 8 times more likely to report that they constantly reevaluate their vaccine decisions than parents who accepted all vaccines. Although parents tended to report trusting their pediatrician's advice on nutrition, behavior, and the physical examination, they did not believe their pediatrician provided "balanced" information on both the benefits and risks of vaccination.
  
  
  CONCLUSIONS
  These results have implications for future interventions to address parental vaccination concerns. Such interventions may be more effective if they are applied early (during pregnancy) and often (pregnancy through infancy), and cover both the risks and benefits of vaccination.
authors.affiliation: Kaiser Permanente Colorado-Institute for Health Research, Denver, Colo. Electronic address: jason.m.glanz@kp.org.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Glanz
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Wagner
authors.forename: Komal J
authors.initials: KJ
authors.lastname: Narwaney
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: Shoup
authors.forename: David L
authors.initials: DL
authors.lastname: McClure
authors.forename: Emily V
authors.initials: EV
authors.lastname: McCormick
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Daley
mesh_terms: D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010290:Parents / Q000523:psychology*; D011368:Professional-Family Relations; D016312:Treatment Refusal / Q000523:psychology*; D035502:Trust / Q000523:psychology*; D014611:Vaccination / Q000523:psychology*
keywords: immunization; mixed methods; vaccine decision making; vaccine refusal