title: Parent and provider perspectives on immunization: are providers overestimating parental concerns?
abstract: OBJECTIVE
  Data are limited on whether providers understand parental attitudes to recommended childhood immunizations. We determined parental attitudes and assessed how accurately providers estimated parental opinions.
  
  
  METHODS
  Survey of parents and providers (pediatricians, nurses, medical assistants) in randomly selected practices in Houston, Texas. Surveys assessed demographics, perceptions of immunization importance, safety and efficacy, and acceptability of vaccine delivery. Providers estimated parental responses.
  
  
  RESULTS
  401 parents (82% mothers, 12% fathers, 6% other) and 105 providers participated. Parents thought vaccines were important for health (median score 9.5; 0=not important, 10=extremely important) but also were concerned regarding vaccine safety and side effects (8.9 on 0-10 scale). 309 (77%) agreed that vaccines effectively prevent disease. Route of administration mattered to 147 (37%), who preferred injection (9.0) over oral (7.3) or intranasal (4.8) routes. Although parents would prefer three or fewer injections per visit, preventing more diseases (189 [47.6%]) was more important than number of injections (167 [42.3%]) when deciding the number of vaccines allowed per visit. White parents rated vaccines less important in preventing some illnesses than did non-white (P≤0.006 for meningitis, hepatitis, HPV, influenza and rotavirus) and rated number of injections per visit more important than number of diseases prevented (51.6% white versus 34.2% non-white; P 0.002). Providers underestimated parental attitudes toward vaccine importance (particularly influenza and HPV), and overestimated the proportion of parents who thought route of administration mattered (63%) and that number of injections per visit was the most important factor (76%) around parental vaccine decisions (P<0.001 for parent-provider mismatch).
  
  
  CONCLUSIONS
  Most surveyed parents believe vaccines are important for child health and rate disease prevention higher than number of injections entailed. Providers underestimate the importance of some vaccines to parents and overestimate parental concerns regarding route of administration. Future research should focus on how this mismatch impacts parental vaccine decisions.
authors: Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Center for Vaccine Awareness and Research, Texas Children's Hospital, 1102 Bates St., Suite 1120, Houston, TX 77030, USA. Electronic address: chealy@bcm.edu.
authors: C Mary
authors: CM
authors: Healy
authors: Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Center for Vaccine Awareness and Research, Texas Children's Hospital, 1102 Bates St., Suite 1120, Houston, TX 77030, USA.
authors: Diana P
authors: DP
authors: Montesinos
authors: Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
authors: Amy B
authors: AB
authors: Middleman
mesh_terms: D000328:Adult; D003657:Decision Making; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007114:Immunization / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D013781:Texas; D014612:Vaccines / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D014612:Vaccines
keywords: CDC; CHIP; Centers for Disease Control and Prevention; Children's Health Insurance Program; HPV; Haemophilus influenzae type b; Hib; Immunization; MA; Parent provider mismatch; Parental beliefs; Provider estimates; VPD; Vaccine hesitancy; human papillomavirus; medical assistant; vaccine-preventable disease