title: Parents' choices and rationales for alternative vaccination schedules: a qualitative study.
abstract: BACKGROUND
  A growing number of parents adopt alternative vaccination schedules for their children. A better understanding of parents' rationales for these choices is needed to guide vaccine decision making.
  
  
  METHODS
  We conducted 24 semistructured telephone interviews with parents of 12- to 36-month-olds and analyzed data using an inductive approach.
  
  
  RESULTS
  We identified 5 alternative vaccination approaches: "Dr Sears" schedule, shot-limiting approach, selective delay or decline, visit-by-visit decisions, and refusal of all vaccines. Parents who adopted alternative approaches expressed a desire for more control of exposure to vaccine ingredients; vaccine safety, immune system burden, and perceived disease risk were articulated as concerns.
  
  
  CONCLUSIONS
  Parents who adopt alternative vaccination schedules can be classified in defined subgroups based on their decision-making approaches, and many describe considered reasons to support their actions. Communications that acknowledge and address those reasons may be better able to engage parents and ultimately enhance the process of decision making about vaccines.
authors.affiliation: Center for Health Decision Science, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Adrianna
authors.initials: A
authors.lastname: Saada
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
authors.affiliation: Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Morain
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Zikmund-Fisher
authors.affiliation: Center for Health Decision Science, Harvard School of Public Health, Boston, MA, USA ewittenb@hsph.harvard.edu.
authors.forename: Eve
authors.initials: E
authors.lastname: Wittenberg
mesh_terms: D002675:Child, Preschool; D002755:Choice Behavior; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D010290:Parents; D036301:Qualitative Research; D014611:Vaccination
keywords: decision making; immunization schedule; immunizations; parents; vaccination