title: Parental attitudes and decision-making regarding MMR vaccination in an anthroposophic community in Sweden--a qualitative study.
abstract: Measles outbreaks occur regularly throughout Europe, up to 31500 cases in the previous year, particularly where there are pockets of populations with lower vaccination coverage than the recommended ≥ 95%. Anthroposophic communities in Europe are one of several groups with relatively low vaccination coverage. In Sweden, outbreaks of measles and rubella were reported from an anthroposophic community. Thus the aim of this qualitative study was to explore facilitators and barriers to MMR vaccination among parents living in anthroposophic communities in Sweden. Twenty parents living in an anthroposophic community were interviewed, focusing on their views and decisions on MMR vaccination. The interviews were analyzed using qualitative content analysis. Two overarching views of health emerged, differentiating broadly parents who vaccinate vs. parents who do not vaccinate. Four themes describing parental attitudes toward measles vaccination were developed and three of these, the conformers, the pragmatists and the attentive delayers describe different approaches toward vaccinations among those who actually vaccinate. The last theme, promoters of natural immunity, represents those postponing or refusing vaccination beyond childhood. This study suggests that there is a spectrum of parental beliefs regarding MMR vaccination in this anthroposophic community. Interventions specifically targeted to the anthroposophic community and strengthening health workers capacity for a constructive dialog on vaccine's benefit and risks may contribute to higher vaccination coverage. This is believed to minimize the risk of future epidemics and contribute to the WHO European Region's goal of eliminating measles.
authors.affiliation: Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Jan Waldenströms gatan 35, 205 02 Malmö, Sweden; Public Health Agency of Sweden, Folkhälsomyndigheten, 171 82 Solna, Sweden. Electronic address: emma.bystrom@folkhalsomyndigheten.se.
authors.forename: Emma
authors.initials: E
authors.lastname: Byström
authors.affiliation: Public Health Agency of Sweden, Folkhälsomyndigheten, 171 82 Solna, Sweden. Electronic address: Ann.Lindstrand@folkhalsomyndigheten.se.
authors.forename: Ann
authors.initials: A
authors.lastname: Lindstrand
authors.affiliation: World Health Organization (WHO) Regional Office for Europe, UN City, Marmorvej 51, 2100 Copenhagen Ø, Denmark. Electronic address: natlikhite@yahoo.com.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Likhite
authors.affiliation: World Health Organization (WHO) Regional Office for Europe, UN City, Marmorvej 51, 2100 Copenhagen Ø, Denmark. Electronic address: RBU@euro.who.int.
authors.forename: Robb
authors.initials: R
authors.lastname: Butler
authors.affiliation: Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Jan Waldenströms gatan 35, 205 02 Malmö, Sweden. Electronic address: maria.emmelin@med.lu.se.
authors.forename: Maria
authors.initials: M
authors.lastname: Emmelin
mesh_terms: D000328:Adult; D001290:Attitude; D002675:Child, Preschool; D003657:Decision Making; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D008457:Measles / Q000453:epidemiology; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D013548:Sweden / Q000453:epidemiology; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data*
chemical_list: D022542:Measles-Mumps-Rubella Vaccine
keywords: Anthroposophic community; Decision-making; MMR; Parental attitudes