title: When parents won't vaccinate their children: a qualitative investigation of australian primary care providers' experiences.
abstract: Increasingly, the experiences and perceptions of parents who decline vaccination are the subject of investigation. However, the experiences of clinicians who encounter these parents in the course of their work has received little academic attention to date. This study aimed to understand the challenges faced and strategies used when general practitioners and immunising nurses encounter parents who choose not to vaccinate their children.
  
  
  
  Primary care providers were recruited from regions identified through the Australian Childhood Immunisation Register (ACIR) as having higher than national average rates of registered objection to childhood vaccination. Interviews began with an exploration of provider experiences with parents who accept, are hesitant towards, and who decline vaccination. Participants were asked specifically about how they addressed any difficulties they encountered in their interactions. Thematic analysis focused on encounters with parents - challenges and strategies.
  
  
  
  Twenty-six general practitioners (GPs), community and practice nurses (PNs) were interviewed across two regions in NSW, Australia. Providers' sense of professional identity as health advocates and experts became conflicted in their encounters with vaccine objecting parents. Providers were dissatisfied when such consultations resulted in a 'therapeutic roadblock' whereby provider-parent communication came to a standstill. There were mixed views about being asked to sign forms exempting parents from vaccinating their children. These ranged from a belief that completing the forms rewarded parents for non-conformity to seeing it as a positive opportunity for engagement. Three common strategies were employed by providers to navigate through these challenges; 1) to explore and inform, 2) to mobilise clinical rapport and 3) to adopt a general principle to first do no harm to the therapeutic relationship.
  
  
  
  Many healthcare providers find consultations with vaccine objecting parents challenging and some, particularly more experienced providers, employ successful strategies to address this. Primary care providers, especially those more junior, could benefit from additional communication guidance to better the outcome and increase the efficiency of their interactions with such parents.
authors.affiliation: Sydney School of Public Health, University of Sydney, Edward Ford Building A27, Sydney, NSW, 2006, Australia.
authors.forename: Nina J
authors.initials: NJ
authors.lastname: Berry
authors.affiliation: Sydney School of Public Health, University of Sydney, Edward Ford Building A27, Sydney, NSW, 2006, Australia.|Lismore Base Hospital, 60 Uralba St, Lismore, NSW, 2480, Australia.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Henry
authors.affiliation: Murdoch Children's Research Institutes, Royal Children's Hospital, 50 Flemington Rd, Parkville, 3052, VIC, Australia.
authors.forename: Margie
authors.initials: M
authors.lastname: Danchin
authors.affiliation: Sydney School of Public Health, University of Sydney, Edward Ford Building A27, Sydney, NSW, 2006, Australia.
authors.forename: Lyndal J
authors.initials: LJ
authors.lastname: Trevena
authors.affiliation: Sydney School of Public Health, University of Sydney, Edward Ford Building A27, Sydney, NSW, 2006, Australia.
authors.forename: Harold W
authors.initials: HW
authors.lastname: Willaby
authors.affiliation: Sydney School of Public Health, University of Sydney, Edward Ford Building A27, Sydney, NSW, 2006, Australia. julie.leask@sydney.edu.au.
authors.forename: Julie
authors.initials: J
authors.lastname: Leask
mesh_terms: D001291:Attitude of Health Personnel; D002675:Child, Preschool; D058006:General Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D009517:New South Wales; D009723:Nurse-Patient Relations / Q000941:ethics; D033282:Parental Consent / Q000941:ethics / Q000523:psychology; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010817:Physician-Patient Relations / Q000941:ethics; D057184:Practice Patterns, Nurses' / Q000941:ethics; D010818:Practice Patterns, Physicians' / Q000941:ethics; D059017:Primary Care Nursing; D011320:Primary Health Care / Q000941:ethics; D036301:Qualitative Research; D000072758:Vaccination Refusal / Q000941:ethics / Q000523:psychology*
keywords: Communication; Consultation; Iimmunisation; Primary healthcare provider; Vaccination; Vaccine-hesitance