Surveys: Physicians play key role in vaccine-safety messages

Apr 19, 2011 (CIDRAP News) – Doctors are parents' most trusted source of vaccine-safety information, and physicians say they're spending more time during well-child visits educating parents about vaccines and addressing concerns, according to two new surveys.

While the finding that many parents hold doctors' opinions about vaccine in high esteem isn't surprising, the new surveys also sketch out the influence of others who are vocal about vaccine safety, including public health officials and celebrities.

Last week doctors opposed a CBS decision to allow two anti-vaccine groups to broadcast their message over a 3-week period on a JumboTron in New York City's Times Square. O. Mario Burton, MD, president of the American Academy of Pediatrics (AAP), wrote an Apr 13 letter to CBS Outdoor president Wally Kelly that said providing ad space to the groups puts children's lives at risk and asked for the ad's removal, according to the science news blog Repectful Insolence.

Leveraging physician influence
The survey gauging what sources affect parents' vaccine-safety perceptions was conducted by University of Michigan researchers and appeared yesterday in an online supplement issue of Pediatrics. The online survey was sent to a nationally representative sample of 2,521 parents with children age 17 and younger. The sample included an increased proportion of areas with high concentrations of Hispanic and black households.

The survey was conducted in January 2009 and had a 62% response rate.

Seventy-six percent of parents said they trusted their child's physician the most for vaccine safety information. The next most trusted source was other healthcare providers (26%), followed by government experts (23%). Respondents said they placed some trust in other sources, including family and friends (67%) and parents who believe their child was harmed by a vaccine (65%). Celebrities were trusted a lot by 2% and somewhat by 24%.

When researchers asked what sources parents used for vaccine-safety information, they found that Web sites from doctors' groups were the most used and most trusted. They also found that attitudes varied by gender, with mothers more likely to report trust in information from parents whose child was injured by a vaccine, celebrities, television shows, and magazine and news articles.

Responses also varied by race. Hispanics and whites were more likely than blacks to trust information from friends and family, and Hispanic parents were more likely than the other two groups to trust vaccine-safety information that came from celebrities.

Researchers said the significant percentage of parents who trusted non-medical sources of information is alarming. "This conflict between health professionals and non-health professionals as information sources regarding vaccine safety is shaping the national dialogue on the issue," they wrote.

Also concerning was the finding that only 23% of parents put a lot of trust in government officials for vaccine-safety information. More study is needed to determine the reasons and how to reverse the trend. The authors suggested that in the meanwhile, government officials could partner with physician groups to deliver immunization messages.

They said the findings suggest it would be helpful to position physicians or physician groups as spokespeople to counter anti-vaccine messages from celebrities.

Physicians see more vaccine-safety concerns
In a survey designed to explore physicians' perceptions of their vaccine-safety discussions with parents, researchers from the University of Colorado Denver found that most physicians believe parents' concerns about vaccines have greatly or moderately increased over the past 5 years. The findings appear in an early online edition of the American Journal of Preventive Medicine.

Conducted in early 2009, the survey included nationally representative responses from 696 pediatricians and family physicians. The authors found that in a typical month, 79% of physicians report at least one vaccine refusal, and 89% get at least one request to spread out vaccinations.

The physicians also reported that vaccine discussions are taking a larger chunk of time out of well-child visits, which some say is compromising their ability to focus on other health needs. About one-third of doctors said the pressure the vaccine discussions put on what can be accomplished during the clinic visit is negatively affecting their job satisfaction.

Allison Kempe, MD, MPH, lead author of the study and professor of pediatrics at the University of Colorado School of Medicine, said in a press release, "Primary care providers in this country have been doing a terrific job trying to counter the misinformation about vaccine safety that is so abundant on the Internet and other media, but they are spending a great deal of their time at well visits discussing these issues alone."

She added that a multipronged approach is needed to educate parents about vaccine safety in the clinic setting, including greater use of educational materials before visits, educational forums for groups, and creative use of media and social marketing tools.

When questioned about the success of their vaccine messages, physicians said personal messages were most effective for convincing skeptical parents, such as sharing stories about their own experiences with their children.

Tips for talking to parents
In a review article on communicating with parents on vaccine safety that appeared yesterday in the same supplement issue of Pediatrics, two immunization experts had several tips for doctors. The authors are C. Mary Healy, MD, of the Center for Vaccine Awareness and Research at Texas Children's Hospital in Houston and Larry Pickering, MD, with the US Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases.

They suggested that physicians first establish an honest dialogue with parents, taking the time to assess their beliefs about immunizations. The next step is to acknowledge that vaccines may be associated with adverse events while also explaining the disease-fighting benefits.

Physicians should be prepared to address common myths about vaccines, especially as they relate to autism and the administration of multiple vaccines, Healy and Pickering wrote. To wrap up the conversation, physicians should provide parents with other information resources, such as Web sites of professional organizations and public health agencies.

The authors acknowledged that sometimes parents will insist on alternate immunization schedules, which should be used only when other options fail. Physicians can use these situations as opportunities to do more targeted vaccine-safety education and keep the dialogue going, they added.

See also:

Apr 14 Respectful Insolence blog post on AAP letter

Apr 18 Pediatrics abstract on sources of credible vaccine-safety information

Apr 18 Pediatrics abstract on communication with vaccine-hesitant parents

May Am J Prev Med abstract

Apr 13 University of Colorado Denver press release

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