“I Thought It Was Better to Be Safe Than Sorry”: Factors Influencing Parental Decisions on HPV and Other Adolescent Vaccinations for Students with Intellectual Disability and/or Autism in New South Wales, Australia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Research Design and Setting
2.2. Participants and Recruitment
2.3. Data Collection
2.4. Data Analysis
3. Results
3.1. Participants’ Characteristics and Key Themes
3.2. Appreciating Diverse Parental Attitudes towards Vaccination
3.2.1. Pro-Vaccination without Persuasion
“I think for me, it’s more because they recommend it. I am kind of very obedient patient, whatever I get (laughs). We say, if we are told the Government recommends, we try it.”Parent (P3)
[Q Why do you think parents make the decision to have their children vaccinated?] “I think it’s because they do want to protect them… our kids are very vulnerable and the parents are very aware of trying to keep them safe and healthy.”School staff (SS3)
[Q Did he receive all the adolescent vaccinations? I think it’s Meningococcal, DTPA and the HPV vaccine.] Ah, I think so, I would actually have to consult the records to be a hundred percent sure. I definitely remember him getting the HPV one, cos I remember thinking “oh, I don’t’ know if that one’s necessary to him in his context”. Whether or not he’s going to grow up to have a normal, you know, sexual life when he’s an adult, I don’t know, because of his disability. But I thought it was better to be safe than sorry.”Parent (P4)
3.2.2. Anti-Vaccination and Unlikely to Change Their Minds
“We probably got two families in the school I guess that are anti-vaxxers.” [Q How do you know?] “Because they tell me. They’ll say, ‘Absolutely no way I want my child vaccinated. They’re not to be vaccinated.’”School staff (SS2)
Then we receive the emails or the phone calls you know, “do not vaccinate my child under any circumstances, or this will end up in a lawsuit…” We’ve had quite a few of those. More so since the Covid sort of thing went down.Immunisation staff (IS9)
“People get really narky, get bogged down in their beliefs and don’t sort of put the blinkers up and don’t want to hear alternative theories…If you give them the right information…some people are very conspiracy theory minded and will just go ‘that’s just’ you know, mainstream medicine trying to convince you, but we know the truth.’”Parent (P2)
“I had a conversation with two other parents, and they were both absolutely adamant that that’s why their children have autism. They were, in their words, “normal”, had their vaccinations and then very soon after started displaying Autistic behaviours. And even though there’s so much evidence that that’s not the case, but when that’s what you see, you know, you’ve got a child and you have seen a difference after a vaccination, it doesn’t matter how much research they read, if that’s what they believe, that’s what they believe.”School staff (SS6)
“I don’t think providing information is gonna change those people’s minds… It’s really hard to reason with people like that because they’re not being reasonable.”Parent (P4)
3.2.3. Vaccination-Hesitant and Needing Information Personalised to Their Concerns
“I tend to find that [special school] parents have a lot of anxieties and concerns because they’ve been within that system for a long time, particularly health systems… They’re very well informed in a lot of aspects. And I think that they really try to make these decisions with the best of intentions… What I’m trying to say, for a child without a disability, their parents probably wouldn’t exactly think twice sometimes. They’d probably just go “yep, sure, no worries, cos you’re healthy.” Whereas these parents I guess, it’s almost like that helicopter, that over-protectiveness. Like, they kind of really want to make sure that what they’re doing is gonna offer them an advantage, given that there’s already so many things that they’re having to deal with.”Immunisation staff (IS2)
“They don’t want to do any harm to their child, especially with special needs children that already have quite a lot of problems… They don’t want to provide any more harm to their child. But they also want to protect their child from infection as well… You know, ‘can you guarantee this won’t harm my child?’ … is the main thing.”Immunisation staff (IS8)
“I think [teachers’ worries about the restrictive practice policy] was also kind of carried across in the parents who usually go ‘I’ll consent but we might give them a go when they’re getting dental work done at the children’s hospital or something.’ … So I think there’s some anxieties about how the students might react at clinic, that kind of prevents them from consenting.”Immunisation staff (IS8)
“I said no to the HPV one because, as hard as this, I don’t believe they’re gonna be sexually active. So, for me that would be the reason if they were going to be sexually active, that’s yeah, so I didn’t um, say yes to that one.”Parent (P3)
“Sometimes the boys aren’t consented for the HPV vaccine because I guess parents think that boys aren’t gonna get it cos it’s related to cervical cancer.”Immunisation staff (IS5)
“It being a sexually transmitted disease that we’re looking to prevent, a lot of parents don’t see the necessity at that time, for those students in Year 7… they’re already saying ‘oh, but my kid’s not gonna be sexually active for another, you know, forty years,’ they think, ‘why do I need to vaccinate them now?’”Immunisation staff (IS2)
I think some parents have got that idea of “my kid’s had enough vaccinations in the last two years, I don’t really want any more vaccinations at the moment”Immunisation staff (IS6)
“Some of them are burnt out as well. Amongst everything that their children require. There’s a lot of (inaudible) to the doctor, or fight with the kid over the doctor…”School staff (SS9)
“if they’re hesitant, yes, providing the facts in an easy to understand way, might overcome their hesitancy…”Parent (P4)
3.3. Educating Parents and Managing Vaccination Questions and Concerns
3.3.1. Perceptions of the Government Vaccination Information Pack
“I just wonder to what extent these packs are accessible. Like especially if parents themselves might have intellectual disability...”School staff (SS2)
“We have a large, and I mean I’m talking around seventy percent low socio-economic, have not finished year ten. So, realistically, they can’t even read the forms.”School staff (SS4)
“Perhaps there is a gap in the program in where we need a leaflet, or brochure, for parents of children attending special schools…and perhaps part of that [online] process we can include advice…”Immunisation staff (IS10)
[Q What can be done to improve vaccination coverage in special schools?] I think potentially making the resources a little bit more explicit, cos it’s very general, … potentially that’s something we need to look at internally and developing resources that kind of address these questions that parents might have. Like, “My child has autism, can they still be vaccinated at school? What can you do for them at school if they have particular, you know, sensitivities or that kind of thing…” Or could we be making resources that are disability friendly…or easy to read… Or even for students to have a look at, in terms of educating them about why this is happening…Immunisation staff (IS3)
3.3.2. Role of Schools in Informing Parents about the Vaccination Program
“Most parents feel a lot better about emailing the school…if they do have any queries or concerns... ‘I don’t want to get my child vaccinated, or I do want to get my child vaccinated, how do I go about it?’ And then the [school] coordinator will either answer their question or forward it onto us. In terms of general communication about vaccines and their importance and ‘this is why you should get it’, the school coordinators don’t generally do that. It depends on kind of their background.”Immunisation staff (IS3)
“Especially as we’re not a medical professional, I don’t think we can legally say ‘we think your child can get this’, because if something went wrong. So I guess if a parent had questions, I would try to refer them to somewhere to get the right answers but I would never recommend or I would not tell a parent they should be doing this…”School staff (SS6)
“We do try and say you know, why we think these things are a good idea but I can’t make that choice for them. […] it’s completely the parental choice.”School staff (SS3)
I would simplify it. I would say the Human Papilloma[virus], “this will prevent cancer”, and…the reason we give it to our students, is because there is evidence to say…School staff (SS4)
“I think HPV, there’s still a little bit of that “oh, it’s a girls’ vaccine” type and I sometimes hear teachers saying that to parents. It’s for girls, you don’t have to get your son that HPV vaccine.”Immunisation staff (IS3)
[Q It sounds like you’re very positive in terms of trying to give them that information in order to make that decision] “Yeah. I think it’s more around the questions around the vaccination, like will it hurt, will they get sick, what are the side effects, the consequences. And to reinforce that we will monitor your child, we will make sure that they’re ok.”School staff (SS7)
3.3.3. Role of Nurses in Shaping Parental Attitudes to Vaccination
“We’re not even really interacting with the parents.”Immunisation staff (IS7)
“We don’t have any way of communicating with parents directly.”Immunisation staff (IS3)
“If parents don’t provide consent, we can’t contact them, unless they contact us.”Immunisation staff (IS8)
“The people who are ringing me aren’t vaccine hesitant, they’re people wanting to genuinely get their kids vaccinated.”Immunisation staff (IS9)
“I’ve gotta find out what their concerns are and then tailor my response to that... So, it’s about good communication and listening as well, and finding out what is it that they’re worried about? … and you know, we talk to them about weighing the risk of side effects of the vaccination and providing them with how the vaccine does work, what it’s protecting the child against…”Immunisation staff (IS8), nurse
“It’s about the information that we’re actually putting out there to them. And I think it’s also about understanding the individual and all of the individual circumstances…We really probably need to be able to see the entire picture to go “oh, yeah, alright…if these are your concerns or this is your history, or this is what you’ve experienced, this is the information that you need to know about.”Immunisation staff (IS2), nurse
4. Discussion
4.1. Results in Context
4.2. Implications and Recommendations
4.3. Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Carter, A.; Klinner, C.; Young, A.; Strnadová, I.; Wong, H.; Vujovich-Dunn, C.; Newman, C.E.; Davies, C.; Skinner, S.R.; Danchin, M.; et al. “I Thought It Was Better to Be Safe Than Sorry”: Factors Influencing Parental Decisions on HPV and Other Adolescent Vaccinations for Students with Intellectual Disability and/or Autism in New South Wales, Australia. Vaccines 2024, 12, 922. https://doi.org/10.3390/vaccines12080922
Carter A, Klinner C, Young A, Strnadová I, Wong H, Vujovich-Dunn C, Newman CE, Davies C, Skinner SR, Danchin M, et al. “I Thought It Was Better to Be Safe Than Sorry”: Factors Influencing Parental Decisions on HPV and Other Adolescent Vaccinations for Students with Intellectual Disability and/or Autism in New South Wales, Australia. Vaccines. 2024; 12(8):922. https://doi.org/10.3390/vaccines12080922
Chicago/Turabian StyleCarter, Allison, Christiane Klinner, Alexandra Young, Iva Strnadová, Horas Wong, Cassandra Vujovich-Dunn, Christy E. Newman, Cristyn Davies, S. Rachel Skinner, Margie Danchin, and et al. 2024. "“I Thought It Was Better to Be Safe Than Sorry”: Factors Influencing Parental Decisions on HPV and Other Adolescent Vaccinations for Students with Intellectual Disability and/or Autism in New South Wales, Australia" Vaccines 12, no. 8: 922. https://doi.org/10.3390/vaccines12080922