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Evid Based Nurs 9:27 doi:10.1136/ebn.9.1.27
  • Qualitative

Mothers’ decisions about MMR vaccination were framed by their children’s vulnerabilities and wider social trends


 
 Q How do mothers think and decide about measles, mumps, and rubella (MMR) vaccination for their infants?

DESIGN

Ethnography.

SETTING

2 areas in Brighton and Hove, UK.

PARTICIPANTS

23 mothers who had children <3 years of age and attended any of 5 different parent-toddler groups; 8 general practitioners (GPs) and 3 practice nurses; and 6 health visitors.

METHODS

Short informal group discussions and participant observation included 4–7 mothers attending 3 of the parent-toddler groups on a given day. 48 conversations were recorded, and 23 were developed into indepth narrative interviews lasting 1–2 hours. Interviews were transcribed and then summarised into 23 parent profiles with associated key themes and vaccination biographies. Themes were expanded and grouped in a working paper that was modified in consultation with a stakeholder advisory panel. GPs, nurses, and health visitors were interviewed together; 3 health visitors were also work-shadowed.

MAIN FINDINGS

Mothers’ narratives about MMR vaccination addressed personal histories, birth events, becoming a mother with other mothers, engaging with health professionals and government, understandings of vaccination and contraindications, and confidence in decision. (1) Personal histories. Mothers’ diverse experiences, knowledge, ways of validating and engaging with information, and expectations of health professionals shaped thinking about MMR vaccination. Some mothers’ political or philosophical beliefs contributed to perceptions that their right to choose was being denied. For some, economic need contributed to a history of compliance. (2) Birth events. MMR vaccination decisions and preferences about childbirth method appeared to be related. Several women who later rejected MMR vaccination had sought natural child birth. (3) Becoming a mother with other mothers. Mother-child groups represented an informal, egalitarian, and friendly environment where mothers rarely sought or gave advice, but simply shared experiences. Information sharing was grounded in the unique relationship and responsibility each mother had for her child. For many, the desire for camaraderie was linked to a way of discussing MMR vaccination that rejected any denial of a parent’s right to choose. Mothers were encouraged and expected to research their parenting options and then make up their own minds. Nevertheless, information seeking was rarely satisfactorily concluded by a decision to vaccinate or not; it merely accentuated a sense of doubt. (4) Engaging with health professionals and government. Although health visitors appreciated mothers’ dilemmas around MMR decision making, they were reluctant to compromise trusting relationships by what might be perceived as heavy handed advocating of vaccination. Mothers actively chose health professionals who they felt would support their vaccination decision. Other mothers didn’t ask questions because they felt patronised or intimidated; providers sometimes mistakenly interpreted this as passive acceptance. (5) Understanding of vaccination and contraindications. Mothers conceptualised vaccine risks within the framework of their personal histories. They were concerned that 3 vaccines were too many for the immune system to cope with or that existing disorders in the family or child could increase susceptibility. Thus, some parents regarded MMR as appropriate for most children, but not their own. Conceptualising risk in such “particularistic terms” meant that a child’s vulnerability to serious adverse effects depended on the strength of his or her immunity, which was shaped by his or her personality and history of strengths and weaknesses. (6) Confidence in decision. Many mothers said lack of confidence or knowledge led to the decision to vaccinate despite concerns about the risks of autism.

CONCLUSIONS

Mothers of infants framed MMR decision making in terms of their own child’s vulnerability to disease or vaccination effects, which required a personalised approach to decisions about which vaccines, their timing, and the use of combined or single vaccines. Societal trends, reflected in greater choices around childbirth and wider access to parental support groups and information, formed the basis of parents’ desire for choice in vaccination decision making. Mothers’ “MMR talk” showed not only their scientific knowledge, but also what they regarded as valued parenthood, responsibility to child, trust in institutions, and their place in parental networks.

Commentary

  1. Francine M Cheater, RGN, PhD
  1. School of Healthcare, University of Leeds
 Leeds, UK

      The findings of Poltorak et al show that a mother’s decision about MMR vaccination for her child is not the result of a single decision based on information and education; rather, it is contingent on a complex interplay of personal history; social relations with other mothers, friends, and family; and interactions with health professionals and institutions. These findings are consistent with other qualitative studies on MMR vaccination1,2 and research on the public understanding of science.3 Poltorak et al showed that mothers’ previous medical experiences influenced their trust in, or suspicions of, recommendations to vaccinate. They suggest that mothers’ compliance with vaccination may reflect reluctance to question health professionals rather than informed realisation that MMR vaccination is safe.

      The ethnographic approach enabled indepth exploration of 23 mothers’ personal experiences relating to MMR vaccination in 2 localities in an English town. The extent to which the findings are transferable to similar individuals and settings on contextual and theoretical grounds is unclear. The key messages for practice include a need for practitioners to actively listen and take into account parents’ personal frames of reference with respect to MMR vaccination, along with the provision of medical evidence of best practice, interpreted in the context of parents’ individual experiences and children. This necessitates a genuine, 2-way exchange during consultations, with a focus on individualisation of information and planned actions aimed at trust building. Such action needs to be supported by research that explores the cost effectiveness of tailored information exchange strategies to support informed parental decisions about childhood vaccinations.

      References

      Footnotes

      • For correspondence: Dr M Leach, Institute of Development Studies, University of Sussex, Brighton, UK. m.leach{at}ids.ac.uk

      • Source of funding: Economic and Social Research Council Science in Society Research Programme.

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