Attitudes and Beliefs of Parents Concerned About Vaccines: Impact of Timing of Immunization Information

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FIGURE 1
Study design for participants in each of the 4 treatment groups. TN indicates Tennessee; CA, California.

TABLE 1

Statements and Questions Used to Evaluate Change in Attitudes and Beliefs Among Study Participants

Statement/Question	Possible Reponses
Statement/Question	Positive		Negative
Vaccines are necessary to prevent certain diseases	Strongly agree	Agree	Neither disagree nor agree	Disagree	Strongly disagree
If I vaccinate my child he/she may have a serious side effect	Strongly disagree	Disagree	Neither disagree nor agree	Agree	Strongly agree
In general, how safe do you think vaccinations are for children?	Very safe	Safe	Somewhat safe	Not at all safe
How confident are you in the safety of routinely received childhood vaccinations?	Very confident	Confident	Somewhat confident	Not at all confident
Getting multiple shots in one visit can overload a child's immune system	False		I don't know	True

TABLE 2

Study Population Demographics According to Treatment Group

	Prenatal Group	1-wk Group	2-mo Group (Reference)	All-Time-Points Group^a
Total, n (%)	79 (36)	77 (35)	61 (28)	55 (100)
Study site, %
Stanford (n = 100)	51	49	36	29
Vanderbilt (n = 117)	49	51	64	71
Education, %
Less than high school/graduated from high school	26	20	31	7
Some/graduated from college	44	49	46	44
Postcollege degree	29	30	21	47
Prefer not to answer	1	0	2	2
Prenatal care initiation, %
First trimester	87	87	90	95
Second trimester	10	12	8	3
Third trimester	3	1	2	0
Prefer not to answer	0	0	0	2
Race, %
White	48	54	48	73
African American	19	13	21	4
Asian/Pacific Islander	22	10	11	16
Native American	0	0	2	0
Other	10	17	16	5
Prefer not to answer	1	6	2	2
Hispanic, %
Yes	9	10	13	2
Prefer not to answer	0	2	2	0
First child
Yes, %	42	56	48	55
If No, mean No. of children	2	2	2	2
Income, %
Less than $30 000	28	21	33	4
$30 001–$49 999	16	21	21	11
$50 000–$74 999	9	21	20	24
$75 000 or more	39	26	16	47
Prefer not to answer	8	11	10	15
Screening survey classification, %
Health advocate	13	18	11	15
Fence-sitter	77	57	69	73
Worried	10	25	20	13

TABLE 3

Attitudes and Beliefs of Study Participants According to Study Group at the Pretest and Posttest

Treatment Group	Vaccines Are Safe, % (95% CI)	I Am Confident in the Safety of Routinely Recommended Vaccines, % (95% CI)	Multiple Vaccines at Once Do not Overload the Immune System, % (95% CI)	If I Vaccinate My Child, He or She Will Probably not Have a Serious Adverse Effect, % (95% CI)	Vaccines Are Necessary to Prevent Certain Diseases, % (95% CI)
Prenatal
At screening	77 (66–86)	73 (62–83)^a	62 (50–72)^a	46 (35–58)	92 (84–97)
After intervention	94 (86–98)	92 (84–97)^a	90 (82–95)^a	45 (34–57)	99 (93–100)
1 wk
At screening	80 (69–88)^a	73 (62–83)^a	50 (38–60)^a	21 (13–32)^a	97 (91–100)
After intervention	97 (91–100)^a	99 (93–100)^a	80 (69–88)^a	52 (40–64)^a	93 (85–98)
2 mo
At screening	89 (78–95)	85 (74–93)	56 (42–68)^a	23 (13–36)	93 (84–98)
After intervention	95 (86–99)	92 (82–97)	82 (70–91)^a	34 (23–48)	93 (84–98)

The all-time-points group was analyzed separately. Results: Vaccines are safe, at screening = 98% (90–100), after intervention = 98% (95% CI: 90–100); I am confident in the safety of routinely recommended vaccines: at screening = 96% (95% CI: 87–100), after intervention = 96% (95% CI: 87–100); Multiple vaccines at once do not overload the immune system: at screening = 96% (95% CI: 87–100), after intervention = 100% (95–100); If I vaccinated my child, he/she will probably not have a serious side effect: at screening = 38% (95% CI: 25–52), after intervention = 49% (95% CI: 35–63); and Vaccines are necessary to prevent certain diseases: at screening = 98% (95% CI: 90–100), after intervention = 98% (95% CI: 90–100). CI indicates confidence interval.
↵a Statistically significant.

TABLE 4

Odds That a Participant in the Treatment Group Will Agree With the Statements After Intervention Compared With Before Intervention

Treatment Group	Adjusted OR (95% CI)^{^a}^,b
Treatment Group	Vaccines Are Safe	I Am Confident in the Safety of Routinely Recommended Vaccines	Multiple Vaccines at Once Do not Overload the Immune System	If I Vaccinate My Child, He/She Will Probably not Have a Serious Side Effect	Vaccines Are Necessary to Prevent Certain Diseases
2-mo	1.11 (1.00–1.23)	1.13 (1.00–1.27)	1.34 (1.16 –1.55)	1.24 (1.05–1.47)	1.04 (0.96–1.12)
Prenatal	1.18 (1.09–1.30)	1.22 (1.10–1.35)	1.34 (1.19–1.52)	0.95 (0.82–1.10)	1.04 (0.97–1.11)
1-wk	1.15 (1.05–1.26)	1.24 (1.12–1.39)	1.43 (1.26–1.63)	1.40 (1.21–1.62)	0.97 (0.91–1.04)

The all-time-points group was analyzed separately. ORs compare the final posttest responses to initial screening test responses. Adjusted ORs: Vaccines are safe = 1.06 (95% CI: 1.00–1.13); I am confident in the safety of routinely recommended vaccines = 1.08 (95% CI: 1.02–1.16); Multiple vaccines at once do not overload the immune system = 1.52 (95% CI: 1.34–1.73); If I vaccinate my child, he/she will probably not have a serious side effect = 1.25 (95% CI: 1.10–1.42); and Vaccines are necessary to prevent certain diseases = 1.02 (95% CI: 0.99–1.05). CI indicates confidence interval.
↵a Adjusted for site, first-time mother, receiving prenatal care, education, race, Hispanic ethnicity, age, and income.

TABLE 5

Study Participants' Preferences About the Timing of Immunization Information

Treatment Group	Satisfied/Very Satisfied With Receiving Information at Study Time, %	Preferred Visit for Immunization Materials
Treatment Group		Prefer Information at Prenatal Visit, %	Prefer Information at a Child Visit Before Vaccination, %	Right Before Vaccination, %
2-mo	93	23	74	3
Prenatal	97	53	46	1
1-wk	96	38	57	5