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Identifier

000454709

Title

Πρακτικές και στάσεις παιδιάτρων σε οικογένειες που αρνούνται ή τροποποιούν τον εμβολιασμό των παιδιών τους

Alternative Title

Practices and attitudes of paediatricians towards families that deny or modify their children's vaccinations

Author

Ζορμπαδάκη, Ειρήνη

Thesis advisor

Περδικογιάννη, Χρυσούλα
Βεργαδή, Ελένη
Παυλοπούλου, Ιωάννα

Abstract

Introduction: Childhood immunization is one of the greatest public health achievements of the 20th century, yet more and more parents have concerns about the safety and effectiveness of vaccines. Parental noncompliance with the recommended childhood vaccination schedule represents a growing public concern according to the American Academy of Paediatrics and the Center for Disease Control. Paediatricians face this challenge in every – day practice, trying to respond to families who refuse or show hesitancy towards vaccines. Some paediatricians may choose to dismiss these families from their office, a practice that appears to be on the rise in the US and Europe. The investigation of the attitudes and practices of the paediatricians in Crete, both in the private and public sector is of particular interest. Methods: This is a descriptive cross-sectional study conducted through a questionnaire. The questionnaire was sent electronically and through-telephone reminders, while wherever it was possible shared in person from October 2022 to January 2023. The sample included all paediatricians of Crete. Gender, age, years of pediatric practice and employment status were recorded. Paediatricians perception of vaccine refusal/delay, parental reasons for refusal and/or delay and the dismissal policies of paediatricians for these families were examined. We assessed the reasons of the dismissal policies if present and the practices towards the families who refuse or significantly change the vaccination schedule. The association of dismissal policies of the families with age group, gender and employment status of paediatricians was examined. Data analysis was performed in Microsoft excel and SPSS. Results: The main reasons for refusal that paediatricians have encountered concern the development of autism spectrum disorders (78.1%), future side effects (75.3%) and immediate side effects (62.2%). The main vaccines for which paediatricians have encountered hesitant parents are the new COVID-19 vaccine (74.3%), MMR (67%) and HPV (49.3%). The rate of refusal to follow children whose families deny vaccinations increases statistically significantly with age of paediatricians. From a low rate of 3.8% in the age group <30 years to a high of 43.8% in the age group 60 years and above (p<0.0001). The rates of refusal of families was found to be significantly higher in the age groups 40-49, 50-59 and 60 years or older than in the age groups <30 years and 30-39 years. In addition, it was observed that the private doctors had higher rate of refusal to follow up families with a denial profile than the doctors of the public health system (39.2% vs. 22.6%) with the difference being at the limits of statistical significance (p=0.052). Those who said they refused to follow up children had significantly more years of experience than those doctors who said they did not refuse to follow up [(18.7 (±8.7) years vs. 12.7 (±8.8), p<0.0001)]. Also, those paediatricians who stated that they understand parental hesitancy about vaccine safety were less likely to dismiss families (OR 0.4321;95% CI:0.205 to 0.907;p=0.027). The most important predictor of dismissing families appeared to be paediatricians request that parents sign a vaccination refusal form. Based on the present study, 60.6% of paediatricians stated that they would not refer patients to other health professionals who would allow them to deviate from the vaccination program. The reason for dismissing families was the possibility of motivating parents to vaccinate their children (85.18%) and the fact that the doctor-patient-parent relationship is affected (74.04%), while the rationale for not dismissing families was the opinion about the necessity of uniform universal care for all children (86.95%) and the expectation that paediatricians would succeed in changing the opinion of parents (74.39%) over time. In both cases, paediatricians mainly used literature data (84%) and official agencies (75.7%) as means of persuasion. Conclusions: The study recorded a high percentage of paediatricians who encounter in their daily practice concerns and hesitation from parents about the safety and effectiveness of childhood vaccines. However, despite this, the policy of rejecting families who refuse to vaccinate their children is not common among paediatricians in Crete and when it does happen, it aims to motivate parents to eventually vaccinate their children. A low percentage of paediatricians were found to refer these families to other health care providers. However, there remains the question of the effects of dismissal policies on individual and public health. The study highlights the need for further research into the achievement of paediatricians’ goals when they decline or accept to follow children who do not follow the recommended vaccination schedule.

Language

Greek

Subject

Dismissal policy

Ethics

Refusal

Vaccine

Vaccine hesitancy

Εμβόλιο

Ηθική διστακτικότητα εμβολίων

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