Why Care giver understanding of childhood immunisation

Abstract Currently in Australia, both the National Health and Medical Research Council ( N H M R C ) and the Public

Health

Association have stated that our immunisation uptake levels arc not of a high enough percentage within the population to prevent outbreaks of childhood vaccine preventable diseases (1996). While the literature discusses factors that are believed to influence care givers' decisions to vaccinate their children, few Australian studies focus on care giver understanding of childhood diseases and vaccination. The purpose of this descriptive study was to profile care givers who presented their children for vaccination public

at

health

clinics regarding their

Why

level

of

understanding of childhood vaccine preventable diseases.

Care giver understanding of childhood immunisation

Two hundred and

By: Alison Blair, Elizabeth Davies, Monica Nebauer, Sandra Pirozzo, Serita Saba, Catherine Turner

forty eight care givers attending one of six public clinics were asked to respond verbally to a researcher administered questionnaire. Demographic information as well as information related specifically

10 Collegian VoU No3 1997

to i m m u n i s a t i o n was c o l l e c t e d from

Care giver understanding of

each participant.

childhood immunisation

248 carers of children was conducted in

The major findings ol this preliminary

Age appropriate vaccination and immuni-

Brisbane during October to November

study indicate a very low level ol knowl-

sation ol children is one of the interna-

1995. The aim of this study was to build

edge among carers presenting their child

tional issues ol concern in health. In the

a profile of the characteristics of carers

for vaccination at the public health clinic.

1980s the W o r l d Health Organisation

presenting their children for vaccination

Twenty-three percent of carers had no

(WHO)

at ihc free immunisalion clinics run by

announced

an

Extended

A n exploratory study i n t e r v i e w i n g

knowledge regarding the vaccinations

Program of Immunisalion w i l h the target

the Brisbane City Council. I he pLirpose

that their child was receiving and the dis-

of eradicating six vaccine preventable dis-

of ihe study was to assess influential

ease for w h i c h the v a c c i n a t i o n was

eases from the world population (1995).

demographic variables that affect immu-

administered.

Currently, in many countries the child-

nisation compliance, care giver under-

In fact, 18 percent ol care givers were

hood immunisalion coverage is still less

standing of childhood immunisation and

unsure of the relationship between vacci-

than optimal (Queensland Health, 1994).

knowledge of vaccine preventable diseases and the sources of information used

nation and the likelihood of their child

The National Health Survey (ABS,

contracting an infectious disease. The

1989-90) ol Australian children aged 0-6

personal health record was not found to

years revealed o n l y 52.9 percent of

be useful as an educational resource.

Australian children to be age appropriate-

L I T E R A T U R E REVIEW

Although 99 percent of care givers

ly vaccinated. I he vaccination status for

Demographic Variables

had the booklet in their possession only

Queensland children in the N a t i o n a l

One of the primary factors studied in

8 percent had referred to it as a source of

Health Survey was 56.1 percent, howev-

relation to immunisalion compliance is

information. The major sources of infor-

er, this figure is now considered an over-

demographics of the care giver. Studies

mation were identified as child health

estimate (Queensland Health, 1994).

nurses (44%) and h o s p i t a l m i d w i v e s

In view of the evidence ol low vacci-

by care givers.

have found that the mother's age, race, education, socio-economic status and the

nation rates and, as such, low immunisa-

b i r t h order of the child are correlated

The results of this study highlight the

tion levels in Australia, it is important to

w i t h immunisation rales (Bobo, Gale,

disparity in knowledge levels among care

research what niggers parents to have

Purusbotiom & Wassilak, 1993). Bates,

givers w i t h regards to vaccination and

their children vaccinated.

(34%).

Fitzgerald, Dittus & W o l i n s k y (1994)

the diseases they prevent and the impor-

D e t e r m i n i n g the factors that con-

conducted a prospective cohort study

tant role of the midwife and child health

t r i b u t e to v a c c i n a t i o n c o m p l i a n c e is

a m o n g p o o r urban infants and t h e i r

nurse in disseminating information relat-

essential to the success ol implementing

mothers to evaluate the r e l a t i o n s h i p

ing to immunisation.

I Liture vaccination programs.

b e t w e e n f i n a n c i a l access,

personal

Collegian Vol 4 N o l 1997 11

f e a t u r e characteristics, mothers' health beliefs and

predicting tisage. Public immunisation

( H a r d i n g & O'l.ooney, 1984, Peckham,

under-immunisation. Only 67 percent ol

programs appeared to be more successful

1989, cited in Bennett & Smith, 1992).

the children in their study had received

in areas with a higher population ol peo-

their first vaccination by three months of

ple from n o n - n n g l i s h - s p e a k i n g back-

parental perception of the susceptibility or

age and only 29 percent were up-to-date

grounds as compared to areas with a high

vulnerability of the child contracting a dis-

at 7 months ol age. I hese researchers

Australian or British population.

ease. Becker, O r a c h m a n and K i r s c h t

Parental knowledge is also related to

l o u n d that adequacy of prenatal care,

The other factor in Bazeley's study

(1974) believed that vulnerability was

m a r i t a l status, co-residence w i t h the

which was considered critical in deter-

associated with greater compliance among

infant's grandmother, and perceived logis-

mining the sticcess of the program was

mothers who believed their children were

tical barriers to care were independently

the amount of administrative staff time

more vulnerable to particular diseases, had

related to both initiation and completion

committed to the program. This was evi-

children who suffered frequent illnesses,

of the vaccination schedule. Of particular

denced by the establishment of a baby

and/or believed that all children were

interest was the fact that free vaccine did

enrolment and reminder system and the

threatened by illness. In a further study by

not guarantee vaccination. The authors

number of hours that the clinic was avail-

I loutrouw and Carlson (1993), trends in

concluded that poor urban infants of sin-

able each month. As a result of surveys

the data suggested that the mother's per-

gle mothers and of mothers who received

conducted, Bazeley (1991) found that

ception of their children's vulnerability to

inadequate prenatal care, and those not

what people looked for in an immunisa-

disease may be a predictor of compliance

living w i t h their grandmother should be

tion service was convenience of location,

with immunisation, however, no signifi-

targeted lor tracking and follow-up.

privacy, lack of crowding, personalised

cant statistical differences were found in

O l the many demographic variables

service and individual attention, expertise

mothers' perceived vulnerability to indi-

studied in Blaze-Temples' (1991) sttidy of

of the provider, low cost and pleasant,

vidual infectious disease and vaccination

non-compliance with measles vaccination,

informative staff.

c o m p l i a n c e or n o n - c o m p l i a n c e . T h e authors found that mothers who perceived

o n l y the association between f a m i l y income and non-compliance was statisti-

Care giver understanding

their children to be vulnerable had a 60

cally significant. The results indicated

of immunisation

percent compliance rate, whereas, only 9.4

that low income lamilies were less likely

In addition to particular demographic fac-

percent of the mothers perceiving non-

to have vaccinated all of their children

tors and the vaccination service itself,

vulnerability were compliant. A major lim-

than middle and high income families.

there is some evidence that parental

itation of this study was the use ol a small

While the association with ethnicity was

knowledge about vaccine preventable dis-

non-representative sample.

not significant, the author notes that the

eases and lear in relation to vaccination

Parental perceptions of the risk/benefit

sample sizes ol particular ethnic groups

outcomes are significant factors in non-

ratio in relation to vaccination are another

were too small to gain a definitive picture

compliance (Blaze-Temple, I 9 9 l ; Bennett

factor related to vaccination compliance

of the cllect ol ethnicity on non-compli-

& Smith, 1992, Scott, 1994). These stud-

and one which is not necessarily congru-

ance. Other factors associated with non-

ies s h o w e d that some parents were

ent with the results ol studies in this area.

compliance were parental lear level, apa-

ignorant about the severity of different

Heery ( 1 9 8 2 ) , G o l d (1990), Igoe and

thy level and ignorance of certain facts

diseases and tended to underestimate the

Goodwin

about measles.

( 1 9 9 1 ) , Jobson and

Levy

benefits ol i m m u n i s a t i o n . A study by

(1991), Moreton (1992), and Wcingarten

Bazcley (1991) conducted a study ol

Peckham and Bedford (1989) showed that

& Gomberg (1992) analysed the risk of

an immunisation delivery system in the

parents' understanding ol the seriousness

possible side effects Irom vaccine pre-

then Castlereagh Health District of NSW,

ol a disease such as measles would be

ventable diseases as opposed to morbidity

w h i c h encompasses a number of local

weighed against the perceived safety ol

and mortality statistics for the same dis-

authorities each providing their own vac-

the vaccine, and would influence the deci-

eases, and concluded that the risks of

cination clinic service. It was found that

sion for i m m u n i s a t i o n . I m m u n i s a t i o n

being infected w i t h the disease if not

the clinic use by the mothers in the area

uptake to prevent diseases such as polio,

immunised were far greater than the risk

varied greatly and ranged Irom over 70

tuberculosis, diphtheria and tetanus may

of a permanent disability or death as a

percent to under five percent. O f the

be reduced because many parents have

side effect of vaccine.

demographic variables which were con-

never heard of these diseases or may

sidered in relation to each area's public

believe they have been eradicated while

misinformed about childhood vaccination

immunisation sticcess, only ethnic compo-

the health threat from diseases such as

by the public media, which is commonly

sition of the population was important in

measles is often considered negligible

used by parents as a major source ol

12 Collegian Vol4 No3 1997

There is evidence that parents may be

information about health issues (Bazeley &

Queensland Health was a 1994 initiative

METHODOLOGY

Kemp, 1994). A study by Harding (1985)

that arose out ol a recommendation of the

Design

of t h e c o n t e n t ol 2 5 3 a r t i c l e s in ( h e

National Immunisation Strategy (1993). It

This descriptive research was undertaken

British m e d i a on v a c c i n e

preventable

was d e s i g n e d to p r o v i d e an a c c u r a t e

using the survey m e t h o d , hthical clear-

c o m m u n i c a b l e diseases s h o w e d that the

source of information to all m o t h e r s of

ance was sought and obtained from the

majority ol articles gave no information

ncw-hom

University.

about the incidence, morbidity/mortality

( Q u e e n s l a n d Health, 1994). T h i s docu-

1 his required evidence of permission

rales, cause, s y m p t o m s and n o n - p e r m a -

ment not only has provisions to record all

to gain access to care givers presenting at

nent side effects of a disease but rather

h e a l t h visits and v a c c i n a t i o n s but also

Brisbane City Council Clinics. Prior to the

d w e l t on unusual r e a c t i o n s or d e a t h s .

e x p l a i n s in detail w h a t p a r e n t s s h o u l d

interview with participants an explanation

Most articles discussed disease prognosis

expect of children wilh regard to growth

of the project was provided and consent

as life threatening without information on

and development at different ages and the

was obtained Irom each care giver.

the availability and place of dispensing

causes, symptoms and available vaccina-

A survey instrument was developed to

v a c c i n a t i o n s , a l t h o u g h 78 a r t i c l e s did

t i o n / t r e a t m e n t for infectious c h i l d h o o d

c o l l e c t data p e r t a i n i n g to a n u m h e r of

emphasise the need for vaccination, par-

diseases. T h e maintenance of this record

dillerenl aspects of the carer and the child

ticularly for diphtheria and pertussis. In

by the parent is purely voluntary. In addi-

presenting for vaccination at child health clinics.

babies

in

Queensland

addition, minor side effects of vaccination

tion to boosting compliance with vaccina-

w e r e never m e n t i o n e d , but f o r t y - t h r e e

tion the intention behind issuing the per-

articles r e c o u n t e d figures for t h e inci-

sonal health record was to e d u c a t e care

•

demographic data on carer demographic data on child

Questions were grouped to ascertain:

dence of major side-effects of vaccination,

givers about childhood infectious diseases

•

such as brain damage. Harding concluded

a n d t h e b e n e f i t s of t h e

•

that while the media coverage could not

process. 1 his type of initiative is congru-

be classed as sensationalist it generally did

e n t w i t h t h e f i n d i n g s of 1 l o u t r o u w &

not give basic and necessary information

Carlson (1993), who identified that verbal

on the disease and its prevention.

c o m m u n i c a t i o n alone is i n a d e q u a t e as a

Care giver understanding and attitude

vaccination

health education cue.

carer p e r c e p t i o n s of, and k n o w l e d g e of, immunisation information

•

child's family composition and immunisation history

•

information on clinic visit on day of interview.

to immunisation are also frequently influ-

Findings of H o u t r o u w a n d C a r l s o n s

An initial pilot survey was undertaken

enced by advice given by health care pro-

descriptive study suggest that mailed

( n = 1 2 ) , which resulted in minor' adjust-

fessionals. Studies have shown that some

reminder cards also increase immunisation

ments to the survey instrument.

health care professionals are

either

compliance. Two recent Australian studies

unaware of, or misinterpret, contraindica-

(Gardner, Menzics, Malko & Hegney 1995

Sampling

tions to immunisation. In many cases, this

and Lee, Nosser & Lee 1995) showed high

Queensland Health conducts approxi-

has r e s u l t e d in r e d u c e d i m m u n i s a t i o n

immunisation uptake rates in local popula-

mately

uptake (Bennett & Smith, 1992; Lakhani,

tions when an immunisation record keep-

throughout Brisbane. At 12 of these clin-

M o r s e , M o r g a n , D a l e , & Vailc, 1987,-

ing and reminder system was introduced.

ics the Brisbane City Council runs a free

50

Child

Health

Clinics

Feckham & Bedford, 1989, Walker, 1990).

However, Rixon, M a r c h & I lolt (1994)

i m m u n i s a t i o n s e r v i c e at c e r t a i n t i m e s

In an attempt to set national standards for

surveyed general practitioners in Northern

each week, fortnight or month. A conve-

c o n t r a i n d i c a t i o n s to i m m u n i s a t i o n in

Sydney and found only 16 percent used a

nience sample was selected from carers

and

reminder system for vaccination follow-

presenting children for vaccination at six

Medical Research C o u n c i l ( 1 9 9 4 ) pub-

up. Further descriptive surveys of general

of t h e c h i l d health clinics in Brisbane.

lished a series of guidelines to health care

p r a c t i t i o n e r s in South W e s t e r n S y d n e y

T h o s e clinics chosen for inclusion in the

professionals. While there are limited eval-

were conducted by Kiddle & Harris (1995)

sample were the o n e s with the highest

uation data available on the use of these

and I lerceg & L o n g b o t t o m (1995) w h o

number of children presenting for vacci-

Australia,

the National

Health

publications, some surveys have indicated

found 8 percent and 16 percent respec-

n a t i o n . T h r o u g h p u t was an i m p o r t a n t

that the majority of general practitioners

tively used a reminder' system. T h e Herccg

s a m p l i n g c o n s i d e r a t i o n because five of

are using these publications as guidelines

and Longbottom (1995) study showed

the clinics provided a sampling period of

for immunisation (1 .iddle & Harris, 1995).

that

only one to two hours per fortnight.

health

services

dealing

with

Aboriginal populations were far more like-

1 he convenience sample consisted of

Sources of information

ly to have a record keeping and recall ser-

245 carers p r e s e n t i n g 253 c h i l d r e n for

T h e personal health record distributed by

vice than other practices.

vaccination. A relatively even number ol Collegian Vol4 No 3 1 W 1 3

respondents was obtained from each clinic, with the exception of Fortitude Valley,

data and cross tabulations between vari-

A number of reasons were given for being accompanied as illustrated in Figure 1.

ables of interest.

where reduced opening hours of one hour

Because of the wide range of values for

The largest number of children pre-

per month limited sample size. Horlitude

variables such as age, source of informa-

senting at the clinics were those dtre for

Valley was retained in the sample because

tion, residence and country of origin of

the two-month vaccination (27%). These

it was ethnically diverse. Sample numbers

respondent it was not possible to do fur-

were followed by those presenting lor the

ther analysis of variance between these and

s i x - m o n t h vaccination (26%) and the

other variables because of the high number

four-month vaccination (20%). There was

Table 1:

of empty cells in the cross tabulation.

a noticeable decrease in numbers of chil-

Sample numbers from each clinic.

Another harrier to further analysis was the

dren presenting lor vaccination that was

overwhelming percentage ol respondents

due at 12 m o n t h s ( 1 0 % ) , 18 m o n t h s

in one category for variables such as race,

(14%) and five years (6%). There was one

gender and relationship to child.

person presenting for the vaccination dtie

lor each clinic are outlined in Table I.

Clinic

Number Interviewed

Coorparoo

50

Chermside

48

Indooroopilly

44

Results

Upper M t Cravall

43

Demographic characteristics

nation, 48% had been born in a public

Ashgrove

4t

Of the primary carers 94 percent were

hospital, 5 1 % in a private hospital and

Fortitude Valley

I9

female. The mean age of the carer was

1% born at home. Most of the care givers

31.57 years w i t h a range of 19 to 48

presenting at the clinics had either' one

Data collection To ensure inter-rater reliability, all interviews were conducted over a two month period by one research assistant. All care givers were interviewed prior to their child's vaccination/s. 'I his process was considered necessary to reduce recall bias, because during the vaccination process the doctor explained each vaccination and the diseases targeted.

at 1 5 years. Of the children presenting for vacci-

years. Ninety-eight percent of the carers

(55%) or two (32%) children. Only 9 per-

were the parent ol the child. Other carers

cent ol the care givers had three children

were grandparents and paid carers.

and three percent had four c h i l d r e n .

The majority of carers (72.3 %) were

There were no families presenting with

born in Australia. The remainder (27.7%)

more than four children. When the care

were born in one of 22 different coun-

giver had more than one child in the fam-

tries. Distribution of the carers according

ily 99 percent of those children had previ-

to race indicated 8 7 . 1 % Caucasian, 9.3%

ously been vaccinated. O f the children

Asian, 2.4% Indian, 0.8% Aboriginal and

presenting for vaccination, 61 percent

0.4% M a o r i . O f the respondents inter-

were the first child, 30 percent the second

viewed, 95 percent reported that they had

child, seven percent the third child and

I he, child's mother was assumed to be

no dilliculty reading English and 94 per-

two percent the fourth child.

the primary carer and thus was the person

cent reported that they had no difficulty

interviewed. If the child's mother was not

speaking English.

present then the nearest accompanying relative to the child was interviewed.

Care giver understanding

Tertiary qualifications were held by 46

In response to being asked what diseases

percent of the carers. O l those who did

their child was being vaccinated against,

O n l y responses that were unassisted

not hold tertiary qualifications, 12 per-

only 13.7 percent were able to correctly

by prompts from accompanying people or

cent had a technical or commercial post

name all the diseases. A f u r t h e r 10.1

w r i t t e n material were recorded. II the

high school qualification, 27 percent had

percent were able to correctly name the

carer knew the vaccination names (eg.

completed high school to year 12 and 14

vaccination but not the disease, and 53.6

Triple Antigen, Sahin) then the interview-

percent had attended high school to year

percent were able to name at least one

er prompted lor the name of the targeted

10 or b e l o w . T h e three respondents

vaccine or disease. The remaining 22.6

disease/s.

whose highest education level was prima-

percent had no idea what vaccinations

Data analysis All data were coded and entered into a

ry s c h o o l , were from rural villages

their child was receiving at that visit or

throughout Asia.

the diseases the child should be protected were

from. Comments from the latter group of

SPSS f o r

accompanied by one or more adults. The

care givers included: "I've just forgotten",

Windows software release 6.1 Numerical

a c c o m p a n y i n g person was e i t h e r the

"Its in the book (personal health record)',

values were assigned to each value and

child's lather (52%), the carer's mother

"The ones they are dtie for",- "The boost-

value labels were recorded. Statistical

(24%), another member of the carer's fam-

er"; "The two (tour, six, etc.) month lot".

methods were applied to (hid frequency

ily (14%) or a Iriendof the carer (8%).

W h e n asked for their perception ol an

data

spread

sheet

using

1 4 Colltaiau Vol 4 No 3 1997

A number ol carers ( 2 5 % )

unvaccinated child's likelihood of con-

Figure 1

tracting a specific infectious disease, 56 percent thought that (here w o u l d he a

Reason for Accompanying Carer

17 percent

Toddler control 21.2%

t h o u g h t there w o u l d be a m o d e r a t e

Hold baby 18.2%

chance, 10 percent a lair chance and 18

Shopping 3.0%

great chance. A f u r t h e r

percent thought the likelihood was either

Day carer 3.0%

minimal or were unsure. Visiting 7.6%

Many of the carers who thought there was a minimal chance qualified this state-

Parent role 18.2%

ment by adding words to the effect that

Driver 13.6%

they thought it was not worth taking any

Translating 3.0%

risk. Carers who thought that their child

Moral support 12.1%

had a great chance of acquiring an infectious disease often remarked that they were aware ol cases of measles, mumps or pertussis among Iriends' children or day care/pre-school groups their child attend-

Figure 2

Sources of Information Used by Care Givers

ed. Overall comments from respondents indicated that they felt that diseases such as p o l i o , diphtheria and tetanus had a

Child's teacher 1% General knowledge 14"A

Child health nurse 44% General Practitioner 6%

much lower likelihood ol being acquired than measles, mumps and rubella.

Paediatrician 4%

Home country 2%

Nursing experience 4%

Health record 8%

Sources of information

Family member 11%

Media 7%

Carers used a wide variety of information

Fridge magnet 2%

Friend 4%

sources relating to vaccination, the most

Hospital midwife 30%

Brochures 12%

popular being child health nurses (44%) and hospital midwives (30%). Figure 2 summarises the use of information sources ol information available to the care givers. W h e n asked if they had found the accompanied carers 18.2 percent indicat-

information they had seen or been given

problems for those carers who presented

on childhood vaccination to he useful, 64

at the clinics for vaccinations. Anecdotal

ed that the accompanying person was

percent replied very useful; 16 percent

evidence by care givers supported high

required to hold the baby during the vac-

moderately useful,- and 5 percent found

satisfaction levels of the location of the

cination procedure, while 12.1 percent

the information oi limited use. Comments

clinic and the convenience of the opening

indicated they needed an accompanying

from the latter group included: "I would

hours. However, most mothers attending

person to provide moral support. These

have liked it in my first language",- "I need-

the clinics were not in full time employ-

c o m b i n e d reasons lor accompaniment

ed a more personal explanation ol the dis-

ment and the convenience sample was

(30.3%) indicate a high need by the carer

eases and program".

confined to care givers presenting at clin-

for support during the vaccination proce-

Further anecdotal information highlight-

ics. A major limitation of this study is that

dure which may be perceived as a stressful

ed the value care givers place on personal

it has only studied vaccination compliers.

experience by the carer. Ibis represents a

interaction with health care professionals.

Further research is required to ascertain

significant area for further research.

Respondents had wanted information pri-

the needs of carers in the non-compliance

Previous studies have highlighted the

marily in Chinese but also Vietnamese,

group, in terms of clinic location, opening

educational level ol carers as factors influ-

hours and facilities to assist those accom-

encing immunisation uptake. Results of

panied by other children.

this study suggest that the carers attend-

Korean, Japanese and Afrikaans.

Discussion Both clinic hours and location posed no

A significant number of carers (25%)

ing clinics for the vaccination of their

were accompanied to the clinic. Of the

children generally have a higher level of Collegian Vol 4 No 3 l!)97 15

feature education. It is carers with lower levels of

a Personal Health Record to every mother

redressing some of the confusion and lack

education w h o have previously been iden-

in Queensland has not been an effective

of k n o w l e d g e r e g a r d i n g v a c c i n e s a n d

tified by Bobo et al ( 1 9 9 4 ) a n d Rlaze-

strategy in e d u c a t i n g care givers about

i m m u n i s a t i o n . A c c o r d i n g lo Bazeley's

Temple (199]) for tracking and follow up

vaccination. I lowever results suggest it

(1991) research, and supported by anec-

of vaccination compliance.

could

as a

dotal c o m m e n t s , people want person-

A p p r o x i m a t e l y live p e r c e n t ol t h e

reminder. O n l y 8 percent of the sample of

alised service a n d individual a t t e n t i o n

respondents reported difficulty speaking

carers used the record as a source of infor-

when they attend for immunisation.

and reading English.

mation, even though the sample was con-

Flowever, personalised service alone

fined lo care givers w h o chose to vacci-

has b e e n i d e n t i f i e d by H o u t r o u w a n d

W h e n correlated with the location of

p I ay a s t r o n g i n f l u e n c e

Carlson

( 1 9 9 3 ) as i n a d e q u a t e ,

and

requires the backup of written inlormat i o n . It is also i m p o r t a n t to n o t e t h e i n a d e q u a c y ol the Q u e e n s l a n d

Health

personal health record alone as a source of information in this study as only eight percent of care givers used this information. the clinic this indicated that most of these

nate their child, yet 99.2 percent of care

r e s p o n d e n t s p r e s e n t e d at I n d o o r o o p i l l y

givers interviewed b r o u g h t the b o o k l e t

Conclusion

(58%) and Fortitude Valley (25%). This

with lhem to the clinic.

T h e purpose ol this descriptive study was

would indicate the appropriateness of dis-

Only I 3.7 percent of carers could accu-

to profile care givers who presented their

t r i b u t i n g b r o c h u r e s in languages o t h e r

rately name the diseases their child was

children for vaccination at public health

than English at these locations.

being vaccinated against and 22.6 percent

clinics regarding their level of understand-

T h e Queensland Health Department

of carers had no knowledge ol either the

ing of childhood vaccine preventable dis-

p u b l i s h e s i m m u n i s a t i o n b r o c h u r e s in

disease or the vaccination. H o w e v e r 56

eases. T h e major findings of this study

Chinese, Japanese and Vietnamese, how-

percent of the carers sampled perceived a

indicate a very low level of k n o w l e d g e

ever, anecdotal information from the child

great chance of their child contracting an

among carers, the limited usefulness of the

health

the

infectious disease. T h e s e figures support

personal health record as an educational

D e p a r t m e n t had often been oul-ol-stock

studies such as those by Becker et al (1974),

resource and the importance of the nurse

in the preceding 12 months. This meant

M a k et al ( 1 9 8 4 ) a n d H o u t r o u w a n d

as a source of information. I he results ol

that the clinic nurses were often unable to

Carlson ( I 9 9 3 ) w h o found that mothers

the study highlight that although the sam-

supply, care givers with the information

who perceived

be

ple was biased towards care givers w h o

req Lies ted.

extremely vulnerable lo disease had a much

complied with the immunisation schedule,

greater immunisation compliance rate than

even the majority of t h o s e had limited

mothers with less fear of vulnerability.

knowledge regarding vaccination and the

nurses

indicated

that

Results ol this study were consistent with findings that the birth order of the

their children

to

child correlates with immunisation compli-

Results indicating care givers lack of

targeted childhood diseases.

ance. A significant number (61%) of chil-

understanding were surprising given that

T h e r e is an excellent opportunity for

dren presenting at the clinic were first born

these care givers were seeking vaccination

nurses lo provide the personalised service

within their family. Fewer children (30%)

for their children and 85percenl had rated

desired by clinic clients along with writ-

w e r e p o s i t i o n e d s e c o n d in t h e family.

the information they received as uselul.

ten information in the form of the person-

Twenty-seven percent of children present-

This may indicate that the perceived use-

al health record, brochures and so on, as

ing at the clinics were there to receive their

fulness of inlormation is related more to

p a r t of t h e i r h e a l t h e d u c a t i o n role in

first two-month vaccination. Of the sample

w h e n to a t t e n d for v a c c i n a t i o n r a t h e r

immunisation clinics. T h e importance of

of carers, 55 percent had only one child

than why. T h i s could be an example of

t h i s r o l e n e e d s lo be a p p r e c i a t e d a n d

and 32 p e r c e n t had two c h i l d r e n . T h i s

r e l i a n c e on an e x t e r n a l c u e , w h e n to

enacted by other nurses "at the coalface",

result could suggest that it is not conve-

attend, rather than on intrinsic motiva-

such as p a e d i a t r i c nurses, c h i l d h e a l t h

nient for carers with more than two chil-

tion. As Child Health Nurses (44%) and

nurses, c o m m u n i t y nurses and midwives

dren to attend the clinics, which have very

Hospital Midwives (30%) were the major-

in order to increase vaccination compli-

limited physical space and resources for

sources of information for the carers sam-

ance within the community.

small children.

pled, they represent the major potential

Results suggest that the distribution of 1 6 Collegian Vol 4 No 3 1997

that nurses have as h e a l t h e d u c a t o r s in

1 he results of this study lend support to the p r o p o s e d c h a n g e s lo the H e a l t h

( D r u g s & Poisons) R e g u l a t i o n , 1996, in Q u e e n s l a n d which will allow nurses with a p p r o p r i a t e e n d o r s e m e n t to a d m i n i s t e r c h i l d h o o d vaccination. T h e r e is potential lor further research focusing on the value of the interaction between nurses and prim a r y c a r e r s a n d t h e i n f l u e n c e of t h i s interaction on the carer's decision to vaccinate their child.

Implications for further research T h e r e are three issues raised hy this study which warrant further research. T h e s e are carer information, carer need for support during the procedure and the value of the personal health record distributed

by

Q u e e n s l a n d I lealth. T h i s s t u d y focused only on users of Brisbane C i t y C o u n c i l C l i n i c s . F u r t h e r studies to capture data from carers using o t h e r locations lor vaccination would be useful t o d e t e r m i n e il the results can be extrapolated to the wider

community.

These other locations would

include

G e n e r a l P r a c t i t i o n e r Offices, Aboriginal Medical Services and the like. It would also be of value to determine the correlation between carer understanding of the significance of c h i l d h o o d vaccination in p r o t e c t i n g against disease and the information sources used. T h e design of this study did not provide for this relationship to be determined. Nurses were identified as a significant source ol information, but a limitation in data gathering was the lack of discrimination in determining w h e t h e r the information related to the need to attend for the r o u t i n e c o u r s e of v a c c i n a t i o n or actual education about protection from

specific

diseases. T h e results of this study indicate d e m o n s t r a t e d c o m p l i a n c e may rest with direction to attend rather then

informed

decision making on the part ol the carer. It is further r e c o m m e n d e d that

future

studies focus on reasons why carers perceive the p r o c e d u r e of vaccination to be so stressful that they seek the support of o t h e r s during the p r o c e d u r e . T h i s infor-

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