Educating Children and Adolescents about Vaccines: A Review of Current Literature

"[C]hildren remain a virtually unstudied population with regards to vaccine hesitancy."

The fact that children will grow up to be future vaccinators is only one of the arguments to be made for why more vaccine hesitancy research involving child and adolescent populations is warranted. This article reviews literature on childhood and adolescent attitudes toward vaccination, psychological frameworks that could govern how children process information on immunisation, and opportunities presented by new digital media to better communicate with children. Even though empirical evidence demonstrates that children can elicit emerging competence at a very young age, the goal of this research is to not argue for children's competence in making vaccine-related decisions but, rather, to establish a foundation for future research on the knowledge, attitudes, and beliefs children hold related to vaccines.

Given the fact that early childhood experiences can influence future adult attitudes, it is worth considering that the pain associated with administering immunisations is a significant source of distress for children, their parents, and health professionals administering needles. The researchers review some options for minimising pain during childhood vaccinations, which can aid in preventing future avoidance behaviour.

While little is known about early childhood attitudes toward vaccination, some research has focused on adolescents' and young adults' views on vaccines, primarily as it relates to the human papillomavirus (HPV) vaccine and influenza. For example, school-based vaccination interventions involving educational brochures and skits/presentations have been successful in decreasing perceived barriers toward influenza vaccination, increasing intention to receive an influenza vaccination, and increasing influenza vaccine update among rural adolescents. In fact, education and knowledge about vaccines in children and adolescents through school-based programmes could be a strategy for reducing vaccine hesitancy.

Another avenue to explore is the potential to educate children with the objective of influencing their parents, which is particularly salient given the persistence of vaccine hesitancy among adults. An increasing amount of literature suggests that there is a bidirectional influence between parent and children, with many parents reporting that their values and attitudes are influenced by their children.

When considering strategies on how to educate and influence children's attitudes toward vaccines, the researchers note that how to frame messages is critical. A gain-framed message used to increase vaccine uptake might be: "Getting your flu shot can make you healthier". Conversely, a loss-framed message with the same goal might be: "You could get sick if you don't get your flu shot". More research into child and adolescent populations within this area is needed. Another consideration with regard to message framing and the adoption of healthy behaviours in children is whether the intervention is developmentally appropriate.

Along those lines, the use of emerging digital technologies specifically addresses some of the challenges to educate children by permitting flexible messaging framing that can be tailored to the developmental level of the child. These technologies allow increased interactivity, sensory vividness, networkability, modifiability, and ease of use, along with lower cost of dissemination. Furthermore, considering that a significant majority of children today are engaged in social media, and that peer-group provision of information is highly influential, social media can be used for health promotion through customisable messages, connections to social support systems, personal engagement, and participation and interactivity. In addition, mobile apps could provide a means of proactive communication about vaccine and vaccine side effects. The article provides several examples of immunisation education using digital media.

In fact, as reported here, educational institutions from all levels of study have begun integrating new information and communication technologies (ICTs), such as virtual and augmented realities (VR and AR, respectively), into teaching methodologies in order to improve the learning process. (See, for an example, the video below.) Whereas a VR user is unable to see the real world around them, AR superimposes computer-generated elements onto the real world, blending the two. Research suggests that in order to promote learning using VR or AR, the games or simulations used must provide users a sense of autonomy, identity, and interactivity. As the accessibility to VR and AR technology increases, these tools will be increasingly incorporated into clinical and educational environments, providing a means to normalise immunisation information and promote positive attitudes toward vaccines.

Figure 1 in the paper (and above) explores a concept map for reasons for focusing on children: (i) the importance of childhood cognitive development on formation of core beliefs; (ii) the fact that children's primary experience with vaccination is pain, which can create future vaccine hesitancy; (iii) the prospect that vaccine-hesitant parents could convey their beliefs on their children; and (iv) the reality that involvement in vaccine decision-making is occurring earlier in life due to the increase in adolescent vaccines.

The researchers suggest that further research is needed to help combat future vaccine hesitancy and that it should: (i) document childhood perceptions about vaccines in multiple settings, different age groups, and among multiple demographic groups; (ii) examine the stability of these attitudes over time; (iii) determine the impact of interventions and different delivery mechanisms on impacting these attitudes; (iv) identify the key early years to influence childhood attitudes; and (v) explore how best to use new digital technologies to educate children and adolescents about vaccines and to reduce hesitancy.