Parents' Experience and Views of Vaccinating Their Child against Influenza at Primary School and at the General Practice

The purpose of this study was to gain an in-depth understanding of parents' experience and views of vaccinating their four- to six-year-old child against influenza at school and at the general practice (GP), or doctor's office, in the United Kingdom (UK). One goal was to ascertain what would make children's future participation in the influenza immunisation programme more acceptable to non-consenting parents.

The study population consisted of parents and guardians of children in Reception Year and Year 1 in eight schools in Barnet, Bury, Leicestershire, and Surrey, England. These schools were randomly selected for participation in an evaluation by University College London (UCL) of the pilot implementation of the seasonal childhood influenza vaccination programme in England, during winter 2015/2016. The same schools were chosen in this follow-up study. Interview participants included five mothers and two fathers.

The primary reason parents gave for vaccinating their child was to prevent their child from contracting influenza. The most prevalent reason participants gave for refusing the influenza vaccine for their child was that their child was healthy, and not in a vulnerable group. The novelty of flu vaccination for children also contributed to the uncertainty about the purpose and benefits of this programme.

Figure 2 in the article gives an overview of venue preferences reported by the parents, broken down by whether their child was vaccinated at the GP, at school, or was not vaccinated at all. Amongst respondents whose child was vaccinated in school, none expressed a preference for vaccinating at the GP in future. Parents whose child was vaccinated at the GP expressed interest in both venues (two expressed interest in vaccinating at the GP, and one in the school), as did parents whose child was not vaccinated against flu at all that year (three expressed interest in vaccinating at the GP, and four in the school).

Parents' perceived benefits of vaccinating in schools were to avoid the inconvenience of having to take their child to the GP, and that their child would behave better at school. Parents viewed that accompanying their child for the vaccination at school would undermine the convenience and peer-pressure advantages of the school as a venue. No parents expressed concern about their child being too young to be vaccinated in school.

"Children were perceived to express more anxiety about vaccination at the GP with their parents than at school with their classmates. However, it may be worth investigating whether children are feeling inward anxiety about having the vaccine at school without a parent present. If school-based vaccination is to be expanded in coming years this issue should be investigated, especially considering that existing literature suggests that early vaccination experiences may have consequences for subsequent vaccine hesitancy."

The discussion section of this paper looks at the implications of these findings for future communication efforts on the part of the National Health Service (NHS) of England. "Some interviewees communicated that they had great trust in doctors, and in at least one case a parent was convinced to accept the vaccine for her child because of her doctor's efforts to seek out and share information about the vaccine. It has been well documented that a vaccine recommendation from a health care professional can increase the likelihood of vaccination....It is also well-known that public trust in the medical profession can be leveraged in health promotion campaigns, for example by featuring real GPs in posters and billboards....If it remains challenging to communicate the rationale for vaccinating children against influenza, then getting physician endorsements, or even personalising informational letters with a local GP's signature, may increase confidence in this new programme."

In conclusion, this research suggests that the school is a desirable venue for childhood influenza vaccination, both from the parents' view and given that influenza vaccination coverage is higher when delivered through schools than GPs.