Abstract
An important influence on parents’ decisions about pediatric vaccination (children under 6 years of age) is the attitude of their health care providers, including complementary and alternative medicine (CAM) providers. Very limited qualitative research exists, however, on how attitudes towards vaccination develop among healthcare professionals in-training. We explored perspective development among three groups of students: medical, chiropractic, and naturopathic. We conducted focus group sessions with participants from each year of study at three different healthcare training programs in Ontario, Canada. Semi-structured and open-ended questions were used to elicit dynamic interaction among participants and explore how they constructed their attitudes toward vaccination at the beginning and part way through their professional training. Analyses of verbatim transcripts of audiotaped interviews were conducted both inductively and deductively using questions structured by existing literature on learning, professional socialization and interprofessional relations. We found five major themes and each theme was illustrated with representative quotes. Numerous unexpected insights emerged within these themes, including students’ general open-mindedness towards pediatric vaccination at the beginning of their training; the powerful influence of both formal education and informal socialization; uncritical acceptance of the vaccination views of senior or respected professionals; students’ preference for multiple perspectives rather than one-sided, didactic instruction; the absence of explicit socio-cultural tensions among professions; and how divergences among professional students’ perspectives result from differing emphases with respect to lifestyle, individual choice, public health and epidemiological factors—rather than disagreement concerning the biomedical evidence. This last finding implies that their different perspectives on pediatric vaccination may be complementary rather than irreconcilable. Our findings should be considered by developers of professional and interprofessional educational curricula and public health officials formulating policy on pediatric vaccination.
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Notes
Interestingly, this progressive, constructivist approach to professional education has parallels in patient education. Previous research indicates that parental vaccine related decisions are influenced by the patient-provider interaction, balanced information and discussion (Glanz et al. 2013; Smith et al. 2006).
References
Abbott, A. (1988). The system of professions: An essay on the division of expert labor. Chicago: University of Chicago Press.
Anderson, P. (1972). More is different: Broken symmetry and the nature of the hierarchical structure of science. Science, 177(4047), 393–396.
Beattie, A. (2003). Journeys into thirdspace? Health alliances and the challenge of border crossing. In A. Leathard (Ed.), Interprofessional collaboration: From policy to practice in health and social care (pp. 146–157). New York: Brunner-Routledge.
Bell, I. R., Caspi, O., Schwartz, G. E. R., Grant, K. L., Gaudet, T. W., Rychener, D., et al. (2002). Integrative medicine and systemic outcomes research: Issues in the emergence of a new model for primary health care. Archives of Internal Medicine, 162, 133–140.
Benin, A. L., Wisler-Scher, D. J., Colson, E., Shapiro, E. D., & Holmboe, E. S. (2006). Qualitative analysis of mothers’ decision-making about vaccines for infants: The importance of trust. Pediatrics, 117, 1532–1541.
Bradshaw, M. J., & Lowenstein, A. J. (2007). Innovative teaching strategies in nursing and related health professions. Sudbury, MA: Jones & Bartlett.
Busse, J. W., Kulkarni, A. V., Campbell, J. B., & Injeyan, H. S. (2002). Attitudes toward vaccination: A survey of Canadian Chiropractic students. Canadian Medical Association Journal, 166, 1531–1534.
Busse, J. W., Walji, R., & Wilson, K. (2011). Parents’ experiences discussing pediatric vaccination with healthcare providers: A survey of Canadian naturopathic patients. PLoS ONE, 6(8), 1–6.
Busse, J. W., Wilson, K., & Campbell, J. B. (2008). Attitudes towards vaccination among chiropractic and naturopathic students. Vaccine, 26, 6237–6243.
Council on Foreign Relations, Vaccine preventable outbreaks. (n.d.). Retrieved January 20, 2013, from http://www.cfr.org/interactives/GH_Vaccine_Map/#map.
Creswell, J. W. (2009). Research design: Qualitative, quantitative, and mixed methods approaches (2nd ed.). Thousand Oaks, CA: Sage.
Davis, B., & Sumara, D. (2003). Why aren’t they getting this? Working through the regressive myths of constructivist pedagogy. Teaching Education, 14, 123–140.
Dubé, E., Vivion, M., Sauvageau, C., Gagneur, A., Gagnon, R., & Guay, M. (2013). How do midwives and physicians discuss childhood vaccination with parents? Journal of Clinical Medicine, 2, 1–10.
Glanz, J. M., Wagner, N. M., Narwaney, K. J., Shoup, J. A., McClure, D. L., McCormick, E. V., et al. (2013). A mixed methods study of parental vaccine decision making and parent–provider trust. Academic Pediatrics, 13(5), 481–488.
Gust, D. A., Darling, N., Kennedy, A., & Schwartz, B. (2008). Parents with doubts about vaccines: Which vaccines and reasons why. Pediatrics, 122, 718–725.
Gust, D. A., Kennedy, A., Shui, I., Smith, P. J., Nowak, G., & Pickering, L. K. (2005). Parent attitudes toward immunizations and healthcare providers: The role of information. American Journal of Preventive Medicine, 29, 105–112.
Hall, P. (2005). Interprofessional teamwork: Professional cultures as barriers. Journal of Interprofessional Care, 19(S1), 188–196.
Healy, C. M., & Pickering, L. K. (2011). How to communicate with vaccine-hesitant parents. Pediatrics, 127(Suppl. 1), S127–S133.
Kennedy, A., Lavail, K., Nowak, G., Basket, M., & Landry, S. (2011). Confidence about vaccines in the United States: Understanding parents’ perceptions. Health Affairs, 30, 1151–1159.
Klein, J. T. (1983). The dialectic and rhetoric of disciplinarity and interdisciplinarity. Issues in Integrative Studies, 2, 35–74.
Kraut, A., Graff, L., & McLean, D. (2011). Behavioral change with influenza vaccination: Factors influencing increased uptake of the pandemic H1N1 versus seasonal influenza vaccine in health care personnel. Vaccine, 29(46), 8357–8363.
Leischow, S. J., Best, A., Trochim, W. M., Clark, P. I., Gallagher, R. S., Marcus, S. E., & Matthews, E. (2008). Systems thinking to improve the Public’s Health. American Journal of Preventive Medicine, 35(S2), 196–203.
McMurtry, A. (2009). Knowers and phenomena: Two different approaches to interdisciplinarity and interprofessionalism. Issues in Integrative Studies, 27, 1–16.
McMurtry, A. (2011). The complexities of interdisciplinarity: Integrating two different perspectives on interdisciplinary research and education. Complicity: An International Journal of Complexity and Education, 8(2), 19–35.
Newell, W. H. (2001). A theory of interdisciplinary studies. Issues in Integrative Studies, 19, 1–25.
Opstelten, W., van Essen, G. A., Heijnen, M. L., Ballieux, M. J., & Goudswaard, A. N. (2010). High vaccination rates for seasonal and pandemic (A/H1N1) influenza among healthcare workers in Dutch general practice. Vaccine, 28(38), 6164–6168.
Piaget, J. (1970). Genetic epistemology (E. Duckworth, Trans.). New York: Columbia University Press.
Pope, C., van Royen, P., & Baker, R. (2002). Qualitative methods in research on healthcare quality. Quality and Safety in Health Care, 11, 148–152.
Pope, C., Ziebland, S., & Mays, N. (2000). Qualitative research in health care: Analysing qualitative data. British Medical Journal, 320, 114–116.
Proulx, J. (2006). Constructivism: A re-equilibration and clarification of the concepts, and some potential implications for teaching and pedagogy. Radical Pedagogy, 8(1), 1–19.
Public Health Agency of Canada. (2006). Canadian National Report of Immunization, November, 32S3.
Ridda, I., Lindley, R., Gao, Z., McIntyre, P., & MacIntyre, C. R. (2008). Differences in attitudes, beliefs and knowledge of hospital health care workers and community doctors to vaccination of older people. Vaccine, 26(44), 5633–5640.
Rodgers, B. L., & Cowles, K. V. (1993). The qualitative research audit trail: A complex collection of documentation. Research in Nursing & Health, 16, 219–226.
Salmon, D. A., Moulton, L. H., Omer, S. B., Chace, L. M., Klassen, A., Talebian, P., et al. (2004). Knowledge, attitudes, and beliefs of school nurses and personnel and associations with nonmedical immunization exemptions. Pediatrics, 113, e552–e559.
Salmon, D. A., Moulton, L. H., Omer, S. B., DeHart, M. P., Stokley, S., & Halsey, N. A. (2005). Factors associated with refusal of childhood vaccines: A case–control study. Archives of Pediatrics and Adolescent Medicine, 159, 470–476.
Smith, P. J., Kennedy, A. M., Wooten, K., Gust, D. A., & Pickering, L. K. (2006). Association between health care providers’ influence on parents who have concerns about vaccine safety and vaccination coverage. Pediatrics, 118(5), e1287–e1292.
van-Haaren, K. M., van-den-Brande, K. J., Dekker, F. W., Ligthart, G. J., & Springer, M. P. (1995). [Influenza vaccine in 85-and-over aged: motivation of elderly and family physicians to vaccinate or not] [original article in Dutch]. Nederlands-tijdschrift-voor-geneeskunde, 139(42), 2144–2148.
Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Cambridge, Massachusetts: Harvard University Press.
World Health Organization (2014) WHO statement on the meeting of the International Health Regulations Emergency Committee concerning the international spread of wild poliovirus, World Health Organization. Retrieved July 7, 2014, from http://www.who.int/mediacentre/news/statements/2014/polio-20140505/en/.
Wilson, K., Mills, E., Boon, H., Tomlinson, G., & Ritvo, P. (2004). A survey of attitudes towards paediatric vaccinations amongst Canadian naturopathic students. Vaccine, 22, 329–334.
World Health Organization. (2006). Weekly Epidemiological Record, 81, 189–196.
Zimmerman, R. K., Barker, W. H., Strikas, R. A., Ahwesh, E. R., Mieczkowski, T. A., Janosky, J. E., et al. (1997). Developing curricula to promote preventive medicine skills. The Teaching Immunization for Medical Education (TIME) Project. TIME Development Committee. JAMA, the Journal of the American Medical Association, 278, 705–711.
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Appendixs containing the (1) Focus Group Interview Questions and (2) Questions Used to Structure Deductive Data Analysis, are available upon request.
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McMurtry, A., Wilson, K., Clarkin, C. et al. The development of vaccination perspectives among chiropractic, naturopathic and medical students: a case study of professional enculturation. Adv in Health Sci Educ 20, 1291–1302 (2015). https://doi.org/10.1007/s10459-015-9602-4
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DOI: https://doi.org/10.1007/s10459-015-9602-4