Immunisation Audience Research

Key Results

Attitudes and beliefs:

• Parents/caregivers who have not fully immunised their children aged 0–5 years hold a variety of attitudes and beliefs about immunisation. These can be grouped into attitudes and beliefs about the relevance and importance of immunisation and concerns about immunisation and its effects. For Pākehā and some Māori participants, their concerns outweigh the relevance and importance of immunisation, which has contributed to or resulted in decisions and/or behaviour not to fully immunise their children.
• There is a general perception that immunisation is less relevant to children in New Zealand today, which is driven by low incidence of vaccine preventable diseases in 2010.
• There is concern amongst Pākehā over possible negative long-term health impacts from immunisation (e.g. link with autism) and concern amongst Māori over potential adverse reactions to immunisation leading to serious complications.
• There is concern amongst Pākehā and to a lesser extent Māori, over the standard course of immunisation (e.g. immunisation starts too early in a child's life, too many vaccines in the schedule, too many vaccines in the one syringe).
• Māori, and to a lesser extent, Pākehā lack confidence in the effectiveness of immunisation. Pacific people however consider their children more at risk of disease and hold more positive attitudes and beliefs about immunisation.

Knowledge and understanding:

• Parents/caregivers who have not fully immunised their children have varying degrees of knowledge and understanding of immunisation. Pākehā participants overwhelmingly mention there is a lack of balanced information on immunisation, with most information being either pro-immunisation or anti-immunisation. Pākehā are heavy users of the Internet to gain knowledge and understanding of immunisation.
• Māori knowledge of the immunisation process (such as the make-up of the vaccines and the immunisation schedule) is very low. 
• Māori tend to be far less likely to have considered the benefits and risks of immunisation. Knowledge and understanding that they have attained tends to be through engagement with whānau and midwives.

Skills and confidence:

• In most cases, parents/caregivers who do not fully immunise their children have not actively opted not to immunise. Some are not aware that they have a choice, some do not feel confident or empowered to make a choice, and some are sitting on the fence by delaying decisions around immunisation. Some also find the immunisation experience completely overwhelming and distressing. Many Māori participants seem to lack confidence in navigating the immunisation system.

Role of others:

• The attitude and encouragement of providers, the services they provide and the advice they give are key drivers to parent/caregiver behaviour and decisions on child immunisation. Family/whānau, and to a lesser extent partners and peers, play important roles in providing knowledge and shaping views.

Environmental factors:

• Environmental factors (i.e. location, availability and cost of accessing immunisation services, experience with different schedules and the media) appear to be less of a factor in immunisation behaviour and decisions, although some Māori identify transport costs and availability as barriers to accessing health services in a timely way.
• There is significant stigma associated with non-immunisation, meaning participants still don't like talking about their decisions or circumstances publically.

Message and concept testing:

• A number of ideas for facilitating access to uptake of immunisation services were presented and tested amongst participants. Messages and concepts that speak directly to parents/caregivers and family/whānau have greater relevance than those that speak at a societal level. Of the messages and concepts tested, financial incentives are more likely to encourage immunisation uptake amongst parents/caregivers who do not fully immunise their children. Māori prefer an in-home setting and Pacific people prefer a clinical services setting.

Typologies:

• Five key typologies are apparent for parents/caregivers who do not fully immunise their children: "Nurturers", "Fearfuls", "Vulnerables", "Unwell" and "Rejecters". Each of these typologies has different characteristics and there are different mechanisms for change to facilitate immunisation decisions.
  • "Rejecters" - opposed to most or all child immunisation.
  • "Nurturers" - not opposed to immunisation, but believe their children are at low risk of disease.
  • "Fearfuls" - find the immunisation experience emotionally distressing for both themselves and their children.
  • "Vulnerables" - not opposed to immunisation, but face barriers to accessing child immunisation.
  • "Unwell" - open to immunisation, but don't due to their child's poor health.
• Pākehā aligned more with the "Rejecters" "Nurturers" and "Fearfuls" typologies, Māori typically aligned with the "Vulnerables" "Unwell" and "Fearfuls" typologies and Pacific tend to align with the "Unwell" typology.