Immunisation and Health Beliefs: A Study on Educational Interventions

This study focuses on the effectiveness of educational interventions in reducing false beliefs and increasing childhood immunisation. It discusses the research methodology, reliable sources of information, and key findings. The study aims to provide evidence-based information to help parents make informed decisions about their children's healthcare.

Assessment 1 (2000 words)
Instructions:
 Please read the background information below. When you have read the background
information, you can proceed to the questions on the Assessment Template. These
questions relate to the background information.
 You will need to apply the knowledge that you have gained from Topics 1-4 to complete
these questions.
 The marks allocated to each question are stated next to the question.
 The word count is stated next to each question. Note that when the word count says
‘equivalent’ it means that you do not need to have that exact number of words to
answer the question – just provide as much detail as required to answer the question.
 You are advised to frequently refer to the Assessment Feedback Sheet to guide you on
what characteristics of a reponse constitute an F2, F1, P2, P1, C, D, and HD grade.
 As with all academic work, if you refer to the work of others to support your responses,
you must reference this information using the UniSA Harvard Reference System. You do
not need to reference the articles listed in the Tables in Question 5 but if any other
sources are used, these should be referenced.
Background: Immunisation – Health beliefs
*Nursing students: You are working as a registered nurse in a GP Practice and one of your
roles is to promote immunisation for children (this may be the MMR or other recommended
immunisations). You have had a few parents refuse vaccinations for their children and this
concerns you as you believe that this may leave the child and communities vulnerable to
outbreaks of serious diseases.
*Midwifery students: You are working as a midwife in an antenatal clinic. One of your roles
is to promote vaccination against pertussis(whooping cough) for pregnant women. You have
had a few pregnant women decline vaccination. This concerns you as you know that if the
pregnant woman is immune to pertussis that passive immunity is passed to her unborn baby
to protect them against pertussis when they are newborn until thery are able to be
immunised themselves
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You do not think that parents/pregnant women would deliberately expose their
children/baby/themselves to the risk of serious disease unless they were guided by a belief
that immunisation was not safe. You are vaguely aware via media reports that there is an
anti-vaccine movement, and you want a quick overview of what it is all about. As most of us
would do, you consult Google, and you find the following information. Read the information
video below:
The History of Vaccines: History of the anti-vaccination movement
The College of Physicians of Philadelphia (2017)
<https://www.historyofvaccines.org/content/articles/history-anti-
vaccination-movements>
You could now choose one (or all) of the following actions:
 Conclude that parents/pregnant women are entitled to make decisions about their
child’s/baby’s/own healthcare, even if it is against public health policy.
 You could question your own belief system – after all, you are basing your practice
on government guidelines and you trust that the government will make decisions
about health care that are evidence-based, informed by experts in the field, and in
the best interests of Australians. You haven’t checked the literature for evidence of
immunisation safety yourself.
 You could investigate whether there is any evidence of harm caused by
immunisation, and to identify information that may influence parent’s/pregnant
woman’s beliefs or fears about immunisation.
Naturally, you are a great nurse/midwife with an inquiring mind. You want to be certain that
there is good evidence that demonstrates that immunisations are safe for children and
pregnant women. You want to understand what information has led parents/pregnant
women to be concerned about immunisation. Finally, you want to be able to have an
informed discussion with the parents/pregnant women about their concerns based on
current evidence to enable them make the right decision for their children/babies and
themselves.
*Please do not include this page of background information when you submit the
assessment template to learnonline.
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Assessment 1 Template
*Equivalent means that your responses may not equate exactly to the number of words that
you have written. As the format for this assessment is a template an approximate word
count is given that reflects the work required to complete the template. Suggested word
counts may be given in the template to guide you in how much detail is required in your
response. The template word count is not included in your word count. The template itself
(without the background) equates to approximately 900 words. You will note an elevated
similarity percentage when this is submitted via TurnItIn because of the template. Your
lecturers/tutors are aware of this.
Questions 1-4 (25 marks – 500 word equivalent)
Question 1a. From the background information provided above relating to immunisation, develop a
researchable question. Type the question below:
Are Educational intervention are effective for parents in reducing false beliefs and increasing
childhood immunisation?
Question 1b: Identify the elements of (words relating to) PICO (or PIO, if appropriate) in the research
question that you have formulated:
P parents
I Early Educational interventions
C No interventions
O Reduction of false beliefs and
increasing childhood immunisation
Question 2a. What type of research methodology do you think should be used to answer the
research question that you have formulated?
☐Quantitative
☒Qualitative
☒Mixed methods
Question 2b. Justify why this methodology was chosen to answer the question (Approx 75 words -
reference/s used to support your response should be written below your answer and are not included
in the word count).
Quantitative method such as randomised controlled trial along on the focus group is effective
to identify the answer of question. The prime reason behind it is that the it assists researchers
to gain the factual as well as emotional data of the parents where new treatment or
interventions can be compared between two groups such as intervention group and controlled
group (Bryman, 2017). The quantitative method also shows reduced level of biases for
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obtaining the accurate information.
Question 3a. List 3 places/sources of information that can be used to obtain reliable evidence to
answer the research question that you have formulated:
1. Schollin Ask, L., Hjern, A., Lindstrand, A., Olen, O., Sjögren, E., Blennow, M.,and Örtqvist, Å. 2017.
Receiving early information and trusting Swedish child health centre nurses increased parents’
willingness to vaccinate against rotavirus infections. Acta Paediatrica, 106(8), 1309-1316.
2. Taddio, A., Shah, V., Bucci, L., MacDonald, N. E., Wong, H., and Stephens, D. 2018. Effectiveness
of a hospital-based postnatal parent education intervention about pain management during infant
vaccination: a randomized controlled trial. CMAJ, 190(42), E1245-E1252.
3. Willis, E., Sabnis, S., Hamilton, C., Xiong, F., Coleman, K., Dellinger, M. and Nugent, M. 2016.
Improving immunization rates through community-based participatory research: Community health
improvement for Milwaukee’s children program. Progress in community health partnerships: research,
education, and action, 10(1), 19.
Question 3b. Using one of the resources listed above,provide the details of a specific
resource/publication that is an example of best available evidence to assist you in answering your
research question. Complete the table below:
Provide the full reference/title for the
resource/publication
Taddio, A., Shah, V., Bucci, L., MacDonald, N. E.,
Wong, H.,and Stephens, D. 2018. Effectiveness of a
hospital-based postnatal parent education intervention
about pain management during infant vaccination: a
randomized controlled trial. CMAJ, 190(42), E1245-
E1252.
Provide the URL https://www.ncbi.nlm.nih.gov/pubmed/30348739
Question 3c. Explain why the information source chosen is an example of best available evidence for
answering the research question that you have formulated. Refer to the Levels of Evidence and
Hierarchy of Evidence tables in Topic 2 (Approx 75 words - reference/s used to support your response
should be written below your answer and are not included in the word count).
This paper is chosen as the best piece of evidence because it is a peer reviewed journal where
researchers conducted randomise controlled trial to evaluate the effect of the educational
interventions in the parents with the control group who never received education. The result of
the research suggested that hospital-based postnatal education is effective since many parents
are able to manage the pain which further reduce their false beliefs regarding the immunisation
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and increase child immunisation.
Question 4a: List three key words that will assist in finding suitable literature in a library database to
answer the research question that you have formulated. For each of the search terms, suggest an
alternate word for which the Boolean function “or” could be used and truncations and wildcards.
Keyword Search term/s for
Boolean ‘or”
Truncation/s Wildcards
1 immunsation Vaccination
Vaccination *
Vaccination(‘’ ‘’ ‘’)
2 educational intervention Hospital based
education
Hospital based
education*
Hospital based
education(‘’ ‘’ ‘’)
3 effectiveness of
educational interventions
in reducing the false
beliefs
effectiveness of
educational
interventions in
reducing the false
beliefs
effectiveness of
educational
interventions in
reducing the false
beliefs*
effectiveness of
educational
interventions in
reducing the false
beliefs (‘’ ‘’ ‘’)
Question 4b: What actions could be taken to extend or limit the number of articles found or
improve the quality/relevance of the articles found in the search? (Approx 75 words - reference/s
used to support your response should be written below your answer and are not included in the word
count).
In order to extend the limit of the articles with improved quality and relevancy to the topic ,
more research term can be used to explore variety of literature related to the research and
appropriate data bases can be used such as CINAHL, pubmed, google scholar and medline
(Hartas 2015). To narrow down the research to the high quality, limiting research through
specific study design, peer reviews along with search engine optimisation is required.
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Question 5 (25 marks - 500 word equivalent)
Complete the template below by providing the requested information relating to some of the specific components of the research articles listed. IBNU
students only need to complete the two articles that are for ‘IBNU students only’ and IMBW students only need to complete the two articles that are for
‘IBMW students only’.
Table 1.
IBNU students only:
IBMW students only:
Nowak, GJ, Sheedy, K, Bursey, K, Smith, TM & Basket, M 2015, ‘Promoting influenza vaccination: insights from a qualitative meta-
analysis of 14 years of influenza-related communications research by US Centers for Disease Control and Prevention
(CDC)’, Vaccine, vol. 33, no.24, pp.2741-2756.
https://doi.org/10.1016/j.vaccine.2015.04.064
Furuta, M, Sin, J, Ng, ES & Wang, K, 2017. ‘Efficacy and safety of pertussis vaccination for pregnant women–a systematic review of
randomised controlled trials and observational studies’, BMC Pregnancy and Childbirth, vol. 17, no. 1,pp.1-20.
https://doi.org/10.1186/s12884-017-1559-2
Type of study (e.g.: meta-
analysis, systematic review,
cohort, RCT, ethnography,
phenomenology, etc)
Nowak et al. ( 2015), conducted a qualitative meta-analysis of 29 unpublished and , primarily qualitative studies sponsored by CDC
and study was undertaken in between 2000 to 2013 and it is based on the flu and flu vaccination knowledge, attitude and beliefs .
Furuta et al. (2017), conducted review on 15 articles where 12 study population was undertaken where total 203,835 mother-
infant pair , Israel, UK, US , Belgium and Vietnam. Out of 15, two randomised controlled trial and rest 13 were observational
study.
Issue/Topic (what was being
studied)
Nowak et al. ( 2015), conducted the research through systematic review and meta-analysis to identify the values and beliefs
regarding flue and vaccination along with knowledge.
Furuta et al. (2017), evaluated the efficacy and safety of pertussis vaccinations which were given to the pregnant women for
protecting their infants from the disease.
Purpose/aims of the study
(why was the study being
undertaken?)
The study was conducted by Nowak et al. ( 2015), because the values and beliefs of health care provider as well as the
parents towards the flu and flu associated vaccination is affecting the immunization of the children which further increase
mortality rate.
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The study conducted by Furuta et al. (2017), because there is an increase of risk of the disease and a considerate number of
women believed that pertussis vaccinations which were given to the pregnant women for protecting their infants from the
disease increases the risk in maternity.
Inclusion/exclusion criteria Inclusion criteria of the study by Nowak et al. (2015) were in-depth interviews, focus group, within 2000 to 2013, message testing
involved health professionals and sub population at risk of influenza. The study rejected all elements other than these.
Inclusion criteria of the study by Furuta et al. (2017), were Pertussis infection, Severe complications attributed to pertussis, in
infants up to 12 months of age, Adverse vaccine-related outcomes and perinatal complications.
Search strategy (methods) Nowak et al. ( 2015) did not mention search strategy
Furuta et al. (2017) used Medline, Embase till 16 th may 2016 with search term ‘‘pertussis vaccine,’ whooping cough’, ‘pregnancy’
‘tetanus, diphtheria and pertussis vaccines’ and ‘perinatal’.
Data analysis Nowak et al. ( 2015) conducted statistical analysis
Furuta et al. (2017) conducted data extraction forms designed specifically for this review and bias assessment
Results (main findings) Nowak et al. ( 2015) suggested that there high level of awareness observed regarding influenza but also few are unaware of it
The result of the study conducted by Furuta et al. (2017) suggested that the risk pertussis is increases around the world where
pertussis vaccination is given to the pregnancy do not increase the risk in maternity.
Conclusion/recommendations Nowak et al. ( 2015) suggested research required for obtaining result which is quantifiable and generalizable to the population
as a whole.
Furuta et al. (2017) suggested that only Uk based studies were included. Further researches are required
Table 2.
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IBNU students only
IBMW students only:
Knuf, M, Leroux-Roels, G, Rümke, HC, Abarca, K, et al, 2015, ‘Safety and immunogenicity of an MF59®-adjuvanted A/H1N1
pandemic influenza vaccine in children from three to seventeen years of age’, Vaccine, vol. 33, no.1, pp.174-181.
https://doi-org.access.library.unisa.edu.au/10.1016/j.vaccine.2014.10.085
Wiley, KE, Cooper, SC, Wood, N & Leask, J 2015, ‘Understanding pregnant women’s attitudes and behaviour toward influenza and
pertussis vaccination’, Qualitative Health Research, vol. 25, no 3, pp.360-370.
http://journals.sagepub.com/doi/pdf/10.1177/1049732314551061
Type of study (e.g.: meta-
analysis, systematic review,
cohort, RCT, ethnography,
phenomenology, etc)
Knuf et al. (2015) conducted review
Wiley et al. (2015) conducted survey and focus group interview
Issue/Topic (what was being
studied)
Knuf et al. (2015) conducted review for evaluating the efficiency of MF59 and AS03 Influenza Vaccines in children against
mismatched influenza virus strains and seasonal trivalent influenza vaccines are ineffective
Wiley et al. (2015) explored risk perception of influenza and pertussis and vaccination from the point of view of the pregnant
woman.
Purpose/aims of the study
(why was the study being
undertaken?)
The study was undertaken by Knuf et al. (2015) because Influenza has identified as the major reason of hospitalisation
The study was undertaken by Wiley et al. (2015) because it was highlighted in literature that beliefs of the pregannat women
differs from each other. Mothers are more concerned about the risk of their baby then them.
Population (how many
participants, age, gender,
disease, etc)
Knuf et al. (2015) focused on the children less than 5 years
Wiley et al. (2015) recruited total 815 pregnant women with their perception and attitudes and awareness toward influenza and
pertussis vaccinations for survey and 132 for interview.
Materials/Method (how was
the study set up and
implemented; what
intervention was used)
Knuf et al. (2015) suggested no materials and method. However, mentioned that children aged 16–72 months received two doses
of an MF59 ATIV which was further evaluated to see efficacy in children.
Wiley et al. (2015) conducted interviews using grounded theory in from different demographic status
Data analysis Knuf et al. (2015) provided summative over view.
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Wiley et al. (2015) conducted interviews using grounded theory
Results (main findings) Knuf et al. (2015) suggested that MF59 and AS03 are proved to be immunogenic in young children as well as provide cross
protection against mismatched influenza virus strains.
Wiley et al. (2015) suggested that the susceptibility to disease, health professional’s advice and social norms influenced the
vaccination of the pregnant women. They always consider their children risk over them for pertussis whereas thy consider
influenza as a disease which can only affect them.
Conclusion/recommendations Knuf et al. (2015) suggested that further primary study is required to document level of improvement
Wiley et al. (2015) suggested that this result cannot be taken as representative of all pregnant women.
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Question 6 – (45 marks – 1000 words)
Discuss the reasons why the studies above would or would not be helpful in enabling a nurse/midwife to have an informed discussion with parents/a
pregnant woman about immunisation for their children/themselves. Comment on the relative value of the studies to the argument. Identify any further
information that may be useful in an informed discussion with parents/a pregnant woman about immunisation for their children/ themselves.
(Reference/s used to support your response should be written below your answer and are not included in the word count).
With the increased burden of the disease, Communicable disease is the major reason behind the hospitalization of children, especially of children less than
5 years old. A study highlighted that a considerate number of children of 5 years or more than 5 years are at high risk of communicable disease such
Pneumonia, measles, pertussis and influenza which further contributed to the global burden of the disease ( Rabinowitz et al. 2016). A study by Wong et
al. (2016), highlighted that 47.5 deaths per 100,000 live births are observed because of the high-risk level of communicable disease in infants. Few of the
disease is acquired by their mothers during pregnancy and become fatal which leads to the premature deaths of infants. These diseases not only increase
hospitalization but also responsible for substantial economic burden, further contributing to a maximized number of outpatient appointments along with
missed school and antibiotic use in children. The disease also affected the mental wellbeing of parents and the children. The world health organization
highlighted that because of the implementation of the vaccines reduced 2 to 3 million deaths every year which is partly because of herd immunity. On the
other hand, literature highlighted that a considerate number of parents along with pregnant women refuse to get vaccinated to their children and few
pregnant women have false beliefs and different risk perception which led to the refusal of vaccination. The above studies undertaken in the paper are
useful for enabling to have an informed discussion or pregnant women. Considering the first paper, Nowak et al. (2015), conducted a qualitative meta-
analysis of 29 unpublished and , primarily qualitative studies in-between 2000 to 2013 where researchers showed that changes in the attitude, beliefs,
and knowledge associated with influenza and influenza vaccine, especially changes in the beliefs regarding scope and scale greatly improves uptake of the
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vaccination both in children and pregnant women. Therefore, the research enables nurses or midwife to have an informed discussion with parents that
changing in the perception through knowledge and increasing awareness will reduce their anxiety regrading vaccination and protect their children from the
communicable disease. Health care provider’s advice which is based on their perception plays a huge role in changing the perception of parents and
increasing the vaccination coverage (Chervenak et al., 2017). Considering the second paper, Furuta et al. (2017), conducted the review on 15 articles
where 12 study population was undertaken where total 203,835 mother-infant pair, Israel, UK, US, Belgium, and Vietnam. The researchers showed that
because of the high risk of the pertussis is not only affected the pregnant women but also infect the foetus. Majority of the women have the perception
that vaccination would cause a side effect in pregnancy. Therefore, the result showed that pertussis vaccination is given to the pregnancy do not increase
the risk in maternity which would further help nurses to have informed the discussion with parents and pregnant women showing evidence to empower
them for facilitating the decision of the vaccination for their children. Considering the third paper, Knuf et al. (2015) conducted the review for evaluating
the efficiency of MF59 and AS03 Influenza Vaccines in children less than five years where seasonal trivalent influenza vaccines are proved to be ineffective
and failed to support that the wellbeing. The result suggested that MF59 and AS03 are proving to be immunogenic in young children which help nurses to
provide education and develop a community-based program where they will have an opportunity to have informed the discussion with parents and
empower them showing statistical evidence to reform their beliefs. The paper is valuable in reforming beliefs of parents and it will also provide
researchers a scope to further research on the area communicable disease. Considering the fourth paper, Wiley et al. (2015) conducted a survey and
focus group interview for exploring explored risk perception of influenza and pertussis and vaccination from the point of view of the pregnant woman. The
researchers highlighted that they always consider their children risk over them for pertussis whereas thy consider influenza as a disease which can only
affect them which further highlighted the false beliefs of the women. Therefore, the study would help nurses or midwives to have an informed discussion
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about the false beliefs and perception of risk they have regarding the communicable and to empower them through proper knowledge and anxiety
management. The researchers also highlighted the different needs of pregannat women and how they use the advice of the health professionals through
the interview. This information further helps nurses to have informed the discussion with pregnant women regarding the immunisation of their child or
them prioritizing their needs of the vaccination and considering other factors that influence the decision making of vaccination. Each of the four studies
considered in the paper are valuable since they are peer reviewed high quality and they fulfil the answer of the argument that majority of the parents and
pregnant women have false beliefs about vaccination and risk perception that influenced their decision regarding the vaccination which further can be
reduced by educational opportunity , participation of the community based program and other interventions ( Topçu et al. 2019). However, in each paper
limitation are present which is required to focus to gain the accurate result. Majority of the parents are being paranoid because of the pain their child
would experience during vaccination which influenced the vaccination decision making. Moreover, prophylaxis because of hypersensitivity reaction is
another reason that parents feel paranoid to make a decision regarding their vaccinations. Therefore, the journal obtained to answer the PICO question
highlighted that Pain management and prophylaxis regrading information can be useful in an informed discussion with parents/a pregnant woman about
immunisation for their children/ themselves. Taddio et al. (2019) showed that parents are able to manage thespian their child is experiencing. Therefore,
through education and arranging community based program in the community with the assistance of health professionals, Parents will fell empower, it will
boost their self-esteem which further increases child immunization around the globe.
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Refernces:
Rabinowitz, M., Latella, L., Stern, C. and Jost, J.T., 2016. Beliefs about childhood vaccination in the United States: Political ideology, false consensus, and the
illusion of uniqueness. PloS one, 11(7), p.e0158382.
Wong, L.P., Alias, H., Sam, I.C. and Zimet, G.D., 2019. A nationwide study comparing knowledge and beliefs about HPV among female students before and
after HPV vaccination. Journal of pediatric and adolescent gynecology, 32(2), pp.158-164.
Chervenak, F.A., McCullough, L.B. and Brent, R.L., 2016. Professional responsibility and early childhood vaccination. The Journal of pediatrics, 169, pp.305-
309.
Topçu, S., Almış, H., Başkan, S., Turgut, M., Orhon, F.Ş. and Ulukol, B., 2019. Evaluation of childhood vaccine refusal and hesitancy intentions in
Turkey. The Indian Journal of Pediatrics, 86(1), pp.38-43.
Bryman, A., 2017. Quantitative and qualitative research: further reflections on their integration. In Mixing methods: Qualitative and quantitative research (pp.
57-78). Routledge.
Hartas, D. ed., 2015. Educational research and inquiry: Qualitative and quantitative approaches. Bloomsbury Publishing.
Schollin Ask, L., Hjern, A., Lindstrand, A., Olen, O., Sjögren, E., Blennow, M.,and Örtqvist, Å. 2017. Receiving early information and trusting Swedish child
health centre nurses increased parents’ willingness to vaccinate against rotavirus infections. Acta Paediatrica, 106(8), 1309-1316.
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Taddio, A., Shah, V., Bucci, L., MacDonald, N. E., Wong, H., and Stephens, D. 2018. Effectiveness of a hospital-based postnatal parent education
intervention about pain management during infant vaccination: a randomized controlled trial. CMAJ, 190(42), E1245-E1252.
Willis, E., Sabnis, S., Hamilton, C., Xiong, F., Coleman, K., Dellinger, M. and Nugent, M. 2016. Improving immunization rates through community-based
participatory research: Community health improvement for Milwaukee’s children program. Progress in community health partnerships: research, education,
and action, 10(1), 19.
Nowak, GJ, Sheedy, K, Bursey, K, Smith, TM & Basket, M 2015, ‘Promoting influenza vaccination: insights from a qualitative meta-analysis of 14 years of
influenza-related communications research by US Centers for Disease Control and Prevention (CDC)’, Vaccine, vol. 33, no.24, pp.2741-
2756.https://doi.org/10.1016/j.vaccine.2015.04.064
Furuta, M, Sin, J, Ng, ES & Wang, K, 2017. ‘Efficacy and safety of pertussis vaccination for pregnant women–a systematic review of randomised controlled
trials and observational studies’, BMC Pregnancy and Childbirth, vol. 17, no. 1,pp.1-20. https://doi.org/10.1186/s12884-017-1559-2
Knuf, M, Leroux-Roels, G, Rümke, HC, Abarca, K, et al, 2015, ‘Safety and immunogenicity of an MF59®-adjuvanted A/H1N1 pandemic influenza vaccine in
children from three to seventeen years of age’, Vaccine, vol. 33, no.1, pp.174-181.
https://doi-org.access.library.unisa.edu.au/10.1016/j.vaccine.2014.10.085
Wiley, KE, Cooper, SC, Wood, N & Leask, J 2015, ‘Understanding pregnant women’s attitudes and behaviour toward influenza and pertussis vaccination’,
Qualitative Health Research, vol. 25, no 3, pp.360-370. http://journals.sagepub.com/doi/pdf/10.1177/1049732314551061
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