Research Methodologies (NURS 3044): SP4

This article discusses research methodologies for the NURS 3044 course. It includes a researchable question, sources of information, search terms, and actions to improve search results. It also covers the importance of studies on vaccines and their side effects, with a focus on MMR vaccines. The article cites several studies that establish the effectiveness and safety of MMR vaccines.

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Research Methodologies (NURS 3044): SP4
Student’s Name
University
Course
Lecturer
Date

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Research Methodologies (NURS 3044): SP4
Assessment 1
Question 1
Question 1A researchable question
P—parents with immunizable children
I—perception of parents towards vaccines
CO- What do parents consider in vaccines
What perceptions do parents of children within immunizable age consider in accepting
vaccination of their children.
Question 1B: Sources of information
Source of information Type of information
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5165048/ Factors influencing
vaccination decision
making
https://www.sciencedirect.com/science/article/pii/S0264410X17312756 Vaccination uptake
https://www.hindawi.com/journals/apm/2012/175694/ Vaccination decision
making
Question 1C: List five search terms for finding literature
Keyword Search term for Boolean ‘or”
1 immunization Immunization or side effects
2. immunization Immunization and parental resistance
3 effectiveness Effectiveness of immunizatiosn vs parental knowledge
of benefits
4. intended results Intended results of immunizations vs unintended
results
2. unintended consequences Immunization vs parental disagreement
Question 1D: the actions to be taken to improve search results.
If the search fails to yield the best results for the study, the nextr approach will be changing
key words that I used in the previous search. If in the initial search I used sentences, then I
will narrow down the search to a few words or even single words for easy search. When
searching the internet for study resources, the search engines organises the available
information from what the system feels as the best result and organises them in ascending

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order. This does not mean that the results indicate the best resource that meets the needs of
the research (Pagatpatan & Arevalo 2016, p. 48). Therefore, the search can be refined by
changing the key words to refine the results.
Another way to search the internet for materials is the use of Boolean operators as a way of
expanding or narrowing down the search. For example, this can Immunization vs side effects
which will give a list of search results that relate to the Boolean words. When the search
engine does not offer the right results, the user can change from the use of the word versus to
the use of words like “or/and”. The researcher can then use the minus operator to narrow
down the search to fewere sources.

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Question 2
Table 1. Meta-analysis (+/- systematic review)
Full reference:
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(Taylor, et al., 2014). Access via https://ac-els-cdn-com.access.library.unisa.edu.au/S0264410X14006367/1-s2.0-
S0264410X14006367-main.pdf?_tid=0faa94de-0985-11e8-a381-
00000aab0f01&acdnat=1517732953_c2e06dba46682bf164edc03782248b99
Search strategy the researchers developed a checklist of twenty seven items and used a combination of the following search terms: autism,
immunisation, Asperger, PDD and pervasive developmental disorder.
Inclusion/exclusion
criteria
The inclusion/ exclusion criteria was based on retrospective and prospective cohort studies using the words vaccination
and disorders that focussed on MMR vaccination or cumulative thimerosal dosage. Papers from the United States with
cohorts from Vaccine Adverse Event Reporting Sytems were not included due to their study limitations, underreporting,
biasess, and lack of control groups (Taylor et al. 2014, p. 3624).
Issue (what was being
studied)
The study sought to quantify the existing literature on autism and childhood vaccination to substantiate that there
isnodirect effect of vaccines on autistic children.
Context (study setting) The context of the study was to focuson any article that focused on MMR vaccination, cumulative thimerosal dosage and
cumulative mercury. There was no limit on date or language thus expanding the search strategy.
Outcome (main findings) The study found no link between vaccination and the risk of developing autistic spectrum disorder in children.
From the study twelve identified studies conclude that there was no evidence linking vaccination to autism.
Only one research item conclueded there is a relationship between the two based on the etiology of autism suggested that
environmental factors can contribute to the disorder through toxins (Ratajczak 2011, p. 78).
The patient needs to weigh the benefits and risks of any treatment in relation to the side effects that can be witnessed.

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Table 2. Systematic review
Full reference
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Jefferson, T., Price, D., Demicheli, V., Bianco, E. and European Research Program for Improved Vaccine Safety
Surveillance (EUSAFEVAC) Project, 2003. Unintended events following immunization with MMR: a systematic review.
Vaccine, 21(25-26), pp.3954-3960. Access via ScienceDirect Journals (Available from 1995 volume: 13)
Search strategy The search strategy for the research was comparative prospective or retrospective studies. The search narrowed down on
Cohrane Control Register of Controlled Trials, the NHS Database of Abstract, ochrane Database of Systematic Review
and biological Abstracts from 1985 (Jefferson, et al. 2003, p. 3955).
Inclusion/exclusion
criteria
For inclusion in the study, the resources must have been published between 1969-2003 and carried out on healthy
individuals who are fifteen years and below (Jefferson, et al. 2003, p. 3955).
Issue (what was being
studied)
The study sought to investigate the unintended effects of MMR vaccine that have led to drop in vaccination rates.
Context (study setting) The study context was a global search based on any comparative and retrospective research study that has ever been done
on unintended effects of MMR vaccines.
Outcome (main findings) There was limited evidence on the safety of MMR vaccines
The safety of the MMR vaccines are attributed to their universal use which makes them safer with low unintended
consequences.

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There is need to adequately capture safety outcomes in vaccine studies for proper documentation of outcomes.
The incindence outcomes like rash, fever, cough, myalgia, lymphadenopathy, anorexia and arthralagia in both MMR nad
Rubella vaccines makes the incindecne of unwanted effects low (Swartz et al. 1974, p. 117).
Table 3. Experimental quantitative studies
Full reference:
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Prymula, R., Bergsaker, M.R., Esposito, S., Gothefors, L., Man, S., Snegova, N., Štefkovičova, M., Usonis, V., Wysocki,
J., Douha, M. and Vassilev, V., 2014. Protection against varicella with two doses of combined measles-mumps-rubella-
varicella vaccine versus one dose of monovalent varicella vaccine: a multicentre, observer-blind, randomised, controlled
trial. The Lancet, 383(9925), pp.1313-1324. Full text available via Elsevier ScienceDirect (Available from 07/01/1995
volume: 345 issue: 8941)
Study Design (e.g.:
cohort, RCT,)
The study design was cohort study of children aged between 12-22 months in 111 study centersI Europe Czech republic
(22), Greece (11), Italy (9), Lithuania (9), Norway (5), Poland (10), Romania (10), Russia (14), Sweden (5) and Slovakia
(17).
Population (how many
participants, age, gender,
disease, etc)
The study used 5803 children from the above named countries that are varicella endemic and aged between the age 12-22
months at the time of first vaccination and a negative history of mumps, varicella, measels, and rubella. The eligible
participants for the study were parents who had a telephone and had a high possibility of complying with research
requirements (Prymula et al. 2014, p. 1315).

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Intervention (what was
being implemented)
The study was assessing the protection against varicella in children who received the dose against MMRV.
Comparison (was the
intervention being
compared to another
strategy, e.g. placebo?)
Then study was a comparison between the findings in a single dose and a double dose of varicella in children. Two groups
were used; the efficacy cohort and non-efficant cohort. The former included chidren who received two doses while the
latter received a single dose (Prymula et al. 2014, p. 1316).
Outcome (main findings) Varicella cases were confirmed in 37 participants in the MMRV group.
The efficacy of one varicella dose was 65.4%
The efficacy of two dose MMR was effective in 94.9% of the population.
The efficacy of the MMRV dose against severe varicella was 90% effective.
There side effects of reported fever in 57% of the children after 15 days
Table 4. Qualitative study
Full reference
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Guillaume, L.R. and Bath, P.A., 2004. The impact of health scares on parents’ information needs and preferred
information sources: a case study of the MMR vaccine scare. Health Informatics Journal, 10(1), pp.5-22. Full text
available via SAGE (Available from 1999 volume: 5 issue: 1)
Study Design (ie: cohort) Guillaume, & Bath, (2004, p. 9) used a semi-structre approach to gather information from parents.
Population (how many
participants, age, gender,
disease, etc)
The study targeted seventeen parents whose information was collected through semistructured interviews to gather their
views towards the research problem.

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Issue (what was being
studied)
The study focussed on examining MMR vaccination scare and the impact it has parents of the children within the
vaccination age and the information needed to increase their knowledge.
Context (study setting) The context of the study was parents whose information was available in the Sheffield Children’s Information Service
who had children within the MMR vaccination age.
Outcome (main findings) Parents desired information on the importance of MMR vaccination and the side effects that children can have to make a
decision.
There was a concern over lack of adequate information on the vaccine to assist parents in decision making. This is also
seconded by Brazy et al. (2001, P. 45).
Parents were concerned with lack of medical research information.
The mass media was the source scare on MMR vaccine.
Informational needs of parents are not being properly adressed by officialUK bodies.
Hcp provided support information for parents where they were scared.
The major concern of parents in the study was the validity of the information that they received.

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Question 3 – Importance of the studies
The scare of vaccines and the side effects of some vaccines has elicited reaction from
parents on whether their children should be vaccinated or not. This has been attributed by the
ability of highlyeducated parents to question lack of adequate information on the role of the
vaccinesand the unintended side effectsthat can be felt (Williams 2014, p. 2588). Researchers
have worked on the challenges of the national imunizational immunization programs in
different countries as a way of justifying the vocal opposition to vaccines and immunizations.
Civil rights groups and religious institutions like the catholic have strongly opposed some
vaccines quoting the public health threat that they pose to the individual. This has led to
reduced confidence by parents in vaccines that should be administeredon their parents.
The articles offer great insight on side effects of threats that the vaccines pose on the
health of the individual. Jefferson, et al (2003, p. 3955) carried out a sytematic review of all
studies that have ever been carried out on MMR from 1969-2003 to quantify the uninteded
side effect of the vaccine to the population. This research found no difficult side effects that
could not be managed but rather minor problems like fever which appearedafter sometime.
On the other hand, Taylor et al (2014, p. 3624) sought to understand the relationship between
MMR vaccineand development of autistic spectrum. The study revealedthat there was no
relationship between the vaccine and the development of autisticdisorder nor did autistic
children exhibit any side effects that were different from children without the disorder.
Lastly, Prymula et al. (2014, p. 1315) study in six European countries reported positive
benefits in children who were exposed to two doses of the MMR vaccine as compared to
those who used one. The three studies established the effectiveness of MMR vaccines and
justified their universality as one of way confirming that the vaccines are safe for children.
These three studies are heloful in justifyingto the world that indeed the vaccinnes are
intended to benefit the children rather than harm them. Schuchat (2011, P. 120) states that
the role of vaccines is to reduce global outbreak of diseases like polio, measles, Hib, hepatitis

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B, and varella. These vaccines reduce fourteen million infections and thirty-three thousand
mature deaths around the globe. Hardt, et al. (2013, p. 205) adds that before the global
vaccine program, preventable diseases were challenging to the world leading to preventable
deaths and treatment of infections that cost the world a lot of resources. This articles can be
used in justifying the benefits of vacinnes rather than the side effects that most parents have.
The role of information education communication in acceptance of medical
interventions is an imprortant element in the healthcare industry. The principle of autonomy
allows patients to make a decision whether to accept a certain medical intervention or not
(Barnighausen et al. (2011, p. 2374). According to Guillaume, & Bath (2004, p. 10) parents
rely heavily on the available information to makedecisions on whether to accept the
vaccinnefor their children or not. This means that informed consent relies heavilyon the
availableinformation about the vaccine. As the world becomes more global, information can
be easily accessed through the internet to guide parents in decision making. The fact that
most parents rely heavily on media to understand the benefits and side effects of any
vaccination, it means that there is need to provide access to quality and reliable information.
Guillaume, & Bath, (2004, p. 5-22), study is relevant in understandingthe information needs
of parents and how the level of information that they access improves vaccination awareness
and acceptance.
Brunson (2013, p. 5469) adds that information accessed through the media is limited
since it is not comprehensive but rather covers specific issues that need to be seen or heard by
the public. These studies therefore offer suggestions on the need to make vaccination
information readily available to parents. The currentinformation offered by the public health
through leaflets does not cover all the information needed by parents. The studies above have
been complementedby Williams et al. (2014, p. 478), which indicated that parents are
comfortable receiving information from their practitioners rather than any other source. This

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means that it is important for the public health institutions to offer reliable information to
parents that can be used in decision making.
Therefore, the studies can are heloful in the field of public health by improving parent
decision making towards vaccination acceptance and at the same time justifying then
reliabilityof vaccines to the public. However, there is need to carry out research on other
vaccinesto justify their relaibility to children. Such information improves decision making
and leads to improved decision making by parents.

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References
Bärnighausen, T et al 2011, Rethinking the benefits and costs of childhood vaccination: The
example of the Haemophilus influenzae type vaccine. Vaccine, Volume 29, pp. 2371-2380.
Brazy J, Andersin BPB & Becker M, 2001, How parents of premature infantc gather
information and obtain support. Neonatal Network, 20(2), pp. 41-48.
Brunson EK, 2013, How parents make decisions about their children’s vaccinations. Vaccine,
Volume 31, p. 5466–5470.
Guillaume LR, Bath PA, 2004, Impact of Health Scares on Parents' Information Needs and
Preferred Information Sources: A Case Study of the MMR Vaccine Scare. Health
Informatics, 10(1), pp. 5-22.
Hardt K et al 2013. Sustaining Vaccine Confidence in the 21st Century. Vaccinnes, 1(3), pp.
204-224.
Jefferson T, Price D, Demicheli V & Bianco E, 2003, Unintended events following
immunization with MMR: a systematic review. Vaccine, 21(25-26), pp. 3954-3960.
Pagatpatan JC & Arevalo J, 2016, Systematic Literature Search Strategies for the Health
Sciences. The Philippine Journal of Nursing, Volume 86, pp. 48-55.
Prymula R, et al 2014, Protection against varicella with two doses of combined measles-
mumps-rubella-varicella vaccine versus one dose of monovalent varicella vaccine: a
multicentre, observer-blind, randomised, controlled trial. The Lancet, 383(9925), pp. 1313-
1324.
Ratajczak HV, 2011, Theoretical aspects of autism: Causes—A review. Journal of
Immunotoxicology, 8(1), pp. 68-79 .
Schuchat A, 2011, Human vaccines and their importance to public health. Procedia in
Vaccinology , Volume 5, pp. 120-126.
Swartz T, Klingberg W & Klingberg M, 1974, MA. Combined trival bivalent measles,
mumps and rubella virus vaccination. A controlled trial. Infection, 2(3), pp. 115-117.
Taylor L, Swerdfeger A & Eslick G, 2014, Vaccines are not associated with autism: an
evidence-based meta-analysis of case-control and cohort studies. Vaccine, 32(29), pp. 3623-
3629.
Williams E et al, 2014, A Randomized Trial to Increase Acceptance of Childhood Vaccines
by Vaccine-Hesitant Parents: A Pilot Study. Academic pediatrics, 13(5), p. 475–480.
Williams SE, 2014, What are the factors that contribute to parental vaccine-hesitancy and
what can we do about it?. man Vaccines & Immunotherapeutics, 10:9,, 10(9), pp. 2584-2596.

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