Immunisation Research: Assessment 1, Health Beliefs and Practices

This assignment solution addresses immunisation research, focusing on factors influencing vaccination decisions within different population groups in Australia. It begins by formulating a researchable question related to this topic, followed by identifying the elements of PICO (Population, Intervention, Comparison, Outcome). The student then justifies the use of a qualitative research methodology, citing relevant literature to support their choice. The solution lists sources of reliable evidence, including PubMed, EMBASE, and CINAHL Plus, and provides details of a specific resource from PubMed. It explains why this source exemplifies best available evidence, referencing the Levels of Evidence and Hierarchy of Evidence tables. The assignment also identifies keywords for literature searches, suggests alternative search terms using Boolean functions, and discusses strategies to refine search results. Finally, the solution analyzes research articles, providing details on study types, topics, aims, inclusion/exclusion criteria, and search strategies. The student completes a template, providing requested information relating to specific components of the research articles listed in the assignment brief, demonstrating an understanding of research methodologies and the evaluation of evidence.

Assessment 1
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
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
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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.
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
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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:
Factors affecting vaccination decision making in different population groups in Australia
Question 1b: Identify the elements of (words relating to) PICO (or PIO, if appropriate) in the
research question that you have formulated:
P vaccination decision making
I Different population groups
C
O Auatralia
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).
Qualitative research is naturalistic inquiry seeking an in-depth understanding of social
phenomena in natural settings. The focus of such studies is on the why, rather than the
what of the social phenomena being studies. Thus the focus of this study will be to look for
studies that have been done in the past especially systematic reviews that have gathered
data from previous studies to develop a conclusion of the state of research on the topic
(Hamid, Ghaleb, Aljadhey, & Aslanpour 2014, p. 5).
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. PubMed
2. EMBASE
3. CINAHL Plus
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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
Forbes, T. A., McMinn, A., Crawford, N., Leask, J., &
Danchin, M., 2015. Vaccination uptake by vaccine-
hesitant parents attending a specialist immunization clinic
in Australia. Human vaccines & immunotherapeutics,
11(12), 2895–2903. doi:10.1080/21645515.2015.1070997
Provide the URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5054782/
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).
PMC is a leading database with over 29 million citations for biomedical literature ranging
from MEDLINE, online books and science journals. The citations for articles that are
found on this database vary from website to website and may be from PubMed Central and
publisher websites. The resource is wide and the databases that publish here are organized
in biomedical topics to assist in research and easy finding of the required resource. This
means that when searching the database, keywords have to be used to narrow down and
refine the search to get the required results.
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 vaccination decision
making
Vaccination and
decision making
Vaccination* Vaccine bar???
2 vaccine hesitancy in
Australia
Vaccine and
hesitancy
Vaccination
hesitancy*
Vaccine heist???
3 vaccine beliefs in
Australia
Vaccination and
beliefs
Vaccination beliefs Vaccine 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).
T search for resources, it depends on the type of website being used. Some websites allow
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refining of the results of the search through searching for specific topics. For example, if
the search is for example topic specific queries are used I PubMed to refine the search.
This means that Boolean search terms are used to search for specific words that define the
topic. To refine the search well, specific keywords can be removed in the Boolean search
by using the word “not” so that the ones that are not needed are removed. Truncation can
then be used to increase the search so that only resources with a specific word are included
(Whitehead 2013, p. 38). This makes it easy for the researcher to refine the search for
example by adding the year so that only those that fall within the criteria are used.
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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)
This study was a meta-analysis of 14 years of influence related communication research by the CDC. According to
Timulak (2009, p. 605), a qualitative meta-analysis is a secondary mixed method and qualitative study that worked
like a quantitative meta- analysis but rather than statistical analysis it uses textual reports by identifying the themes
that have been reported over time. Thus this method is valid for this study since it is based on critical medical studies
that have been done by the CDC to determine the findings of the study.
Issue/Topic (what was being
studied)
The role of this study is to determine the existing knowledge on the topic by presenting reports that have been
developed by different CDC studies that have been done in the past.
Purpose/aims of the study
(why was the study being
undertaken?)
The objective of this study was to accomplish three aims, the first was to avail the 29 unpublished seasonal influenza
vaccination communication conducted by the CDC for 14 years. The second objective was to determine the key
themes from influenza-related vaccination issues and lastly, to highlight the intersection between the findings and
influenza-related communication.
Inclusion/exclusion criteria The reports that were included in this meta-analysis were qualitative reports based on focussed group discussions and
in-depth interviews that had been documented but not adequately communicated for other people to understand. The
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studies that were excluded are the ones that were exclusively related to H1N1 influenza vaccination. According to
Shaughnessy, Zechmeister & Jeanne (2011, p. 15) exclusion and inclusion needs to be carefully designed so that the
correct responses and data can be collected for the study.
Search strategy (methods) The search strategy was based on a summary and final of reports that had been prepared by contractors who had
undertaken studies on influenza. The search for the study was based on identifiers that were used to determine the
nature of each study that was used in the research.
Data analysis The data analysis for the studies was based on identifying the themes and using identifiers in the study and several
themes that were identified in the studies.
Results (main findings) The studies indicated that the members of the public had limited knowledge about influenza since they did not know
its common forms of transmission. From the meta-analysis of the studies, seven facilitators of influenza vaccination
were identified: perceived susceptibility or health threat, prevention and protection from influenza, the relationship
between age and health status, healthcare provider recommendations, experience of patients with influenza illness, the
convenience of the vaccine and the importance of active promotion in creating awareness to patients and the public to
reduce hesitancy.
Conclusion/recommendations The study concluded the need to understand the factors that influence decision making n vaccinations. Thus the views
that people have on the severity, vaccines reactions and effectiveness are rooted in the personal experiences that
people have. This means that communication is an important element in increasing the response of people to
vaccinations since this makes them understand how to increase the decisions that they make on vaccination.
According to Goodwin (2015, p. 23) grand studies need to offer the best recommendations that can be used to
improve the field of study and at the same time propose ways that can be used to improve the field of study. This
study recommends that the eight themes associated with influenza vaccination can be important in developing
strategies for communicating the findings of the studies to communicate well with the populations and ensure that the
messages can be applied in increasing access and acceptance of vaccines.
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Table 2.
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 behavior 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)
This study was a multinational single-blind randomized dose range study conducted for three years across 11 study
sites in different locations. According to Sandroff, et al. (2018, p. 4) randomised control trials offer the best study
method for the nature of the problem since it allows the use of the control group and the general group in the study
thus allowing the researcher to compare the effects in the control group to report the changes. This means that in a
single-blinded study, the researcher and the medical team are aware of the differences between the two groups which
makes it easy to document the findings of the study
Issue/Topic (what was being
studied)
The safety and immunogenicity of an MF59®-adjuvanted A/H1N1pandemic influenza vaccine in children from three
to seventeen years of age.
Purpose/aims of the study
(why was the study being
undertaken?)
This study sought to determine the optimal dose an MF59®-adjuvanted, monovalent, A/H1N1 influenza vaccine that
needs to be administered to healthy subjects.
Population (how many
participants, age, gender,
disease, etc)
This was a multinational randomized control trail done in six countries. The subjects for this study were divided into
two cohorts 3-8 years and 9-27 years and were scheduled to receive a vaccine.
Materials/Method
(how was the study set up and
implemented; what
intervention was used)
The study was based on the use of 3-8 year patient cohort which was to be administered with 3.75g antigen with
half(4.875 mg squalene) the standard dose of MF59 adjuvant (3.75-HalfMF59), 7.5g antigen with a standard/full dose
(9.75 mg squalene)of MF59 (7.5-Full MF59), or a non-adjuvanted 15 _g formulation(15-No MF59), respectively. On
the other hand, another cohort of 9-17 years was used in another group where all the patients were randomised and
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treated with the same vaccination but with a dose fort the adults. The blood samples from each of the group were
collected in day one, day 22, day 43, day 366, and then safety follow up for a period of 18 months due to nature of the
vaccines.
Data analysis The analysis of the findings was based on the percentage of subjects achieving sero-conversion for HI antibodies were
calculated to determine the data for the study. Immunogenicity analyses were also run on a per-protocol set based on
the patients that received all the doses correctly with no major protocol violations.
Results (main findings) The results of the study indicated that a single dose of MF59-adjuvanted formulation meets the European licensure
criteria for pandemic influenza vaccines (HI titres ≥1:40 > 70%; sero-conversion > 40%; GMR > 2.5). On the study
reported that non-adjuvated vaccine doses are required for patients as licensed by the medical units in the country.
This study reported high confidence levels for the study in the vaccine groups since they reported the highest results.
Conclusion/recommendations The study concluded that an MF59-adjuvanted influenza vaccine containing 3.75_g of A/H1N1 antigen meets the
European licensure criteria after a single dose has been administered in healthy populations from 3-17 years.
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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).
Immunization challenges are based on the different believes that patients and parents
hold and the effect or validity of the vaccines that are administered to them. This is based on
the fact that there have been instances where even professionals have raised issues on the
validity of certain vaccines and the effects that they cause to the patient. In other cases we
have seen activists and even religious institutions on the front line against some vaccinations
like the case of measles vaccine that has been linked to being the cause of autism in children
(Dube, et al. 2016, p. 248). This means that as a healthcare professional, knowledge of such
issues is important in dealing with hesitancy issues within the population. It is important to
understand that the issue of vaccine challenges that are faced within clinical and medical
settings vary from group to group. Nurses and midwives need to have informed discussions
on the issues that relate to vaccinations and how they can be used to deal with the issues
revolving around parents and pregnant women who require to get immunizations jabs or
medications. The two studies are important in improving the knowledge of a professional in
dealing with the issues.
Nowaka, Sheedy, Bursey, & Smith (2015, p. 2741) suggests that each year people are
vaccinated against influenza among other diseases. This is the call to reduce the economic
burden of the disease by ensuring that parents and pregnant women participate in this study
as a way of ensuring that they are able to prevent the harm of the disease. Arede, et al. (2018,
p. 2) suggests that the nurses need to understand the clinical requirements of the vaccines and
the way this needs to be carried out according to the region that the patients come from. As a
nurse knowledge on the developments of the vaccines around the globe is important in
determining how patients can be advised on the intake of the vaccination. Pandemic influenza
awareness is one way of ensuring that the public understands the challenge at hand and
response to this threat using the healthcare models that are available. Despite the fact that
governments have put measures for seasonal vaccinations or diseases like influenza, they are
still dependent on the patients and their decision-makers to respond to the call for
participation in these campaigns. This means that the government has to put measures in
place that will align its citizens with government set strategies and the need to address the
challenges that they face.
One common way of dealing with the challenges of vaccination is increasing
communication and creating awareness to people so that they can understand the importance
of vaccination. Different patients have varying knowledge, attitudes, and beliefs on the effect
of disease vaccinations. This means that the nursing profession needs to be on the front
runners on advising the patients on the importance of vaccination. This will address the
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developing challenges of hesitance that people have. For example, in the case of influenza
Nowaka, Sheedy, Bursey, & Smith (2015, p. 2753) reported that with increased
communication and awareness creation, more parents are willing to take part in vaccinations
and at the same time recommend vaccinations to their children. This study also reported that
communication increases awareness of the disease to at-risk populations by assisting them to
understand the signs of the diseases and the general effects on the population. These changes
are taking place through clearly at modest rather than desired levels. Which means that the
response of the population seems to be increasing.
From these two studies, we can also, learn the importance of administering proper
dosages as per the requirements of the relevant health bodies in the country that the patients
belong to. For example, Knuf, et al. (2015, p. 180) concluded that there are requirements for
different doses of drugs like influenza which are required for different paediatric subjects.
This means that professionals need to understand the dosage required for them and the
number of doses to be done and how to follow up. Thus patients need to be enlightened on
the level of dosage and they will take and the importance of them ensuring that they are able
to respond to the issues that affect them. The findings of this study are important in
determining the best way to administer medications to patients. Boucher, et al. (2016, p. 4)
argues that interventions to improve acceptance of vaccinations in different populations needs
to be based on the knowledge that exists in the field which the patients belong to and the need
to ensure that all the requirements for the vaccination can be met. Thus vaccinations can be
administered well if the knowledge of both the patients and the professionals is improved so
that the requirements for the vaccination are met.
Therefore, nursing professionals need to understand how to communicate vaccination
requirements to patients by giving relevant information to patients that will increase their
ability to accept vaccinations. The hesitance of patients is based on the lack of knowledge and
proper communication of the vaccination requirements that patients need to take. It is also
important that professionals understand the vaccine requirements, how to administer the
doses and even follow up on the vaccinations that are required that to ensure that the patient
goes through all the required medical dosages that patients need. This means that
communicating vaccination knowledge is important in ensuring that patients understand the
importance of vaccination and how the practitioner needs to be informed on the right doses
and the best way to ensure that patients respond well to all the requirements of the disease.
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References
Arede, M. et al., 2018. Combating Vaccine Hesitancy: Teaching the Next Generation to
Navigate Through the Post Truth Era. Frontiers in Public Health, 6(381), pp. 1-10.
Boucher, V. G. et al., 2016. Interventions to improve vaccine acceptance among rheumatoid
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Check, J. & Schutt, R., 2012. Research methods in education. In: Thousand Oaks: Sage
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Cohen, N. & Arieli, T., 2011. Field research in conflict environments: Methodological
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Dubé, E. et al., 2016. Vaccine acceptance, hesitancy and refusal in Canada: Challenges and
potential approaches. Canadian ommunicable Disease Reports, 42(12), pp. 246-251.
Few, S., 2014. Show me the numbers: designing tables and graphs to enlighten. Oakland:
Analytics Press.
Forbe, T. A. et al., 2015. Vaccination uptake by vaccine-hesitant parents attending a
specialist immunization clinic in Australia. Human Vaccine Immunotherapeutics, 11(12), pp.
2895-2903.
Hamid, A., Ghaleb, M., Aljadhey, H. & Aslanpour, Z., 2014. A systematic review of
qualitative research on the contributory factors leading to medicine-related problems from the
perspectives of adult patients with cardiovascular diseases and diabetes mellitus. BMJ Open,
5(2), pp. 1-10.
Howell, K. E., 2013. Introduction to the Philosophy of Methodology.. London: Sage
Publishers.
Knufa, M. et al., 2015. Safety and immunogenicity of an MF59®-adjuvanted
A/H1N1pandemic influenza vaccine in children from three to seventeen yearsof age.
Vaccine, Volume 33, pp. 174-181.
Nowaka, G. J., Sheedy, K., Bursey, K. & Smith, T. M., 2015. Promoting influenza
vaccination: Insights from a qualitative meta-analysis of 14 years of influenza-related
communications research by U.S. Centers for Disease Control and Prevention (CDC).
Vaccine, Volume 33, p. 2741–2756.
Ponto, J., 2015. Understanding and Evaluating Survey Research. Journal of the advanced
practitioner in oncology, 6(2), p. 168–171.
Sahaya, A., Hutchinson, M. & East, L., 2015. Exploring the influence of workplace supports
and relationships on safe medication practice: A pilot study of Australian graduate nurses..
Nurse Education, 35(2).
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Sandroff, B. M. et al., 2018. Rationale and design of a single-blind, randomised controlled
trial of exercise training for managing learning and memory impairment in persons with
multiple sclerosis. BMJ Open, 8(12), pp. 1-13.
Singleton, R. & Straits, B., 2009. Approaches to social research .. New York: Oxford
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Timulak, L., 2009. Meta-analysis of qualitative studies: a tool for reviewing qual-itative
research findings in psychotherapy. Psychotherapy Research, 4(5), p. 591–600.
Whitehead, D., 2013. Searching and reviewing the research literature. In: Nursing &
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