Factors Influencing Immunization: Nursing Assignment Research

This nursing assignment delves into the multifaceted topic of immunization, encompassing research on parental attitudes, vaccine safety, and the impact of health scares. The assignment begins by formulating a researchable question concerning the factors influencing negative attitudes towards immunization among Australian parents, followed by the identification of relevant information sources and search terms. The core of the assignment involves a detailed analysis of four research articles, including a meta-analysis, a systematic review, an experimental quantitative study, and a qualitative study. Each article is dissected to extract key information such as the search strategy, inclusion/exclusion criteria, the issue under investigation, the study context, and the main findings. Finally, the assignment requires a critical discussion on the relevance of these studies in informing discussions with parents or pregnant women about immunization, evaluating the value of each study in supporting an argument. The assignment aims to enhance the student's ability to synthesize research, analyze evidence, and apply it to practical scenarios in nursing practice, specifically related to patient education and advocacy regarding immunization.

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Nursing Assignment
Name:
Institution:

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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 2, but if any other
sources are used, these should be referenced.
Assessment template

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Question 1 (20 marks) (400 word equivalent)
Question 1A
After reading the background information, develop a researchable question from the
background information that you have been given relating to immunisation. Type your
question below:
What are the factors influencing negatives attitudes towards immunization among Australian
parents?
Question 1B: List three sources of information that would provide you with strong
evidence that would enable you to answer your research question. For each of the three
sources, give an example of the type of information that you would source:
*The example provided below is an example of a source of information and a type of
information available from that source. It is not suggested that this example represents
strong evidence.
Source of information Type of information
Example: Australian Government Department
of Health website
Example: Whooping Cough brochure (2016)
Government endorsed health websites and
top industry bodies (e.g. the Australian
Medical Association)
online blogs posted on websites
Health support groups Research reports and bulletings
Health information journals Peer-reviewed journal articles

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Question 1C: List five search terms that would assist you to find suitable literature to answer
your question. For each of the search terms, suggest an alternate word for which the
Boolean function “or” could be used.
Keyword Search term for Boolean ‘or”
1. Preventive medicine preventive health
2. Anti-vaccination movement anti-immunization movement
3. vaccination immunization
4. medical policy public policy
5. vaccination of children immunization of children
Question 1D: If your search failed to find a satisfactory number of quality articles, what
actions could you take?
while it is wodely believed that use of search queries and advanced search queries such as
Boolean search are the best methods of accessing quality journal articles during research,
sometimes they may fail to yield the best quality journal article for use. In this scenario,
Smith (2010), Bernard (2011) and Groat & Wang (2013) suggest that reserachers can choose
to refine their search strategy by alternating words such as OR, AND or NOT. This gives the
data source/ database better alternatives for accessing quality articles.

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Question 2 (40 marks) (800 word equivalent)
Complete the attached table with the relevant information from each of the four articles.
Table 1. Meta-analysis (+/- systematic review)
Full reference:
Nursing
*Please delete the article that you are not using
Taylor, L.E., Swerdfeger, A.L. and Eslick, G.D., 2014. Vaccines are not associated with autism: an evidence-based meta-
analysis of case-control and cohort studies. Vaccine, 32(29), pp.3623-3629.
Search strategy The study conducted a search strategy aided by a PRISMA chart. First, a set of 1,112 relevant studies were collected and
screened before retrieval. The retrieved articles were subjected to inspection and this led to the elimination of 953
articles. 159 journal articles remained for further analysis. Upon conducting a detailed evaluation, 113 of the articles
were discovered to have no cohort data, thus were excluded from the study. The exclusion resulted in 46 potentially
suitable articles for inclusion based on the exclusion criteria. Consequently, 36 of the articles did not meet the inclusion
criteria and were excluded. As a result, 10 studies were left for use, as they contained usable and relevant information
for the study.
Inclusion/exclusion
criteria
Taylor et al (2014) majorly aimed at including case-control and Cohort studies based on the relationship between
disorders and vaccination. In this regard, studies that were eligible for inclusion were those that looked at cumulative
thimerosal dosage and cumulative mercury or MMR vaccination. On the other hand, all studies that had cohort
participants from the Vaccine Adverse Event Reporting System (VAERS) in the US were excluded from the study due to
high-risk of bias and numerous limitations such as inconsistency of data quality and unverified reports.
Issue (what was being
studied)
The study was majorly triggered by a debate over the possible relationship between vaccination and the emergence of
autism within the public health fraternity. This speculative relationship had instilled fear among the community and led
to an increase in preventable diseases as a result of vaccine boycott. In response, the meta-analysis was launched to

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investigate any link between vaccination and autism with an aim of establishing the clarity of the matter. It purposed to
summerise evidence from previous cohort and case-control studies through a meta-analysis.
Context (study setting) Study setting describes the study environment including the experimental setup and the location. In the case of Taylor et
al (2014), th study was conducted in a web environment, where data was majorly collected from secondary sources
(online databases such as EMBASE, PubMed, MEDLINE and Google Scholar). However, study preferred sources that were
conducted in case-control or cohort studies, which were the settings the sources had to be based on.
Outcome (main findings) Upon conducting a meta-analysis of 5 cohort studies and 5 case-control studies, there was no revealed evidence of a
relationship between vaccination and any subsequent development of autistic spectrum disorder or autism. Moreover,
the study found no relationship between vaccination and thimerosal or mercury.
Table 2. Systematic review
Full reference
Nursing
*Please delete the article that you are not using
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
Search strategy The research was based on a specialized search strategy aimed at identifying relevant studies that were
published in the periods between 1969 and early 2003. This was done under the guidance of an information
specialist who supervised the search in Cochrane, NHS database, MEDLINE, and EMBASE. Furthermore, the
search included a screening of all references accompanied by the retrieval of possible hard copy articles that
could be included in the study. The possible studies were then subjected to inclusion criteria, with an
arbitrator on standby in case a disagreement on the inclusion of a study ensued.
Inclusion/exclusion criteria The study majorly included comparative retrospective or prospective research studies that focused on
healthy individuals of age below 15 years. The included studies also had to be those carried out between

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1969 and 2003, or those that assessed the type and frequency of unintended or adverse subsequent
occurrences after an independent administration of measles, mumps and rubella (MMR) vaccine; given
within a time schedule, with a placebo, or in any dose. Specifically, the comparative studies considered for
inclusion were those that had an index group exposed to MMR compared with another group(s) not exposed
to MMR. Other studies considered for inclusion were cohort studies, case-control studies, ecological studies,
cross-over studies case-only studies and time-series studies. Ultimately, studies that did not meet the
inclusion criteria were excluded.
Issue (what was being studied) The study was triggered by an emerging debate over the safety of MMR vaccine characterized by a drop in
vaccination levels experienced in several countries. This was against the background that the vaccine ‘s
effectiveness had been largely accepted and was endorsed by several state health authorities. Hence, the
study was initiated to conduct an investigation over the availability of any (harmful or beneficial) effects of
MMR based on the findings of previous research. Hence, th study was a systematic literature review on the
effects of MMR vaccine on humans.
Context (study setting) The study was web-based, with online sources of data.
Outcome (main findings) While the study found no adverse effects of the vaccine apart from those associated with its role in
preventing the disease, it was revealed that the vaccine could be associated with low incidences of upper
respiratory tract infection, higher risk of irritability, and joint and limb complaints.
Table 3. Experimental quantitative studies

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Full reference:
Nursing
*Please delete the article that you are not using
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.
Study Design (e.g.: cohort,
RCT,)
The study was a randomised control trial
Population (how many
participants, age, gender,
disease, etc)
The study involved healthy children of age 12-22 months. Each of the 10 European countries had 200 enrolled
participants who were selected through a computer-generated randomized list (the study had no gender specifics).
However, all the enrolled children had to be healthy at the time of vaccination.
Intervention (what was
being implemented)
The intervention involved an administration of two doses (MMRV, MMR+ V)of MMR vaccination and monovalent
Varicella vaccine in a combined vaccination.
Comparison (was the
intervention being
compared to another
strategy, e.g. placebo?)
The intervention compared the effectiveness of protection against varicella with a combined dose of MMR-varicella
vaccine with the effectiveness of a single dose of monovalent varicella vaccine
Outcome (main findings) The study revealed that a combined dose of MMR-varicella vaccine was more effective against varicella in short course
and could ensure that a child is optimally protected from the varicella disease.
Table 4. Qualitative study
Full reference *Please delete the article that you are not using

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Nursing 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.
Study Design (ie: cohort) The study was cross-sectional, where a survey characterized by interview questions was conducted among parents of
young children.
Population (how many
participants, age, gender,
disease, etc)
The study involved the interviewing of 17 parents of children below the age of 5 years. Prior to that, two parents
participated in a pilot interview to enable the refining of questions in preparation for the main study. All in all, the
participants consisted of 16 females one male.
Issue (what was being
studied)
The main aim of the study was to investigate the MMR vaccine scare and how the scare impacted on parents of young
children. Equally, the study aimed at exploring how vaccine scare affected the parent’s need for health-related
information.
Context (study setting) Because the study mainly focused on making a meaning of vaccine scare and its impacts, the participants were studied
in their natural setting.
Outcome (main findings) It was found that vaccine scare led to an increased need for health information by the parents, especially with regards to
making a decision whether to have their children vaccinated or not.

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Question 3 – 800 words
 Discuss the reasons why you think that the studies above would or would not be
helpful in enabling you 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 your argment.
Taylor, L.E., Swerdfeger, A.L. and Eslick, G.D., 2014. Vaccines are not associated with
autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine,
32(29), pp.3623-3629.
This study was launched to investigate any link between vaccination and autism with an aim
of establishing clarity on whether vaccination has any relationship with Autism. It purposed
to summarise evidence from previous cohort and case-control studies through a meta-
analysis. Based on the aims and objectives of Taylor et al (2014), the study could be quite
helpful in informing my discussion with a pregnant woman over immunization. This is
because it summarises several other studies that clarifiy whether a child who undergoes
vaccination can subsequentoy have autism, a clarity that any woman would want to have.
The usefulness of this study as an informant for the discussion also emerges strongly
because it analyses evidence from 10 primary studies (5 cohort studies and 5 case-control
studies) which found no relationship between vaccination and autism, and according to
Taylor et al (2014), is sufficient evidence to demystify any notion of relationship between
vaccination and autism. Hence, the fact that the study addresses a major issue with regards
to vaccination and its effects makes the study a useful tool and piece of evidence upon
which a discussion with a pregnant woman over vaccines and their effects can be held.
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
A major concern among most pregnant women or those with children is whether the MMR
vaccine has any major side effects on children. In fact, according to Jefferson et al (2003),
this worry might have been the contributory factor behind a drop in vaccination rates in
most countries. To directly address this issue, Jefferson et al launched a study aimed at
exploring the subsequent effects (positive or negative) of MMR vaccination on children aged
15 years and below. Hence, this study would be highly helpful, relevant and informative to a
discussion with a pregnant woman over vaccines; not only due to its detailed nature but
also due to its two-sided approach of viewing the effects of vaccination.

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The study would help inform a woman that whereas the MMR does not have any adverse
effects on the child, parents should expect some negative effects that are associated with
the normal functioning of the vaccine to prevent the disease. Hence, a discussion held with
specific reference to this study would prepare a pregnant woman, or a woman with a child,
that most of the effects (joint limb complaints, parotitis, or higher incidence of irritability)
may see in their children after the vaccination are normal side effects that are associated
with how the vaccine works.
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.
This study compared and gave insights on the use of combined vaccination (MMR plus
varicella vaccination) versus the use of single vaccination (varicella vaccine) and their level of
effectiveness. Basically, this study would inform a discussion with a woman who could be
perceiving combined vaccination as an overdose of the child. While Prymula et al note that
most women may not be’ comfortable’ with combined vaccination, they launch a study
which addresses this issue with evidence from a primary research, which they conduct and
end up proving that use of combined vaccination (MMR + Varicella) has more optimum
results and works more effectively.
Hence, using evidence from Prymula et al, it would be easier to convince a woman who may
not be comfortable with combined vaccination, to understand the reason why it is
important to combine some vaccines. Similarly, the study would form a basis upon which
one would argue the reason why some vaccines work better when combined with others
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.
This study would be useful in a discussion about vaccine scare because it would inform me
on the kind of information a woman would need and how to deliver the information in a
manner that demystifies the notion or perception that vaccines are generally bad. I would
use the findings of this study to prepare for the discussion, gaining tips on the kind of
information the woman may want to have while discussing the subject of vaccination.

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References
Taylor, L.E., Swerdfeger, A.L. and Eslick, G.D., 2014. Vaccines are not associated with autism:
an evidence-based meta-analysis of case-control and cohort studies. Vaccine, 32(29),
pp.3623-3629.
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
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.
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.
Smith, M. (2010). Research Methods In Sport. London, Sage Publications.
Bernard, H. R. (2011). Research Methods In Anthropology: Qualitative And Quantitative
Approaches. Lanham, Md, Altamira Press.
Groat, L. N., & Wang, D. (2013). Architectural Research Methods. Chichester, Wiley.