Parents' views about pre-school immunization: an interview study in southern England

Background National Health Service immunization statistics for England indicate that uptake of the first plus second dose of measles, mumps and rubella (MMR) vaccine, and pre-school booster against diphtheria, tetanus, polio and pertussis, is lower than for the primary course alone. This qualitative study aimed to explore parents' views about pre-school immunization and to identify possible reasons for lower pre-school uptake compared with the primary course. Methods Semi-structured interviews were conducted with 21 parents of children aged 2-5 years from 19 family units. The parents were recruited from nine playgroups and pre-schools in three locations in southern England. Data collection and analysis were guided by a modified Grounded Theory approach. Results Although most parents believed pre-school immunization to be important and most intended to immunise, a minority questioned whether it was necessary based on their understanding of the duration of protection provided by the primary course. Compared with primary immunization, parents typically received no information about pre-school doses prior to their invitation to attend and had little or no contact with healthcare professionals. Other barriers included minor illness, apprehension about taking an older child for vaccinations and work or childcare commitments. Conclusions Parents reported uncertainties, anxieties and time constraints, all of which may contribute to poor attendance for pre-school immunization. These findings have important implications for providing parents with timely information about boosters and the two-dose MMR programme. They indicate the potential value of playgroup or pre-school involvement and the need for improved communication with children about immunization.