What are parents' perspectives on psychological empowerment in the MMR vaccination decision? A focus group study - skin care instrument

Instead of mandatory immunization requirements, most developed countries make proposals.
While parents should make an informed, autonomous (I . e. , authorized) decision on their child's vaccination, there is no evidence of how the parent explains this requirement and there is no evidence of their decisionmaking.
The purpose of this study is to obtain insights from parents living in low measlesmumps-
In the decision they have to make to the child's rubella vaccination, the measles (rubella) absorption field about what is the feeling of empowerment.
Qualitative research was designed using focus group interviews.
11 vaccination centers and hospitals have been set up in Trento, Italy.
The fathers of 24 mothers and 4 children who participated in the 6 focus groups are still waiting for the MMR vaccination decision.
Results autonomy and competence are prominent themes related to empowerment and are further related to beliefs about legal responsibility and liberal ethics for decisions, the relationship between parents and pediatricians (trust, determine the feelings of relevance to the associated stress and seek, avoid, or fear of vaccination --
Relevant information.
Ability is interpreted as medical knowledge and information
Seeking skills, but this also has to do with the degree to which parents think a pediatrician is capable.
Conclusion since the parents' interpretation of empowerment is not only about informed and autonomous views, but also varies between different individuals, it is important that, the best practice must properly interpret and implement this structure, for example, by explicitly adopting the concept of an autonomous relationship.
Understanding whether parents want to make a decision on authorization, and what their information and autonomous needs are, can help health professionals adjust their communication about immunization and facilitate parents' informed, autonomous decisions about making
Instead of mandatory immunization requirements, most developed countries are targeted to make proposals.
While parents should make an informed, autonomous (I . e. , authorized) decision on their child's vaccination, there is no evidence of how the parent explains this requirement and there is no evidence of their decisionmaking.
The purpose of this study is to obtain insights from parents living in low measlesmumps-
In the decision they have to make to the child's rubella vaccination, the measles (rubella) absorption field about what is the feeling of empowerment.
Qualitative research was designed using focus group interviews.
11 vaccination centers and hospitals have been set up in Trento, Italy.
The fathers of 24 mothers and 4 children who participated in the 6 focus groups are still waiting for the MMR vaccination decision.
Results autonomy and competence are prominent themes related to empowerment and are further related to beliefs about legal responsibility and liberal ethics for decisions, the relationship between parents and pediatricians (trust, determine the feelings of relevance to the associated stress and seek, avoid, or fear of vaccination --
Relevant information.
Ability is interpreted as medical knowledge and information
Seeking skills, but this also has to do with the degree to which parents think a pediatrician is capable.
Conclusion since the parents' interpretation of empowerment is not only about informed and autonomous views, but also varies between different individuals, it is important that, the best practice must properly interpret and implement this structure, for example, by explicitly adopting the concept of an autonomous relationship.
Understanding whether parents want to make a decision on authorization, and what their information and autonomous needs are, can help health professionals adjust their communication about immunization and facilitate parents' informed, autonomous decisions about making
Patient Empowerment and patient appeal-
Central care, which is prevalent in almost all healthy settings, also involves parents as decision makers representing their children.
In terms of immunization, the prominent principles of preserving and promoting individual autonomous choice and action have been translated into the principles of protecting and promoting the ability of parents to make and take free, informed decisions, from "capable and unaffected thinking ".
With increasing ethical attention to vaccination decisions, the current vaccination programme in most developed countries now calls on parents to be willing to make deliberate, informed and autonomous decisions.
For practical purposes, this was transferred to the widespread use of informed consent to disclose the risks and benefits of immunization 2 and to develop or maintain a policy for vaccinationcompulsory.
Therefore, public health authorities in 3, 4 implicitly interpret empowerment as a morally reasonable process after the recognition of official advice, resulting in a decision that is both uncontrolled and not legally authorized.
However, in addition to the mere use of informed consent and non-informed consent, there is little concern about how to effectively recognize, maintain and promote empowerment in vaccination decisions
Compulsory immunity.
1 How parents explain and to what extent they adopt the requirements they make when choosing whether to vaccinate their children is just a small exploration.
5 In addition, while several predictors are known, six predictors, such as risk perception, 7-11 beliefs and attitudes, 12-16 security issues, 17-19 Trust 10 26. to date, parents' views on empowering them in vaccination decisions have been almost completely ignored, as they may be drivers of vaccination behavior, although previous work has shown the relevance of empowerment --
Related dimensions such as self
Self-efficacy
The determination of this healthy decision.
5 Psychological empowerment although considered to be a key factor in the current transition to patients
Focusing on health care, there is little agreement on what is psychological empowerment.
27. in more than 1980 years, empowerment has received increasing attention in the field of health.
Zimmerman28 proposes the definition of psychological empowerment, a structure consisting of three interrelated structures
Relevant dimensions: (1) introspection dimension consisting of cognitive assessment of control, ability, motivation and selfesteem;
(2) an interactive dimension consisting of key skills and knowledge;
And (3) behavioral dimensions that reflect participation and change --
Targeted behavior in formal and informal environments and organizations.
On the other hand, Spitzer, 29 and 30, believes that psychological empowerment is the internal motivational structure of an individual and divides Zimmerman's concept of self-empowerment into four dimensions or cognition: (1) meaning (the extent to which what a person does is considered important), (2) ability (the perceived ability of a person to perform an action), (3) influence (perception of making a change through some action) and (4) self
Determination (the degree to which what we do is considered autonomous ).
In terms of health, it is found that empowerment is related to positive health outcomes, with 31 more positive decisions --
Improve knowledge and self-improvement
Be more satisfied with your decision.
The goal of studying psychological empowerment may vary greatly depending on the individual and the environment and fluctuate over time.
Therefore, one definition and metric cannot be summarized into multiple settings.
36 The purpose of this study was to explore parents' views on empowerment in the context of measlesmumps-
The German measles (rubella) vaccination decision within the low MMR coverage, based on similar previous work 5 and based on a set of four subdimensions proposed by Spreitzer, the meaning of 30 (month) means the extent to which the individual believes that making a vaccination decision on his or her child is an important issue;
(2) ability, which refers to the degree to which the individual believes that a reasonable vaccination decision can be made;
(3) impact, the extent to which the individual believes that a decision on vaccination will result in some results; (4) self-
Refers to the extent to which individuals believe that their vaccination decisions are not affected by control.
To this end, we decided to conduct a qualitative focus group to maximize the discussion of parents, because we believe that the decision to vaccinate is based on an experience built by a society interacting with others. Decision 37-
The production process of this study focuses on the context of the MMR vaccination decision, as this vaccination has many unique features compared to other child vaccinations.
MMR is not only at the center of the autism debate, but because it is made from a live virus reduction, parents may think that vaccination is the closest thing to natural infection.
39. In addition, MMR coverage is declining in some developed countries, and delaying vaccination may have serious consequences for future outbreaks.
40 psychological empowerment although considered a key factor in the current transition to patients
Focusing on health care, there is little agreement on what is psychological empowerment.
27. in more than 1980 years, empowerment has received increasing attention in the field of health.
Zimmerman28 proposes the definition of psychological empowerment, a structure consisting of three interrelated structures
Relevant dimensions: (1) introspection dimension consisting of cognitive assessment of control, ability, motivation and selfesteem;
(2) an interactive dimension consisting of key skills and knowledge;
And (3) behavioral dimensions that reflect participation and change --
Targeted behavior in formal and informal environments and organizations.
On the other hand, Spitzer, 29 and 30, believes that psychological empowerment is the internal motivational structure of an individual and divides Zimmerman's concept of self-empowerment into four dimensions or cognition: (1) meaning (the extent to which what a person does is considered important), (2) ability (the perceived ability of a person to perform an action), (3) influence (perception of making a change through some action) and (4) self
Determination (the degree to which what we do is considered autonomous ).
In terms of health, it is found that empowerment is related to positive health outcomes, with 31 more positive decisions --
Improve knowledge and self-improvement
Be more satisfied with your decision.
The goal of studying psychological empowerment may vary greatly depending on the individual and the environment and fluctuate over time.
Therefore, one definition and metric cannot be summarized into multiple settings.
36 The purpose of this study was to explore parents' views on empowerment in the context of measlesmumps-
The German measles (rubella) vaccination decision within the low MMR coverage, based on similar previous work 5 and based on a set of four subdimensions proposed by Spreitzer, the meaning of 30 (month) means the extent to which the individual believes that making a vaccination decision on his or her child is an important issue;
(2) ability, which refers to the degree to which the individual believes that a reasonable vaccination decision can be made;
(3) impact, the extent to which the individual believes that a decision on vaccination will result in some results; (4) self-
Refers to the extent to which individuals believe that their vaccination decisions are not affected by control.
To this end, we decided to conduct a qualitative focus group to maximize the discussion of parents, because we believe that the decision to vaccinate is based on an experience built by a society interacting with others. Decision 37-
The production process of this study focuses on the context of the MMR vaccination decision, as this vaccination has many unique features compared to other child vaccinations.
MMR is not only at the center of the autism debate, but because it is made from a live virus reduction, parents may think that vaccination is the closest thing to natural infection.
39. In addition, MMR coverage is declining in some developed countries, and delaying vaccination may have serious consequences for future outbreaks.
The 40 method recruited us to recruit our focus group participants through 11 vaccination centers in Trento province, Italy.
MMR coverage in this region is 84.
21% despite the 95% threshold required to achieve group immunization, 41 made it one of the seven regions in Italy, where more than 15% of children were not vaccinated with the first dose of MMR before the age of 2.
To be included in this study, parents must have at least one child under the age of 1, or the MBR vaccination decision has not yet been made and lives in Italy.
Italy's MMR vaccination schedule envisages two doses taken at 12-15 months and 5-6 years of age, respectively.
42 in Trento province, public health and vaccination centers in each of the 11 places divided by the province are vaccinated against children.
Parents are invited to participate in vaccination by written letter; in case of no-
For the scheduled program, parents send two invitation letters.
Vaccination is usually carried out by trained nurses and health professionals who are under the supervision of preventive medicine doctors at the vaccination center.
When the nurse made an appointment for the first or second time for the parents to vaccinate Baibai, baibai (DTaP) vaccine, they sent them an invitation to participate in the study, which was given at the age of 3 and 5 months, respectively.
In Italy, the Baibai break vaccine is mandatory (parents may be fined for refusing to vaccinate their children ).
The objectives of the study, the interview process and the secrecy guarantee are stated in the invitation.
Parents fill out the invitation letter together with the contact information and return it in a box in the waiting room.
We collected invitations and contacted each participant by phone or email to arrange a focus group meeting.
The data collection focus group was held on May 2015 at a private venue within the local health authority building.
Each focus group lasts for 1 hour with 1/2 hosts and a recorder present.
In order to facilitate the discussion, participants sat around.
Prior to starting the interview, we obtained the consent of the participants and informed them of the scope of the study, duration, right to withdraw from the study at any time, and the rewards given to them at the end of the focus group.
After the interview, we asked parents to fill out a short survey asking about vaccination knowledge 43 and social demographic variables (birth, age, education, number of children and age) related to both parents) and gave them a skincare and debriefing letter for their children.
The research team has developed a semi-structured list of questions based on the psychological empowerment literature, designed to investigate the meaning and interpretation of the authorization-related parents in the MMR vaccination decision, spireze's empowerment model and Pre-Health-
Relevant authorization ranges 8, 9 (see Appendix 1 for online supplement ).
The problem is open.
To understand the decision of the parents, it's over.
Process and their experiences and feelings.
We keep the grid as flexible as possible to allow freedom
Smooth discussion
Supplementary Appendix [bmjopen-2015-010773supp.
We use a digital recorder to record every interview and record it word for word.
When we decided that the additional interview would not produce new data, but only confirm the data that has been found, we reached data saturation in the six focus groups.
44 data analysis guarantees the quality of the findings and generates as many insights as possible, which will be merged or further distinguished at a later stage, with two coders (MF and EG) independently analyze the topic of the report card.
We follow the following stages: we initially read the transcript several times to get familiar with the content, manually line the meaningful quotation marks and gradually group them under some labels, organize all labels in layers and create links between them to guide them to a wider range of topics.
The verification results compare the two programmers in-
Between each of the above stages, in order to continuously discuss the preliminary topics, tags and citations, and to address the issue of inconsistent interpretation through dialogue and constant reference to transcripts.
Then, all the topics are compared with the authorization conceptualisation of spirece, which is divided into four dimensions 29 and 30 to check the correspondence.
The transcription and analysis of the interviews were conducted in the original language (Italian.
Recruited us to recruit our focus group participants through 11 vaccination centers in trentos, Italy.
MMR coverage in this region is 84.
21% despite the 95% threshold required to achieve group immunization, 41 made it one of the seven regions in Italy, where more than 15% of children were not vaccinated with the first dose of MMR before the age of 2.
To be included in this study, parents must have at least one child under the age of 1, or the MBR vaccination decision has not yet been made and lives in Italy.
Italy's MMR vaccination schedule envisages two doses taken at 12-15 months and 5-6 years of age, respectively.
42 in Trento province, public health and vaccination centers in each of the 11 places divided by the province are vaccinated against children.
Parents are invited to participate in vaccination by written letter; in case of no-
For the scheduled program, parents send two invitation letters.
Vaccination is usually carried out by trained nurses and health professionals who are under the supervision of preventive medicine doctors at the vaccination center.
When the nurse made an appointment for the first or second time for the parents to vaccinate Baibai, baibai (DTaP) vaccine, they sent them an invitation to participate in the study, which was given at the age of 3 and 5 months, respectively.
In Italy, the Baibai break vaccine is mandatory (parents may be fined for refusing to vaccinate their children ).
The objectives of the study, the interview process and the secrecy guarantee are stated in the invitation.
Parents fill out the invitation letter together with the contact information and return it in a box in the waiting room.
We collected invitations and contacted each participant by phone or email to arrange a focus group meeting.
The data collection focus group was held on May 2015 at a private venue within the local health authority building.
Each focus group lasts for 1 hour with 1/2 hosts and a recorder present.
In order to facilitate the discussion, participants sat around.
Prior to starting the interview, we obtained the consent of the participants and informed them of the scope of the study, duration, right to withdraw from the study at any time, and the rewards given to them at the end of the focus group.
After the interview, we asked parents to fill out a short survey asking about vaccination knowledge 43 and social demographic variables (birth, age, education, number of children and age) related to both parents) and gave them a skincare and debriefing letter for their children.
The research team has developed a semi-structured list of questions based on the psychological empowerment literature, designed to investigate the meaning and interpretation of the authorization-related parents in the MMR vaccination decision, spireze's empowerment model and Pre-Health-
Relevant authorization ranges 8, 9 (see Appendix 1 for online supplement ).
The problem is open.
To understand the decision of the parents, it's over.
Process and their experiences and feelings.
We keep the grid as flexible as possible to allow freedom
Smooth discussion
Supplementary Appendix [bmjopen-2015-010773supp.
We use a digital recorder to record every interview and record it word for word.
When we decided that the additional interview would not produce new data, but only confirm the data that has been found, we reached data saturation in the six focus groups.
44 data analysis guarantees the quality of the findings and generates as many insights as possible, which will be merged or further distinguished at a later stage, with two coders (MF and EG) independently analyze the topic of the report card.
We follow the following stages: we initially read the transcript several times to get familiar with the content, manually line the meaningful quotation marks and gradually group them under some labels, organize all labels in layers and create links between them to guide them to a wider range of topics.
The verification results compare the two programmers in-
Between each of the above stages, in order to continuously discuss the preliminary topics, tags and citations, and to address the issue of inconsistent interpretation through dialogue and constant reference to transcripts.
Then, all the topics are compared with the authorization conceptualisation of spirece, which is divided into four dimensions 29 and 30 to check the correspondence.
The transcription and analysis of the interviews were conducted in the original language (Italian.
The features of the results sample we sent out 1000 invitations to 11 vaccination centers and distributed the quantity according to their size.
Of the total number of invitations sent, we received 128 complete invitation forms with details of the participants.
The nurse of the vaccination center conducts qualification examination for the recruited parents;
Therefore, the invitation form is only given to eligible participants.
We reached out to all 128 parents, of whom 67 could attend the focus group.
Finally, there were 28 parents attending the 6 focus groups (58% drop-out rate), each of which included 4 to 6 participants.
A paper was filled out by all participantsand-
Pencil survey on vaccination knowledge and social population variables.
The majority of participants were mothers (86%) and Italian nationality (82% ).
High share of non
Italian (to 8.
3% immigrants living in Italy), 46 ensures the diversity of origin in our sample.
The average age is 36. 5u2005years (SD=5. 5;
Scope = 28-48), while in terms of education, about half of the sample completed university education (46%) and about half completed secondary education (46%) only two participants often went to a professional school or did not continue to study after the compulsory school.
Most parents (64%) have more than one child, which means that they have made an MMR vaccination decision for at least one older child.
The average knowledge of vaccination was 6. 15 (SD=2. 06;
Range = 0-9) where 9 is the highest possible score.
An overview of participant features is shown in Table 1.
View this table: View inline View pop-up table 1 features of authorized participants in general, parents hold different views on the authorization of an MMR vaccination decision, most participants confirm, their view applies to all pediatric vaccinations, not limited to MMR vaccinations.
When asked why they were involved, most parents said they wanted to find answers to questions about vaccination for children to understand why some parents did not want it, discuss the topic with other parents and get to know what they think as they consider providing information and helping to study citizenship obligations.
The majority of participants felt that vaccination was a public interest and therefore worth discussing and meeting.
In general, about one
Parents in the first quarter reported that due to safety issues, uncertainty, and low perceived capacity, they felt uncomfortable making an MMR vaccination decision, while most reported that they had chosen for themselves
Autonomy is related to ability, which is interpreted as medical knowledge and information --
Seeking skills, but this also has to do with the degree to which parents think pediatricians are capable and the quality of their relationship with pediatricians.
Parents have different beliefs about legal liability (in the case of vaccination, it is possible to take responsibility --
Related or disease
Related adverse events) and freedom of decision, relevance of decision and different feelings of related stress, and different directions of vaccination --
Relevant information.
Ability is the key to autonomy most participants report that it is critical to feel autonomous in the MMR vaccination decision-making to have sufficient capacity.
Competence is interpreted as medical knowledge and a set of skills related to discovery, objective assessment and final understanding of vaccination
Relevant information: [autonomy means] collect information so as not to be affected by other mothers.
I got the information in my prenatal class, where there was a pediatrician.
Then I asked my own pediatrician.
Then the people from the vaccination center came in.
In this sense, I recorded my autonomy.
(Mother, 32, Italian) you will see different websites, different forums and different arguments.
What really needs to be seen.
[. . . ] Then you have to be objective, you have to get out of this thing and say, try to analyze what you just read. Rationally.
(28-year-old mother, Italian) However, few participants stressed that it is impossible to be fully autonomous because parents will never have the proper skills to make their own decisions, but will always need to rely on medical professionals.
I think it is impossible for us, as parents, to be independent if we are not doctors.
We cannot make such a decision.
It's better to rely on someone who does this as a job who can explain to you the pros and cons, the reasons . . . . . . Then you, as a parent, can make your own decisions, but not based on scientific methods, but on your own personal decisions.
(Mother, 48, Italian) most parents report that they feel capable and therefore autonomous when they can also get vaccinations --
Relevant information and guidance from experts they can trust, such as children's pediatricians.
[I feel capable]. . . When I negotiate with someone capable that I can trust.
(Mother, 31, Italian) [feel autonomous] I am totally dependent on a pediatrician.
She was also someone who cared about me before I was 14, so I really trusted her.
If I notice that she is calm, I will also become calm.
In this case, about half of the participants reported that if they thought they had an affinity for opinion, they tended to decide on the advice of the pediatrician.
I'm afraid I'll choose to get closer to my point of view because the last person already has an opinion . . . . . . I think I will . . . . . . I can't be completely objective because if this idea, you end up feeling the most attractive thing to you to be completely consistent with someone
(Mother, 38, Italian) parents also list some of the features that an ideal pediatrician should have, which are considered competent and trustworthy, and established a good relationship of interest and focus.
Few participants complained about the lack of these skills by their pediatrician and as a result they had a poor relationship with them.
When he took the time to give it to me, when I understood that he was listening to me and answering my request.
(Italy, 30 years old, mother) when asked about their interpretation of autonomy in the MMR vaccination decision, autonomy is legal responsibility and freedom, most participants reported, free selection of a child's immunization is equivalent to being asked to take responsibility for any potential positive or negative consequences that a vaccination or non-vaccination may have
Parents had different views on the subject and most reported that they felt that they were appointed as a role that did not belong to them.
These participants felt that making a final decision on vaccination was a matter of legal responsibility and that parents should not take that responsibility because they lacked the medical skills needed to make an informed decision.
Again, they mentioned that competence is critical to autonomy and they reported that their medical understanding was not sufficient to make autonomous, responsible choices.
Autonomy means responsibility to me, you don't always know the situation or be prepared like a doctor, so . . . . . . Well, you're free to choose whether or not, . . . . . . I am not always able to adapt to this situation.
(Mother, 38 years old, Italian) only a small number of participants reported that they were willing to take full responsibility for the decision even if the vaccination or disease had negative consequences.
You can't blame yourself for everything, but you have to take your responsibility.
(Mother, 40, Italian) almost all parents report that autonomy is a question of freedom in vaccination decisions.
Parents have the opposite view on the subject, and half of them believe that autonomy is a dangerous right that parents should not have.
This group of participants included those who were unwilling to take legal responsibility for the MRR vaccination decision.
I don't think this kind of autonomy is fair.
I have noticed that vaccination can easily prevent several diseases transmitted in schools.
These should be mandatory in my opinion.
After all, I can't decide for myself.
(31-year-old mother, Italian) The other half of the parents, while emphasizing the moral aspect of freedom in vaccination decisions, reported that all parents were free to decide on their child's MMR vaccination, this is morally important.
In my opinion, the free choice of anything is fair.
It is reasonable for me that anything is no longer mandatory.
However, if this free choice means that 60 to 70 of the 100 children are vaccinated and 30 are not, then we should re-vaccinate
Assessment.
(Mother, 48 years old, Italy) information orientation most parents report that self-vaccination in MMR vaccination is an issue of actively searching for information and would like information from pediatricians or health authorities, or simply avoid any information.
Half of the participants called themselves active information seekers, who tried to consult as many sources as possible and indicated that information was sought by their parents themselves.
If a person wants information, he or she should go out and look for it.
(Mother, 46 years old, Italy) about 25 participants, rather they expect the health authorities, medical professionals and vaccination centers provide them with convenient and easily accessible information before making an appointment for vaccinations, saying parents should not be looking for vaccinations --
Relevant information.
Information is first provided by a pediatrician.
They take it for granted that we know everything, but that's not always the case.
(30-year-old mother, non-EU) in this case, about 25 participants reported concerns about finding information (possible side effects of MMR vaccination, including autism) the lack of medical knowledge makes it impossible for them to find information about vaccinations and leads them to avoid information provided by other parents.
I tend to stay away from the website because you have seen all kinds of things.
It happened to me once and then I started to worry, started doing it and felt a lot worse than before so I didn't even look at it!
(42 years old, Italian mother) the relevance of the decision and the associated stress on the majority of participants, confidence in the MMR vaccination decision --
Decision-making is related to the relative importance of this decision.
Almost all parents report that the decision to vaccinate is what you just made and that it is not one of the priorities and does not cause stress.
This is the last one for me.
Part of the reason is that I have health problems . . . . . . And then because that's the decision I 've made, in the sense that I know I have to do that, it's not a tough decision.
(30-year-old mother, other EU countries) a small number of people report that making a decision is one of the most important decisions because it becomes a stressful task that consumes time and energy, and create tension among the couple.
These parents are also reported to have a poor relationship with their children's pediatricians.
Deciding that the MMR is really a tense moment between me and my husband . . . . . . I remember.
It's not like deciding whether to breastfeed or not.
This is my decision.
We did go through a period of tension.
(Mother, 38 years old, Italy) sampleWe features 1000 invitations to 11 vaccination centers, distributed by quantity.
Of the total number of invitations sent, we received 128 complete invitation forms with details of the participants.
The nurse of the vaccination center conducts qualification examination for the recruited parents;
Therefore, the invitation form is only given to eligible participants.
We reached out to all 128 parents, of whom 67 could attend the focus group.
Finally, there were 28 parents attending the 6 focus groups (58% drop-out rate), each of which included 4 to 6 participants.
A paper was filled out by all participantsand-
Pencil survey on vaccination knowledge and social population variables.
The majority of participants were mothers (86%) and Italian nationality (82% ).
High share of non
Italian (to 8.
3% immigrants living in Italy), 46 ensures the diversity of origin in our sample.
The average age is 36. 5u2005years (SD=5. 5;
Scope = 28-48), while in terms of education, about half of the sample completed university education (46%) and about half completed secondary education (46%) only two participants often went to a professional school or did not continue to study after the compulsory school.
Most parents (64%) have more than one child, which means that they have made an MMR vaccination decision for at least one older child.
The average knowledge of vaccination was 6. 15 (SD=2. 06;
Range = 0-9) where 9 is the highest possible score.
An overview of participant features is shown in Table 1.
View this table: View inline View pop-up table 1 features of authorized participants in general, parents hold different views on the authorization of an MMR vaccination decision, most participants confirm, their view applies to all pediatric vaccinations, not limited to MMR vaccinations.
When asked why they were involved, most parents said they wanted to find answers to questions about vaccination for children to understand why some parents did not want it, discuss the topic with other parents and get to know what they think as they consider providing information and helping to study citizenship obligations.
The majority of participants felt that vaccination was a public interest and therefore worth discussing and meeting.
In general, about one
Parents in the first quarter reported that due to safety issues, uncertainty, and low perceived capacity, they felt uncomfortable making an MMR vaccination decision, while most reported that they had chosen for themselves
Autonomy is related to ability, which is interpreted as medical knowledge and information --
Seeking skills, but this also has to do with the degree to which parents think pediatricians are capable and the quality of their relationship with pediatricians.
Parents have different beliefs about legal liability (in the case of vaccination, it is possible to take responsibility --
Related or disease
Related adverse events) and freedom of decision, relevance of decision and different feelings of related stress, and different directions of vaccination --
Relevant information.
Ability is the key to autonomy most participants report that it is critical to feel autonomous in the MMR vaccination decision-making to have sufficient capacity.
Competence is interpreted as medical knowledge and a set of skills related to discovery, objective assessment and final understanding of vaccination
Relevant information: [autonomy means] collect information so as not to be affected by other mothers.
I got the information in my prenatal class, where there was a pediatrician.
Then I asked my own pediatrician.
Then the people from the vaccination center came in.
In this sense, I recorded my autonomy.
(Mother, 32, Italian) you will see different websites, different forums and different arguments.
What really needs to be seen.
[. . . ] Then you have to be objective, you have to get out of this thing and say, try to analyze what you just read. Rationally.
(28-year-old mother, Italian) However, few participants stressed that it is impossible to be fully autonomous because parents will never have the proper skills to make their own decisions, but will always need to rely on medical professionals.
I think it is impossible for us, as parents, to be independent if we are not doctors.
We cannot make such a decision.
It's better to rely on someone who does this as a job who can explain to you the pros and cons, the reasons . . . . . . Then you, as a parent, can make your own decisions, but not based on scientific methods, but on your own personal decisions.
(Mother, 48, Italian) most parents report that they feel capable and therefore autonomous when they can also get vaccinations --
Relevant information and guidance from experts they can trust, such as children's pediatricians.
[I feel capable]. . . When I negotiate with someone capable that I can trust.
(Mother, 31, Italian) [feel autonomous] I am totally dependent on a pediatrician.
She was also someone who cared about me before I was 14, so I really trusted her.
If I notice that she is calm, I will also become calm.
In this case, about half of the participants reported that if they thought they had an affinity for opinion, they tended to decide on the advice of the pediatrician.
I'm afraid I'll choose to get closer to my point of view because the last person already has an opinion . . . . . . I think I will . . . . . . I can't be completely objective because if this idea, you end up feeling the most attractive thing to you to be completely consistent with someone
(Mother, 38, Italian) parents also list some of the features that an ideal pediatrician should have, which are considered competent and trustworthy, and established a good relationship of interest and focus.
Few participants complained about the lack of these skills by their pediatrician and as a result they had a poor relationship with them.
When he took the time to give it to me, when I understood that he was listening to me and answering my request.
(Italy, 30 years old, mother) when asked about their interpretation of autonomy in the MMR vaccination decision, autonomy is legal responsibility and freedom, most participants reported, free selection of a child's immunization is equivalent to being asked to take responsibility for any potential positive or negative consequences that a vaccination or non-vaccination may have
Parents had different views on the subject and most reported that they felt that they were appointed as a role that did not belong to them.
These participants felt that making a final decision on vaccination was a matter of legal responsibility and that parents should not take that responsibility because they lacked the medical skills needed to make an informed decision.
Again, they mentioned that competence is critical to autonomy and they reported that their medical understanding was not sufficient to make autonomous, responsible choices.
Autonomy means responsibility to me, you don't always know the situation or be prepared like a doctor, so . . . . . . Well, you're free to choose whether or not, . . . . . . I am not always able to adapt to this situation.
(Mother, 38 years old, Italian) only a small number of participants reported that they were willing to take full responsibility for the decision even if the vaccination or disease had negative consequences.
You can't blame yourself for everything, but you have to take your responsibility.
(Mother, 40, Italian) almost all parents report that autonomy is a question of freedom in vaccination decisions.
Parents have the opposite view on the subject, and half of them believe that autonomy is a dangerous right that parents should not have.
This group of participants included those who were unwilling to take legal responsibility for the MRR vaccination decision.
I don't think this kind of autonomy is fair.
I have noticed that vaccination can easily prevent several diseases transmitted in schools.
These should be mandatory in my opinion.
After all, I can't decide for myself.
(31-year-old mother, Italian) The other half of the parents, while emphasizing the moral aspect of freedom in vaccination decisions, reported that all parents were free to decide on their child's MMR vaccination, this is morally important.
In my opinion, the free choice of anything is fair.
It is reasonable for me that anything is no longer mandatory.
However, if this free choice means that 60 to 70 of the 100 children are vaccinated and 30 are not, then we should re-vaccinate
Assessment.
(Mother, 48 years old, Italy) information orientation most parents report that self-vaccination in MMR vaccination is an issue of actively searching for information and would like information from pediatricians or health authorities, or simply avoid any information.
Half of the participants called themselves active information seekers, who tried to consult as many sources as possible and indicated that information was sought by their parents themselves.
If a person wants information, he or she should go out and look for it.
(Mother, 46 years old, Italy) about 25 participants, rather they expect the health authorities, medical professionals and vaccination centers provide them with convenient and easily accessible information before making an appointment for vaccinations, saying parents should not be looking for vaccinations --
Relevant information.
Information is first provided by a pediatrician.
They take it for granted that we know everything, but that's not always the case.
(30-year-old mother, non-EU) in this case, about 25 participants reported concerns about finding information (possible side effects of MMR vaccination, including autism) the lack of medical knowledge makes it impossible for them to find information about vaccinations and leads them to avoid information provided by other parents.
I tend to stay away from the website because you have seen all kinds of things.
It happened to me once and then I started to worry, started doing it and felt a lot worse than before so I didn't even look at it!
(42 years old, Italian mother) the relevance of the decision and the associated stress on the majority of participants, confidence in the MMR vaccination decision --
Decision-making is related to the relative importance of this decision.
Almost all parents report that the decision to vaccinate is what you just made and that it is not one of the priorities and does not cause stress.
This is the last one for me.
Part of the reason is that I have health problems . . . . . . And then because that's the decision I 've made, in the sense that I know I have to do that, it's not a tough decision.
(30-year-old mother, other EU countries) a small number of people report that making a decision is one of the most important decisions because it becomes a stressful task that consumes time and energy, and create tension among the couple.
These parents are also reported to have a poor relationship with their children's pediatricians.
Deciding that the MMR is really a tense moment between me and my husband . . . . . . I remember.
It's not like deciding whether to breastfeed or not.
This is my decision.
We did go through a period of tension.
(Mother, 38, Italy) ability is the key to autonomy. Most participants reported that having enough capacity is critical to feel autonomous in the MMR vaccination decision.
Competence is interpreted as medical knowledge and a set of skills related to discovery, objective assessment and final understanding of vaccination
Relevant information: [autonomy means] collect information so as not to be affected by other mothers.
I got the information in my prenatal class, where there was a pediatrician.
Then I asked my own pediatrician.
Then the people from the vaccination center came in.
In this sense, I recorded my autonomy.
(Mother, 32, Italian) you will see different websites, different forums and different arguments.
What really needs to be seen.
[. . . ] Then you have to be objective, you have to get out of this thing and say, try to analyze what you just read. Rationally.
(28-year-old mother, Italian) However, few participants stressed that it is impossible to be fully autonomous because parents will never have the proper skills to make their own decisions, but will always need to rely on medical professionals.
I think it is impossible for us, as parents, to be independent if we are not doctors.
We cannot make such a decision.
It's better to rely on someone who does this as a job who can explain to you the pros and cons, the reasons . . . . . . Then you, as a parent, can make your own decisions, but not based on scientific methods, but on your own personal decisions.
(Mother, 48, Italian) most parents report that they feel capable and therefore autonomous when they can also get vaccinations --
Relevant information and guidance from experts they can trust, such as children's pediatricians.
[I feel capable]. . . When I negotiate with someone capable that I can trust.
(Mother, 31, Italian) [feel autonomous] I am totally dependent on a pediatrician.
She was also someone who cared about me before I was 14, so I really trusted her.
If I notice that she is calm, I will also become calm.
In this case, about half of the participants reported that if they thought they had an affinity for opinion, they tended to decide on the advice of the pediatrician.
I'm afraid I'll choose to get closer to my point of view because the last person already has an opinion . . . . . . I think I will . . . . . . I can't be completely objective because if this idea, you end up feeling the most attractive thing to you to be completely consistent with someone
(Mother, 38, Italian) parents also list some of the features that an ideal pediatrician should have, which are considered competent and trustworthy, and established a good relationship of interest and focus.
Few participants complained about the lack of these skills by their pediatrician and as a result they had a poor relationship with them.
When he took the time to give it to me, when I understood that he was listening to me and answering my request.
(Italy, 30 years old, mother) when asked about their interpretation of autonomy in the MMR vaccination decision, autonomy is legal responsibility and freedom, most participants reported, free selection of a child's immunization is equivalent to being asked to take responsibility for any potential positive or negative consequences that a vaccination or non-vaccination may have
Parents had different views on the subject and most reported that they felt that they were appointed as a role that did not belong to them.
These participants felt that making a final decision on vaccination was a matter of legal responsibility and that parents should not take that responsibility because they lacked the medical skills needed to make an informed decision.
Again, they mentioned that competence is critical to autonomy and they reported that their medical understanding was not sufficient to make autonomous, responsible choices.
Autonomy means responsibility to me, you don't always know the situation or be prepared like a doctor, so . . . . . . Well, you're free to choose whether or not, . . . . . . I am not always able to adapt to this situation.
(Mother, 38 years old, Italian) only a small number of participants reported that they were willing to take full responsibility for the decision even if the vaccination or disease had negative consequences.
You can't blame yourself for everything, but you have to take your responsibility.
(Mother, 40, Italian) almost all parents report that autonomy is a question of freedom in vaccination decisions.
Parents have the opposite view on the subject, and half of them believe that autonomy is a dangerous right that parents should not have.
This group of participants included those who were unwilling to take legal responsibility for the MRR vaccination decision.
I don't think this kind of autonomy is fair.
I have noticed that vaccination can easily prevent several diseases transmitted in schools.
These should be mandatory in my opinion.
After all, I can't decide for myself.
(31-year-old mother, Italian) The other half of the parents, while emphasizing the moral aspect of freedom in vaccination decisions, reported that all parents were free to decide on their child's MMR vaccination, this is morally important.
In my opinion, the free choice of anything is fair.
It is reasonable for me that anything is no longer mandatory.
However, if this free choice means that 60 to 70 of the 100 children are vaccinated and 30 are not, then we should re-vaccinate
Assessment.
(Mother, 48 years old, Italy) information orientation most parents report that self-vaccination in MMR vaccination is an issue of actively searching for information and would like information from pediatricians or health authorities, or simply avoid any information.
Half of the participants called themselves active information seekers, who tried to consult as many sources as possible and indicated that information was sought by their parents themselves.
If a person wants information, he or she should go out and look for it.
(Mother, 46 years old, Italy) about 25 participants, rather they expect the health authorities, medical professionals and vaccination centers provide them with convenient and easily accessible information before making an appointment for vaccinations, saying parents should not be looking for vaccinations --
Relevant information.
Information is first provided by a pediatrician.
They take it for granted that we know everything, but that's not always the case.
(30-year-old mother, non-EU) in this case, about 25 participants reported concerns about finding information (possible side effects of MMR vaccination, including autism) the lack of medical knowledge makes it impossible for them to find information about vaccinations and leads them to avoid information provided by other parents.
I tend to stay away from the website because you have seen all kinds of things.
It happened to me once and then I started to worry, started doing it and felt a lot worse than before so I didn't even look at it!
(42 years old, Italian mother) the relevance of the decision and the associated stress on the majority of participants, confidence in the MMR vaccination decision --
Decision-making is related to the relative importance of this decision.
Almost all parents report that the decision to vaccinate is what you just made and that it is not one of the priorities and does not cause stress.
This is the last one for me.
Part of the reason is that I have health problems . . . . . . And then because that's the decision I 've made, in the sense that I know I have to do that, it's not a tough decision.
(30-year-old mother, other EU countries) a small number of people report that making a decision is one of the most important decisions because it becomes a stressful task that consumes time and energy, and create tension among the couple.
These parents are also reported to have a poor relationship with their children's pediatricians.
Deciding that the MMR is really a tense moment between me and my husband . . . . . . I remember.
It's not like deciding whether to breastfeed or not.
This is my decision.
We did go through a period of tension.
(Mother, 38 years old, Italy) The discussion mainly found that the purpose of this focus group study was to explore the psychological empowerment structure in MMR vaccination decision-making in parent samples living in low MMR coverage areas in Italy.
The problem of autonomy and ability has largely dominated our results, and seems to be a cross-border in the strict sense. related.
Autonomy interpreted as responsibility and freedom seems to depend to a large extent on the ability of parents, which in turn depends on their relationship with child health care providers, the relevance of investment in decision-making and their information
Seeking behavior.
First, most participants report that they feel empowered and autonomous not only when they have the right knowledge and information --
Seek skills but can also rely on competent and trustworthy pediatricians.
Other studies have found that trust in pediatricians may be a relatively important factor affecting parents' vaccination decision47-49, considering that, according to the Italian system, children are vaccinated by nurses at the vaccination center rather than by their pediatricians, and it should be further explored whether trust in vaccine providers can also make up for what parents believe is inadequate.
Few parents say they prefer to hear from a pediatrician with similar vaccination advice.
These findings confirm a large number of literature on the importance of child providers to parental vaccination decision50-54 and the trend that many parents have to choose a provider similar to their vaccine beliefs.
55 The result is also in line with the theory of relationship autonomy or serious autonomy, which assumes that our sense of autonomy depends on the influence of others on our lives.
56 The theory emphasizes that "social interaction can affect autonomy not only by affecting individual health --
Related preferences and choices also include their self
Identity of self
Evaluation and autonomy ".
56 our findings suggest that parents may report that they will never be able to make decisions on their own because their health care providers always know more than they do.
However, they can follow the pediatrician's advice at the same time, but in any case they claim that the decision is their own, as it is directed by a credible source in which they are well-connected.
1 Other studies have also confirmed this theory, and 57 studies have found that when this is a decision recommended by a trusted medical professional, the patient feels that he has "owned" his own decision.
Therefore, feeling empowered does not necessarily mean that parents will always make their own decisions.
Ability to negotiate the extent to which a person is involved in decision-makingmaking is key;
In some cases, parents will be guided entirely by health professionals, and in other cases it is a real common decision, while in other cases it is entirely up to parents.
This is a complete background.
Specific decisions.
48 Secondly, the vast majority of participants found that Autonomy was related to issues of responsibility and freedom, thereby reinforcing the idea that Autonomy was related to "morality, personality and age.
While only a handful of educated minorities are willing to take legal responsibility for the creation of autonomous choices, participants share the same disagreement about the ethics of freedom to make final decisions.
Previous studies have found that the perception of adolescents about their legal responsibility to vaccinate may be an obstacle to compliance with immunization.
58 with regard to freedom of choice, the study also found that a small number of people were less likely to be vaccinated when forced immunization.
59, 60 the third major finding was that parents reported their preference for vaccination
When asked about their understanding of the autonomy and ability of MMR vaccination decisions, relevant information.
Participants distinguish themselves as active seekers, passive recipients, or information evaders.
It is worth noting that most information evaders and passive seekers are also less educated.
Prior to the study, it was found that those who were more likely to have access to health
Relevant information and better information
Seeking skills is more likely to make informed medical decisions, 61 and information
Seeking preferences affects vaccination decisions.
49 in addition, it was found that information orientation (participation and fear) can predict the objective and perceived ability of a person to use information technology to promote health.
The last finding of 62A involves meaningful empowerment subdimensions.
When asked to compare the MMR vaccination decision with other decisions made for the child, most participants reported that it was a natural thing, "you just did it", both
These parents also report that their MRR vaccination decisions will affect not only the health of their children, but also the health of their communities.
On the other hand, a small number of people reported that it was a time to decide on the MMR --
Task of consumption, stress above all other decisions.
It is worth noting that these parents also expressed regret for the poor relationship with pediatricians.
Vaccination may be an obvious option and a normal part of raising a child, and depending on the relative relevance of the vaccine, it may more or less need to be thought about and found in previous studies.
Strengths and weaknesses of this study 5, 49, 54 this is the first study designed to reveal parents' understanding of empowerment in MMR vaccination decisions
Production in areas with low MMR coverage.
Previous work explored the structure of psychological empowerment in MMR vaccination decision-making, 5 indicating the correlation of parental self-empowerment
Self-efficacy
Decisions in the context of such decisions.
There are some restrictions on the study.
First, self
The selected nature of our sample may lead to focus group participants primarily being willing to share proof parents that they comply with official immunization advice.
Second, recruiting through the vaccination center may prevent us from reaching out to people who are strongly opposed to immunization, and even those who refuse DTaP vaccination.
However, this can also be seen as an advantage of this study, as many of our participants have not yet fully decided whether to vaccinate.
Third, due to the high drop-out rate, the focus group of the study had only four to six participants per person.
While groups of six participants are often the least recommended in focus groups, discussions between participants are not hampered by a limited sample size due to the diversity of participants' opinions.
In addition, when the focus group is smaller than six participants, the study group participating in the focus group is limited to two members (one moderator and one recorder ).
Finally, since we extracted our results from qualitative reports from a small number of parent samples, our findings cannot be extended to larger populations.
These findings have some implications for both theory and practice.
First, in the context of the MMR vaccination decision, parents seem to think that the structure of empowerment is more subtle than our original concept.
While Autonomy and competence are considered significant aspects of the structure, they are closely related to issues such as freedom, responsibility, trust in pediatricians, relevance of decision-making, and information orientation.
In practice, it is worth noting that the majority of participants reported that there was no distinction between vaccination;
Therefore, our findings can be applied to multiple vaccinations.
Since our participants look at authorization in a different way, all vaccinations need to avoid vague or extreme interpretation of the principle of authorization (such as autonomy), as these may lead to contracts --
Just like the relationship between parents and health professionals, isolate parents from their responsibility for decisions, or limit other possible immune solutions.
63 it should also be noted that not all parents wish to be authorized in the same way.
Some may need to control their decisions, under the guidance of a pediatric pediatrician, by simply following his/her advice or official advice and avoiding any other source of information.
Others may attach great importance to positive information, seek the feeling of being able to do so, and finally make decisions on their own.
As other studies have found, in all cases, 48, 49, 64 should recognize that pediatricians are key to parental empowerment in vaccination decisions.
Not only do they need to be considered competent professionals by their parents, they also have to build a trustworthy relationship with them.
49 in addition, they should be willing to address the concerns and concerns of their parents and strive to understand whether the parents are willing to share this decision --
Understand how their interactions and relationships with their parents can enhance or weaken their parents' abilities and ultimately adjust their way of communication accordingly.
Future studies, 48, 49, 64, because of specific vaccination decisions, attitudes that accept informed consent or promote a given vaccination behavior, may or may not be a manifestation of parental authorization, future quantitative studies must clarify whether the mandate and its subdimensions will have an impact on receiving vaccination proposals.
In this sense, developing appropriate empowerment measures in this particular case and testing its relationship with other key variables such as vaccination knowledge and risk perception will be a valuable
The main findings of this focus group study were aimed at exploring the psychological empowerment structure in MMR vaccination decisions in parent samples living in low MMR coverage areas in Italy.
The problem of autonomy and ability has largely dominated our results, and seems to be a cross-border in the strict sense. related.
Autonomy interpreted as responsibility and freedom seems to depend to a large extent on the ability of parents, which in turn depends on their relationship with child health care providers, the relevance of investment in decision-making and their information
Seeking behavior.
First, most participants report that they feel empowered and autonomous not only when they have the right knowledge and information --
Seek skills but can also rely on competent and trustworthy pediatricians.