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Academic Pediatrics

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Communication in medicine, Immunization of children, Preventive health services


Objective: Presumptive formats to initiate childhood vaccine discussions (e.g. “Well we have to do some shots.”) have been associated with increased vaccine acceptance after one visit compared to participatory formats (e.g. “How do you feel about vaccines?”). We characterize discussion format patterns over time and the impact of their repeated use on vaccine acceptance.

Methods: We conducted a longitudinal prospective cohort study of children of vaccine-hesitant parents enrolled in a Seattle-based integrated health system. After the child’s 2, 4, and 6 month visits, parents reported the format their child’s provider used to begin the vaccine discussion (presumptive, participatory, or other). Our outcome was the percentage of days under-immunized of the child at 8 months old for 6 recommended vaccines. We used linear regression and generalized estimating equations to test the association of discussion format and immunization status.

Results: We enrolled 73 parent/child dyads and obtained data from 82%, 73%, and 53% after the 2, 4, and 6 month visits, respectively. Overall, 65% of parents received presumptive formats at ≥1 visit and 42% received participatory formats at ≥1 visit. Parental receipt of presumptive formats at 1 and ≥2 visits (vs. no receipt) was associated with significantly less underimmunization of the child, while receipt of participatory formats at ≥2 visits was associated with significantly more under-immunization. Visit-specific use of participatory (vs. presumptive) formats was associated with a child being 10.1% (95% CI: 0.3, 19.8; P=.04) more days underimmunized (amounting to, on average, 98 more days under-immunized for all 6 vaccines combined).

Conclusions: Presumptive (vs. participatory) discussion formats are associated with increased immunization.


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