Wednesday, December 12, 2012

Parents Decision on MMR Vaccine

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Rain Daley
12/12/12
Intro to M.A.G.H.
Final Paper

            In the case of childhood vaccination there is much controversy surrounding the evidence provided by the various sources available to parents that help shape their decision making process. One case in particular is the case of the measles, mumps and rubella or MMR vaccine. There have been many writings on the subject of vaccination and the factors that influence parental choice in the decision making process. An article written by Mike Poltorak et al. describes the opinions that parents have on the vaccine and what factors influence those opinions and ultimately the choice that parents make whether or not to vaccinate their children – in the case with the MMR vaccine specifically. The article provides the reader with an in-depth consideration of the social and political influences contributing to the parents decision making process and how those influences can be changed if they are not providing any positive, well-informed support for parents’ inquiry.
            In the past 7 years, the proportion of parents presenting their children for the combined measles, mumps and rubella vaccination has declined significantly.  The trend has presented such a significant decline that the issue has drawn in research interest and many people have aimed much of their research efforts towards investigating what influences has caused such a decline. The writers of this article aim their study toward the perceptions that parents have of the MMR vaccine and how those parents go about gaining information about the vaccine to base their opinions off of. With this vaccine as well as many others becoming more popular across multiple countries as an addition to suggested vaccine schedules the study of its popularity among those who would use it is important for understanding the way it should be presented and taught about. The social context in which information on the MMR vaccine is passed through public avenues is one of the main focuses of this article. In up taking a medical anthropology perspective in this particular case one can discover the external and internal determinants of parents personal research process and the social aspects which eventually lead to the decision they will make on whether or not to vaccinate their children.
            The specific study presented in the Poltorak article on MMR vaccine provides information extracted from the UK and deals mostly with analyzing the knowledge, attitudes and beliefs of parents that has focused particularly on perceptions of the benefits and risks of immunizations and sources of information about these. An alternate article by Ramsay et al. (2002) indicates that “67% of mothers perceive the MMR as safe or to carry only slight risk.” The overall perception of the MMR vaccine seems to be mostly positive despite the drop in coverage over the past decade. What is imagined to be responsible for the drop in coverage is a common fear of the adverse side effects that the vaccine can carry. These fears tend to be passed through means of public information and media sources like web forums and even information passed by word of mouth among various social circles. It is in these social contexts that misinformation can rapidly spread due to the lack of professional advice and opinion. In the case that parents do seek advice from a medical professional it is usually the case that these parents have already done a portion of research themselves through online information sources or other accessible sources of information so they approach a physician with an opinion and are only seeking support for that opinion rather than advice to base it off of. In an ideal case these parents should be seeking information from their clinician first before turning to alternative sources of information. However, these parents feel that their clinicians are usually too time compromised with more important tasks than to simply inform a parent with professional advice on their suggested vaccines. Many parents also struggle with distrust of their clinicians due to their assumption that their clinicians are suggesting vaccines only to meet their vaccine coverage goals. Despite this information, the common fact remains that doctors are still considered the most trusted source of information.
         The article also explores the ways in which information reaches parents during their decision making process and what socioeconomic aspects as well as past events in an individuals social life may influence what information they are willing to retain during inquiry. Pareek and Pattinson (2000) also “linked attitudes with social variables such as age, education, marital status, ethnicity, and class, associating (at least early) concern over MMR with those from higher socioeconomic grades. Other studies go beyond individual beliefs and social status to consider how culture, and social and political processes, shape parents’ immunization dilemmas and practices.” An associated notion of these studies is that of different members of alternate social classes having different levels of acceptance or refusal in regards to MMR vaccination. For example, perhaps lower socioeconomic families with high levels of stress being more accepting of clinician opinion and automatically taking advice for vaccination because of the need to simply get it done.  Opposed are the members of high socioeconomic class with less stressful schedules who may be more involved with natural forms of medicine seeking information through alternative information sources after a vaccine recommendation from their clinician. Apart from social aspects like socioeconomic standing that can play a roll in decisions on vaccination there are personal determinants such as an individuals background in medicine that puts them in a knowledgeable position to make an informed decision. Familial, professional, personal, philosophical and even travel experiences of mothers when they started to engage with vaccination as well as experiences of oneself or others catching childhood diseases with few serious effects, or less frequently, with complications, also feed into people’s perspectives on vaccination that can heavily influence their decision to vaccinate.
         Taking these in-depth, analytical approaches to understanding how parents make their decisions sets this study apart from say a quantitative article provided by the World Health Statistics report that simply converts these complex social arrangements of information and the avenues in which they flow to reach and influence the publics perceptions of vaccination into numbers and statistics about vaccine coverage. In cases such as this it is essential that a medical anthropological perspective is taken into use in order to understand just what really effects the decisions that parents make that can produce these quantitative charts. In understanding the determinants of decision making processes the institutions providing vaccine coverage can then be better advised on how to approach the issue of informing their patients and their parents on the various aspects of MMR vaccination.
         In observing the issues associated with MMR vaccine coverage one who chooses to investigate with a medical anthropological perspective could recognize that there are various opinions and personal experiences that ultimately influence the decisions that each individual makes on vaccination. Another important notion in regards to each parents decision making process is that the decisions made are ultimately based off of each individuals experiences making this a highly individualized process. With the idea of medical attention being so personal, which it should ultimately be perceives as by everyone including health providers, the presence of standardized vaccine schedules has posed many problems. Many parents are simply overwhelmed by the idea of sticking that many needles into their child during their first year of life. Many parents simply cant dedicate the time to going to the doctor so often while usually working and actually raising the child during it’s first year. Others have conflicting opinions that deter them from vaccination based on cultural difference or even an alternate opinion on what health care should look like. Medical pluralism is a very valid issue in regards to vaccination. The emerging belief in and support of natural or other alternative medicines that people tend to pursue when in doubt of standard medical care can play a significant roll in mothers decision to vaccinate. In such cases information such as “mothers who later rejected MMR had sought ‘natural’ or active birth” can be telling of the route in which a parent will take on the journey through vaccination and what their decisions can stem from. While in such cases, both birth and MMR decision might have been shaped by a prior worldview emphasizing a particular notion of ‘the natural’. These previously held views could be those that even develop from inside a medical institution itself. Birth experiences can guide thinking about vaccination, whether by reinforcing or undermining a previously held view.
         In this case, with how heavily weighted the social aspects associated with the decision making process of parents to vaccinate are, the concepts that flow through medical anthropology are easily applicable and very useful in understanding the process parents go through to reach their decision on vaccination.

“While many studies have treated MMR as a single decision, this research suggests this may misconceive parental engagement. Actual outcomes depend not on a singular deliberative calculus and the information and education that informs it, but on contingent and unfolding personal and social circumstances in an evolving engagement.”

         With this perspective in mind the process that parents go through to reach a final decision in the end is no simple, standard, linear process that will lead every parent down the same road to reach the point of a final decision. That is the very reason a medical anthropology perspective is so useful in analyzing the various aspects of the decision making process and what factors ultimately influence the decision a parent makes on whether or not to vaccinate their children with the MMR vaccine along with the many others. In an effort to increase MMR vaccine coverage the medical community must be informed of how to go about communicating with their patients and associated parents about vaccinations in a culturally sensitive way if need be. In the absence of cross cultural communication clinicians still have to be prepared to handle the variation of patients and each of their individual, socioeconomic circumstances and be well prepared to give balance, well-informed advice for their decision. Even in the case that a parent comes in to a doctors office with the intention to not vaccinate but to simply gain more information about vaccination the clinicians must act in an unbiased way in providing proper information for that parent to base their decision off of.
         In the case of the MMR vaccine there are still methods of gaining information through outlets such as web forums and medical articles that can guide a parent in one direction or another towards a final decision. However, understanding the significance and importance of having that information be unbiased, balanced and properly informative is where positive change can take place. The most significant of sources will be the clinicians that parents interact with face to face. It is the responsibility of these clinicians to come to their office prepared to answer the questions of their parents in a friendly informative way to promote trust and dependence on them for information. If these kinds of practices were to be carried out I believe that there could be a positive shift in the reliance of information towards health care providers as well as a similarly positive shift in vaccination coverage of MMR.



Sources:

Poltorak, Mike, Melissa Leach, James Fairhead, and Jackie Cassell. "‘MMR Talk’ and Vaccination Choices: An Ethnographic Study in Brighton." Social Science & Medicine 61.3 (2005): 709-19. Print.






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