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:
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