Childhood vaccination practices and parental hesitancy barriers in rural and urban primary care settings

Authors' Names

Alexandria N. Albers MPH, MSFollow
Emma Wright MDFollow
Juthika Thaker MHAFollow
Kathrene Conway BSFollow
Matthew F. Daley MDFollow

Presentation Type

Oral Presentation

Category

STEM (science, technology, engineering, mathematics)

Abstract/Artist Statement

Nationally and in Montana, children living in rural areas have unique barriers to vaccine access and lower vaccination rates compared to children in urban areas. However, there has been minimal prior research on rural-focused strategies for increasing vaccination rates. Our objective was to compare rural and urban Montana primary care providers’ (PCPs’) practices in promoting childhood vaccination and their perceptions regarding barriers to and strategies for promoting vaccination.

We conducted a mail and online survey of rural and urban Montana PCPs. In October-December 2021, the survey was pilot tested by PCPs across Montana. In January-April 2022, we sent out four survey mailings to all eligible PCPs, 4-6 weeks apart. The last mailing contained a hand-addressed, larger, and different-colored envelope than was previously used. The survey included modules on routine vaccinations in children 0-2 years old and COVID-19 vaccination in children 5-17 years old. We completed descriptive analyses and used chi-square statistical tests to compare responses from rural and urban PCPs.

The participation rate was 36% (n=298). Urban PCPs (90-94%, depending on vaccine) stocked routinely recommended vaccines more frequently than rural PCPs (71-84%), but stocked the COVID-19 vaccine less often (urban: 44%, rural: 71%, pp=0.01) and concerns that vaccination will weaken their child’s immune system (29% vs. 6%, pp=0.01).

This study’s results illuminated potential interventions to increase rural vaccination rates, such as increasing the number of providers stocking all recommended vaccines, identifying strategies to address parents’ concerns, and collaborating with health departments on public vaccine communication campaigns.

Mentor Name

Sophia R Newcomer, PhD, MPH

Personal Statement

Routine childhood vaccinations have prevented millions of serious illnesses and thousands of premature deaths [1-4]. However, children living in rural areas consistently have lower vaccination rates than those in urban areas [5], including lower COVID-19 vaccination coverage in children under 18 years old [6]. Since children are recommended to receive 11 vaccines for 15 diseases by 2 years old, disparities in vaccination rates during early childhood (<3 years>old) contribute to a higher risk of vaccine-preventable illness for numerous diseases [7]. Reasons for lower vaccination rates include vaccine hesitancy and non-hesitancy barriers. Specifically, in addition to challenges with parental vaccine hesitancy, parents living in rural communities also experience barriers to vaccine access, such as transportation obstacles or difficulty accessing providers. However, minimal research has been completed in rural communities to investigate barriers to and facilitators of early childhood vaccinations [8]. Additionally, although research has demonstrated a range of evidence-based strategies to address hesitancy and non-hesitancy barriers to routine childhood vaccinations [9], there is a lack of data on how frequently such strategies are used, particularly in rural communities. Therefore, because the current investigation illuminates providers’ experiences with administering childhood vaccination and the practices that are utilized to promote childhood vaccination across Montana, it is an important contribution to research that is lacking in rural communities. In addition to the study’s importance to the research community, the value of this work is intertwined with myself, the University of Montana, and the Montana community. Leading a Montana-focused project has been critical to my professional development, my understanding of rural communities, and continues to prepare me for future project design and implementation throughout my research career. My work is valuable to the university because the research aligns with the School of Public and Community Health Science’s mission to promote research in rural areas and decrease health disparities in Montana. Lastly, the Montana community of medical providers, parents, and children will benefit from our study's ability to identify where public health interventions could effectively increase access to vaccines and decrease barriers to early childhood vaccination. Because of the importance of the work, the study’s value, and the potential for the results to facilitate primary care providers’ ability to better serve Montana parents and their children, is why my presentation of “Childhood vaccination practices and parental hesitancy barriers in rural and urban primary care settings” should be considered for a "Best of GradCon" award. References 1. Orenstein WA. Pediatr Infect Dis J. 2006;25:1093–101. 2. Ozawa S, et al. Health Aff (Millwood). 2016;35(11):2124-2132. 3. Roush SW, et al. JAMA. 2007;298(18):2155-2163. 4. Whitney CG, et al. MMWR Morb Mortal Wkly Rep. 2014;63(16):352-355. 5. Hill HA, et al. MMWR Morb Mortal Wkly Rep. 2021;70(41):1435-1440. 6. Saelee R, et al. MMWR Morb Mortal Wkly Rep. 2022;71(9):335-340. 7. CDC. February 17, 2022. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html 8. Albers AN, et al. Prev Med Reports. 2022:101804. 9. Cataldi JR, et al. Curr Opin Pediatr. 2020;32(1):151-159.