A survey of UK parental attitudes to the MMR vaccine and trust in medical authority
Introduction
The MMR vaccine has been the subject of tremendous controversy within the United Kingdom following widely publicised and strongly contested reports that the vaccine may be linked to autism and Crohn's disease [1]. In consequence, in many areas MMR uptake continues to be significantly lower than the target levels to prevent wild measles virus circulating in the community [2]. The important political and public health implications of the MMR controversy have aroused a great deal of academic interest, and a number of qualitative [3], [4], [5], [6], quantitative [7], [8], [9], [10] and theoretical [11], [12] studies of parents’ attitudes to, and decisions about, the vaccine have been published in recent years. Other works have discussed the roles played by the media, Department of Health and medical scientists in the controversy and elaborated sociological theories as to why this controversy, based on the speculative interpretation of such limited research, has had such a stong effect on public opinion [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23].
The qualitative studies have provided important insight into the context of parental decision-making, although one of the most in-depth qualitative studies [4] was limited by its exclusion of MMR-refusing parents. They have highlighted the significance of competing notions of risk from the vaccine and from infectious diseases, trust (or lack thereof) in medical practitioners and government, and the importance for information provision of personalised interaction with health professionals.
Because immunisation uptake is crucial at the level of the population, as well as the individual, it is important to assess the extent to which qualitative findings can be extrapolated to larger samples. Previous quantitative studies have suggested that general practitioners (GPs) are the most trusted source of information about the vaccine [7], that adverse media coverage has had relatively little impact on mothers’ attitudes to MMR [8], and that the decline in MMR uptake after 1997 was somewhat higher in more affluent health authorities [9]. However, there has been little integration to date of qualitative and quantitative studies about the MMR controversy, with published quantitative research relying on set questions that may not address parents’ chief concerns. To address this gap, we undertook a survey of parents’ decisions, attitudes and use of information about MMR immunisation, constructing survey questions from in-depth qualitative work [6].
Furthermore, few studies have explicitly addressed parental attitudes to single-antigen vaccines obtained through private clinics. Routinely collected statistics do not provide information about uptake of single-antigen vaccines for measles, mumps and rubella, although one recent survey reported a 21% uptake of single vaccines among children not immunised with MMR in three Lancashire Primary Care Trusts (PCTs) [24].
In order to improve understanding about these important topics, this study had the following aims:
- 1.
To determine the level of agreement, among both MMR-accepting and MMR-refusing parents in a PCT population, with statements about (a) the safety of MMR vaccine, (b) single-antigen vaccines, (c) the importance of immunisation, and (d) trust in medical authority.
- 2.
To determine what sources of information parents had accessed, and which were considered to be most useful.
- 3.
To examine differences between MMR-accepting and MMR-refusing parents in attitudes, use of information about MMR vaccine, socioeconomic status and education.
- 4.
To estimate the uptake of single-antigen vaccines among children not immunised with MMR, and thus to provide an estimate of overall immunisation coverage for measles, mumps and rubella.
Section snippets
Methods
A questionnaire was developed and piloted in the course of extensive qualitative interviews with parents (N = 87), which are being reported separately [6]. The questionnaire asked about (a) the target child's year of birth and whether the child had received MMR or single measles, mumps and rubella vaccines; (b) parents’ level of agreement with 20 statements related to MMR vaccination; (c) use of and satisfaction with information sources; and (d) respondent's gender, age, occupation, level of
Results
One thousand and one hundred seven parents of 2742 mailed (40.4%) returned forms consenting to participate in the study and were sent a postal questionnaire. Of these, 996 (90.0%) returned completed questionnaires, representing 36.3% of all parents invited to participate. Demographic characteristics of the survey respondents are summarised in Table 1 with comparisons to all-PCT data from the 2001 Census where available [28]. A greater proportion of respondents belonged to higher socio-economic
Discussion
The questionnaire response rate of 36% compares favourably to other postal questionnaire surveys [25]. Respondents were from higher socio-economic classes and had higher levels of educational qualification than the general PCT population (as is often the case with postal survey research). Therefore, caution must be used when interpreting the findings in relation to all parents in the general population.
Because the survey was generated on the basis of extensive interview data [6], it addresses
Acknowledgements
This research was funded by The Wellcome Trust, under the Public Engagement with Science Research Studentship scheme. In addition to the authors listed above, Camilla Wadham participated in the data collection and entry for this project. The authors thank Sir Kenneth Calman and two anonymous referees for helpful comments on earlier drafts of this manuscript.
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