Childhood Immunisation Tracking - UK Government Web Archive

Childhood Immunisation Tracking Parents of 0-4s 7 April 2010

Background and objectives This is the 33rd wave of the Parents’ Childhood Immunisation Tracking Survey, which has been running since 1991 • Twice yearly until 2005, annual surveys since then

The survey aims to provide information for strategic planning through tracking opinions, attitudes and behaviour in relation to: • Immunisation in general • The immunisation programme • Experience of immunisations • The introduction of new vaccines In addition the survey monitors current childhood immunisation advertising, publicity and communications

Wave 33 is the first time interviews have been carried out with parents of 3-4 year olds, with the aim of covering the whole immunisation process, from birth to pre-school • Previously only parents of 0-2 year olds have been interviewed, and so all historical data are based on this sample 3

Method Random location sampling in England amongst primary care givers (usually parents, and referred to as parents throughout) of 0-4s Interviews carried out in home using multi-media CAPI Fieldwork took place from18 January to 24 February 2010

Quotas set for parents of 0-2s and 3-4s to ensure a minimum of 1000 interviews in each group, including a boost of parents of 3-4s • 1730 interviews achieved in total • 1142 parents of 0-2s and 1007 parents of 3-4s • 419 had a child in both age groups

Data weighted to reflect the Social Grade and regional profile of parents of 04s, and age of children under 4

4

Spontaneous awareness of publicity Childhood Immunisation Tracking

Q3 Whether seen advertising, information or publicity (other than commercial advertising) about … (top 8) Recall of advertising and information about swine flu dominates this year, displacing awareness of information on childhood immunisations, but not other topics 81% 81% 82%

Swine flu 64% 63% 64%

Smoking Healthy Eating 47% 46% 47%

Drink/drugs

45% 45% 46%

Childhood immunisation

58% 2008, 5-6 in 10 since 2000

37% 37% 36%

Losing weight/obesity

35% 34% 38%

Road safety Exercise

0-4s 0-2s 3-4s

58% 58% 58%

31% 31% 32%

Base: 2010 - parents of 0-4s (1730), parents of 0-2s (1142), parents of 3-4s (1007) Based on all respondents

6

Q4 Spontaneous awareness of advertising, information or publicity on childhood immunisation

Seven in ten are aware of advertising or publicity, unchanged from recent years and with no difference for parents of older children MMR scares 88%

91%

89%

89%

86% 81%

72%

72%

72%

77%

72%*

General immunisation campaign

74%

72%

Pneumo campaign

57% 44% 29% 0-2s - Any 0-2s - TV ad

All

0-2s

3-4s

Base: 2010 - parents of 0-4s (1730), parents of 0-2s (1142), parents of 34s (1007).

Nov 00

50%

44%

Nov 01

Nov 02

27% 16% Nov 03

Nov 04

Nov 05

21%

21%

Nov 08

Feb 10

16% Nov 06

Nov 07

Base: Parents of 0-2s - 2010 (1142), previous years c.1000

Based on all respondents

7

Q5 Key sources of spontaneous awareness of advertising, information or publicity on childhood immunisation NHS used sources (leaflets and TV ads) continue to be most mentioned in 2010, while traditional media sources of “scare stories” maintain the low of recent years Pneumo campaign

MMR scares 88%

72%

91%

89%

89%

86% 81% 74%

72%

77%

72% * Any

Leaflet

Top mentions in 2010 26%

29%

24% 19%

Leaflet

TV ad

Told by doctor/ nurse

25%

17% 10% 7%

Anything

33%

TV in pharmacy/ surgery

Base: 2010 - parents of 0-4s (1730)

32%

29%

28%

8%

27%

7% 6% 5% 2% 3% 2%

6% 3%

12%

14% 6%

26%

22%

25% 16%

13%

31%

28%

9%

5%

TV programme

Newspaper article

Nov 00 Nov 01 Nov 02 Nov 03 Nov 04 Nov 05 Nov 06 Nov 07 Nov 08 Feb 10



8

Q6 What advertising, information or publicity was about Recall of advertising and information about swine flu dominates this year, displacing mentions of MMR and immunisation in general, especially for parents of 3-4s 64% 61% 68% *

Swine flu 27% 29% * 24%

MMR

21% 23%* 18%

Immunisation in general Meningitis

Pre school booster

42% in 2008, 72% in 2004 45% in 2008

7% 7% 6% 7% 5% 9% *

Seasonal flu

6% 6% 6%

Meningitis C

6% 6% 4%

0-4s 0-2s 3-4s

Base: 2010 - parents of 0-4s (1260), parents of 0-2s (835), parents of 3-4s (735) Based on all who recall seeing/hearing publicity

9

Q8 Whether seen anything that might persuade them not to immunise High levels of awareness of swine flu publicity has had little effect on intentions to immunise % Seen anything

% Seen anything

32%

0-2s

33% 28% 23%

19%

17%

20%

17%

Nov 00

All

0-2

20% 14%

Nov 01

Nov 02

Nov 03

Nov 04

Nov 05

Nov 06

17%

Nov 07

17%

14%

Nov 08

Feb 10

3-4

Base: 2010 - parents of 0-4s (1260), parents of 0-2s (835), parents of 34s (735).


Based on all who recall seeing/hearing publicity

10

Q9 Where seen advertising, information or publicity that might have persuaded them not to immunise (5% or more) Media scare stories have receded and the decision not to immunise (largely for swine flu) is more likely to be driven by TV ads and leaflets (may include NHS materials) 13% 11% 15%

TV ad

Leaflet

10% 11% 9%

Internet

9% 11% 8%

TV in pharmacy TV programme Doctor/Nurse Word of mouth

TV programme

44%

Internet

44%

8% 8% 7% 7% 7% 6% 6% 5% 8%

Newspaper article

29% 21% 0-4s 0-2s 3-4s

6% 6% 5%

Base: 2010 - parents of 0-4s (240), parents of 0-2s (147), parents of 3-4s (147)

22%

20% 15%

14%

15% 5%

9%

5%

Nov 04

Nov 05

Nov 06

12% Nov 07

16%

11% 7%* 3%*

13% Nov 08

Feb 10


Based on all who have seen something which might have persuaded them not to immunise

11

Q10 Content of advertising, information or publicity that might have persuaded them not to immunise Reduced mentions of MMR and autism/Crohn’s: Swine flu is the issue in 2010

Side effects

MMR (general)

Danger of Autism / Crohns

14% 16% 11%

54%

50%

46%

Vaccine inadequately tested

Side effects

19% 16% 19%

Bad publicity about swine flu

21% 21% 22%

39%

MMR

41% 0-4s 0-2s

35%

33%

19%

21%

16%

16%

Nov 04

Nov 05

3-4s

Autism / Crohn's

41%

38%

13% 14% 11%

41%

19%

11% 14% 10%

7%

Nov 02

Nov 03

3%

Base: 2010 - parents of 0-4s (240), parents of 0-2s (147), parents of 34s (147)

7%

21%

Nov 06

21% 14%* 17%

16%

Nov 07

Nov 08

*

14% Feb 10


Based on all who have seen something which might have persuaded them not to immunise

12

Summary: Spontaneous awareness of publicity

Swine flu is dominating the information parents recall about immunisations, displacing MMR as the focus Information recalled is most likely to come from TV ads and leaflets – sources used by NHS • It is no longer all about mass-media scare stories Awareness for parents of 3-4s similar to 0-2s • Possibly since swine flu is the focus and applies to children of all ages Despite the change in focus from MMR to swine flu, there is no change in parents’ propensity to reject an immunisation based on what they have seen • But, for those who might be persuaded to reject, this is likely to be about swine flu this year

13

Awareness of DH materials Childhood Immunisation Tracking

Q65-67a Prompted recognition of leaflets Recognition has built steadily for the ‘Guide to Immunisation’ leaflet but remains lower than for the original version, and has dropped for the Pre-school leaflet AWARE OF ANY LEAFLET

69% 71% 68%

Guide to Immunisation for Babies

Rough Guide to Childhood Illnesses

Pre-school leaflet

Measles leaflet

Rough Guide to Childhood Immunisation

55% 59%* 52%

66%

39% 37% 46%*

Pre-school leaflet

Measles leaflet

Guide to Immunisation

17% 17% 19%

73%

Old v1 62%

66%

56%

53% 46%

52%

57% 43%

38%

Old v2

37%*

31%

0-4s 0-2s

22%

3-4s

Old v1

15% 21%

59%

9% 10% 9%

17%

10% Nov 00 Nov 01 Nov 02 Nov 03 Nov 04 Nov 05 Nov 06 Nov 07 Nov 08 Feb 10

Base: 2010 - parents of 0-4s (1730), parents of 0-2s (1142), parents of 34s (1007)



15

Q65-67a Prompted recognition of leaflets – by subgroups Recognition of the leaflets is higher amongst... •Women (57%) •16-34s (59%) •Parents of 0-2s (59%) •Parents with >1 child, all under 5 (68%)

•Men (24%) •C2DEs (20%)

•C2DEs (43%) •16-34s (41%) •Parents of 3-4s (46%) •Parents with >1 child, inc. 5+ (46%)

•Men (13%)

Base: 2010 Parents of 0-4s - women (1513), men (217), 16-34s (1083), C2DEs (922), parents of 0-2s (1142), parents of 34s (1007), parents with >1 child, all under 5 (343), parents with >1 child, inc. 5+ (831) Based on all respondents

16

Q69-72 Internet access and use, awareness of websites Parents are more likely to be aware of and have visited the new Choices website than the Immunisation website. No difference by age of child. 91% of parents of 0-4s have internet access, 86% at home; 81% use it weekly

87% 77% 69% 56%

59%

51% 53% Heard of

Visited

67%

72% 70%

91% 91%

86%

75% 76% 73%

Internet use

57% Heard of Imm website

47% 29%

26%

17%*

7%

5%

8%

7%

6%

8%

11%

Visited Imm website

17%

Internet access

9%

17% 9% Immunisation website

Nov 01 Nov 02 Nov 03 Nov 04 Nov 05 Nov 06 Nov 07 Nov 08 Feb 10 NHS Choices website




17

Summary: Awareness of DH materials The ‘Guide to Immunisation’ leaflet continues to be the most recognised leaflet among parents of 0-2s but is still less recognised than the original version • It is also the most recognised by parents of 3-4s

Recognition of the Pre-school leaflet has dropped among parents of 0-2s

• Unsurprisingly, it is better recognised by parents of 3-4s than 0-2s Lower levels of recognition for the newer leaflets: Measles and Rough Guide to Childhood Immunisations Internet penetration is nearing universal among parents of 0-4s and most who have access use it at least weekly Parents are more likely to be aware of and have visited the new NHS Choices website than the Immunisation website • Awareness of the Immunisation website has dropped among parents of 0-2s

18

Other sources of information Childhood Immunisation Tracking

Q30a/32a Sources used for information about immunisations for 0-2s & 3-4s (prompted) Leaflets are the source of information used by most, followed by ‘Birth to Five’ book. Parents are less likely to use most sources of information about immunisations for 387% * 4s than for 0-2s. Any

73%

Leaflets

Birth to Five book

Immunisation appointment card

Internet

NHS Direct

Childcare/Parenting magazine

Books

Healthcare magazine articles

TV programmes

Newspaper articles

TV ads

46% 40% * 25% 24% 22% 21% * 16% 13% * 9% 11% * 5% 10%* 0-2s 4% 7% 3-4s 5% 7% 6% 6% 8% 6% 6%

61%*

0-2s: Similar pattern of responses to previous years (slightly different question so not directly comparable)

No difference by whether have another child, so difference between 0-2s and 3-4s is driven by child’s age rather than level of parent experience

Base: 2010 - parents of 0-2s (1142), parents of 3-4s (1007) Based on all respondents

20

Q29 Whether would have liked more information about immunisations for 0-2 year old

First time parents and those who did not recognise the leaflets are more likely to want more information about immunisations for 0-2s (differences by sex, age and whether had immunisation are not significant) In previous research 2 in 3 parents of 0-2s said they had enough information 42% 37%

All

41%

36%

Female

41% 36%

Male

47%

45%

16-24

25-34

36%

35%

35+

36% 32%

1 child

>1 child, >1 child, all under 5 >1 over 5

32%

Yes

No

Had immunisations

Yes

No

Aware of leaflets

Base: 2010 parents of 0-2s – all (1142), female (999), male (143), 16-24 (201), 25-34 (589), 35+ (350), 1 child (364), >1 child, all under 5 (324), >1 child, at least 1 over 5 (454), had immunisations (1079), not had (61), aware of leaflets (824), not aware (318) Based on all respondents

21

Q29/31 Whether would have liked more information about immunisations for 0-2/3-4 year old

Women are more likely than men to have wanted more information about immunisations for 3-4s, but otherwise a similar picture to 0-2s – younger and firsttime parents even more likely to want information about their 3-4 year old 0-2s 3-4s

54%

37%37%

39% 36%

42%

41%

39% 36%

28%

All

Female

Male

16-24

25-34

46% 41% 35% 31%

35+

1 child

47% 45% 36%38%

47% 41%

32%34%

36% 34%

>1 child, >1 child, Yes No all under 5 >1 over 5 Had immunisations

35% 32%

Yes

No

Aware of leaflets

Base: 2010 parents of 0-2s/3-4s – all (1142/1007), female (999/886), male (143/121), 16-24 (201/117), 25-34 (589/463), 35+ (350/426), 1 child (364/192), >1 child, all under 5 (324/275), >1 child, at least 1 over 5 (454/540), had immunisations (1079/755), not had (61/235), aware of leaflets (824/700), not aware (318/307) Based on all respondents

22

Q30/32 What information would have liked about immunisations for 0-2/3-4 year old (spontaneous) Parents of both age groups most likely to feel they are lacking information about side effects. Parents of 3-4s more likely to want more information about timings 44% 43%

Side effects 19%

Information about diseases

14% 16% 14%

Purpose of immunisation

11% 15%

More materials

Mentions of swine flu

More/General information

9% *

7% 7% 6%

Timings/Schedule

4%

5% 4%

Mentions of MMR

5% 4%

Research behind immunisation

5% 3%

Advantages of immunisation

5% 5%

Ingredients of vaccination

Evidence of safety

11% *

4% 7%

0-2s 3-4s

All mentions by at least 5% of either group

Base: 2010 - parents of 0-2s (415), parents of 3-4s (372) Based on all who wanted more information

23

Summary: Other sources of information As in previous years, leaflets are the source of information most likely to be used Parents are less likely to have used information sources, particularly leaflets, to find out about immunisations for 3-4s than for 0-2s • There is no difference between first time and experienced parents so this seems to relate to the immunisations rather than parental experience levels However, younger and less experienced parents are more likely to want more information about immunisations, particularly for their 3-4 year old • This may suggest that the lack of information used about the pre-school immunisations is not because they don’t need information, but perhaps because of difficulties in finding it Among those wanting more information, there is greatest demand for more information about side effects • There may also be more confusion over timing for pre-school immunisations

24

The immunisation programme: Awareness and perceived safety of immunisations Childhood Immunisation Tracking

The immunisation schedule

Baby vaccines TB

Birth (if needed)

Hep B*

Birth (if needed)

5 in 1

2/3/4 months

Pre-school booster 3yrs 4 months

Pneumo

2/4/13 months

2nd dose MMR

Men C

3/4 months

Hib/Men C

12 months

MMR

13 months

3-4s vaccines

Seasonal flu

from 6 months

Swine flu

from 6 months

3yrs 4 months

* Not tracked

26

Q12/13 Awareness of immunisations MMR and swine flu are the best known and by far the most top of mind immunisations. Men C is more top of mind than others with similar levels of prompted awareness 92% 87%

Prompted awareness Spontaneous awareness

75% 67%

63% 57% 52%

49% 35%

73%

27%

55% 30% 21%

MMR

Swine flu

Pre-school booster

17% 2nd dose MMR

Men C

15%

15%

17%

5 in 1 vaccine

Hib/Men C

TB

12%

9%

Pneumo

Seasonal flu



27

Q12 Spontaneous awareness of immunisations (baby) Whilst MMR is still most top of mind, in 2010, over half of parents of 0-2s spontaneously mentioned the swine flu immunisation. The likelihood of mentioning a number of immunisations has dropped offering more evidence that swine flu has displaced other concerns.

82%

84%

77% 72%

67%

81%

67% 62%

70% 59%

84%

MMR

82%

81%

77% 63%

75%

60%

50% 39%

40%

41%

50% 44%

51%

52% MenC

39%

39%* 32%*

19%

19%

17%

18%

Nov 00

Nov 01

Nov 02

Nov 03

3%

Nov 04

Nov 05

9% Nov 06

22% 14%

15% 1%

Swine flu Polio

50% 42%

72%*

11% Nov 07

9% Nov 08

16%* 13%

5 in 1 vaccine Hib/MenC Pneumo

Feb 10

Base: Parents of 0-2s - 2010 (1142), previous years c.1000 Based on all respondents

28

Q12 Spontaneous awareness of baby immunisations by subgroups Among parents of 0-2s, awareness of the main immunisations for 0-2s is higher amongst... MMR

Men C

5 in 1

Hib/Men C

Pneumo

Women Aged 35+

ABC1s

ABC1s

Have older children (particularly aged 5+)

Have child aged 3-4

0-2 year old in childcare Similar pattern of responses for prompted awareness Base: 2010 Parents of 0-2s - women (999), 35+s (350), ABC1s (552), parents of 0-2s and 3-4s (419), parents with >1 child, all under 5 (324), parents with >1 child, inc. 5+ (454), 0-2 in childcare (337) Based on all parents of 0-2s

29

Q12/13 Awareness of pre-school immunisations Women are more likely than men to be aware of the pre-school immunisations. Older and ABC1 parents have higher awareness of the second dose of MMR. Prompted awareness Spontaneous awareness

83%

86%

84%

83%

84%

84%

83% 76% 73% 70%

75%

66%

64%

66%

61% 51%

27%

33%

29%

27%

25%

27%

26% 19%

20%

All

Female

13%

10% All

Female

Male

16-24

25-34

35+

ABC1

C2DE

Pre school booster

Male

17%

17%

16-24

25-34

22%

19%

19%

35+

ABC1

C2DE

Second dose of MMR

Base: 2010 parents of 3-4s - all (1007), female (886), male (121), 16-24 (117), 25-34 (463), 35+ (426), ABC1 (452), C2DE (555) Based on all parents of 3-4s

30

Q22/23 Perceived safety of immunisations – completely safe/slight risk

The swine flu vaccine is the main concern for parents now, with MMR on a par with others in terms of perceived safety Slight risk Completely safe

86%

83%

83%

83%

82%

81%

81%

79%

78% 68%

58% 48%

52%

51%

52%

51%

46%

46%

49% 29%

Pre-school booster

2nd dose MMR

5 in 1 vaccine

Seasonal flu

TB

Men C

MMR

Pneumo

Hib/Men C

Swine flu



31

Q22/23 Perceived safety of new immunisations – completely safe/slight risk Safety perceptions of the swine flu vaccine among parents of 0-2s are in line with those seen for other new vaccines when they were first available. Safety perceptions tend to improve once vaccinations are no longer new. 81% 73%

76% 73%

74% 67%

69% 63%

70%

75% 72%

79% 75% 73%

81% 79% 78%

83% 81% 79%

5 in 1 vaccine

69%

MMR

63% Pneumo

Swine flu

Nov 00

Nov 01

Nov 02

Nov 03

Nov 04

Nov 05

Nov 06

Nov 07

Nov 08

Feb 10

Base: Parents of 0-2s - 2010 (1142), previous years c.1000 Based on parents of 0-2s

32

Q14/19 Disease very serious / more serious for 0-2s than 3-4s

In general, the more severe a disease is thought to be, the more common the perception that it would be more serious for younger children, with the exception of diarrhoea and vomiting Meningitis

91%

68% 81%

54%

Septicaemia

68%

59%

Pneumonia

63%

45%

Polio

50%

50%

Swine flu

44%

37%

Diphtheria

41%

42%

Rubella

40%

34%

Tetanus

30%

30%

Hib

29%

37%

Measles

28%

43%

Whooping cough

28%

37%

Mumps

Little change in perceived severity of diseases over time

Diarrhoea and vomiting

12%

48%

11%

28%

Chickenpox

26%

Seasonal flu

23%

Ear infection

8% 6%

Believe disease very serious More serious for 0-2s than 3-4s

Base: 2010 - parents of 0-4s (1730) Based on all respondents

33

Q14 Disease felt to be very serious by subgroups Diseases are more likely to be considered very serious by... Greater proportion consider disease very serious

Women

Younger parents

Older parents

ABC1s

Polio

Polio

C2DEs

Meningitis Septicaemia

Swine flu

Swine flu Diphtheria

Rubella

Diphtheria

Rubella

Hib Base: 2010 Parents of 0-4s - women (1513), 16-24s (250), 35+s (645), ABC1s (808), C2DEs (922) Based on all respondents

34

Q20/21 Proportion who consider vaccine a greater risk than diseases it protects against The swine flu vaccine holds much greater concerns for parents than MMR, which is considered less of a risk relative to diseases than in recent years for parents of 0-2s

No difference by age of child

Total - MMR Spontaneous - MMR

Prompted Spontaneous

26%

22%

20%

Swine flu

12%

8%

18%

4%

5%

5% 2%

2%

MMR

Seasonal flu

Men C


21%

16%

9%

12%

Nov 00

Nov 01

Nov 02

18%

Nov 03

18% 14% Nov 04

15% 12% Nov 05

14%

15% 10%

8%

11%

11%

7%

5%

Nov 06

Nov 07

Nov 08

Feb 10



35

Summary: Awareness and perceived safety of immunisations Awareness of immunisations is generally higher among women, with older, ABC1 and experienced parents also having higher awareness of some immunisations MMR remains the most top of mind immunisation, but safety concerns have receded so it is now on a par with most other vaccinations Swine flu is now the main area of concern for parents • Although it is perceived as among the more serious diseases, the vaccination itself is considered more of a risk relative to the disease than MMR was at the peak of the scares In general, diseases more likely to be considered very serious are also more likely to be considered more serious for 0-2s than 3-4s • Diarrhoea and vomiting seems to be an exception to this (less serious but a greater risk to 0-2s) 36

The immunisation programme: Uptake, refusals and delays Childhood Immunisation Tracking

Q59 Whether ever refused or delayed immunisations Seven in ten parents had all their children’s immunisations done when they were due. Of those who did not have their immunisations at the appointed time, half had already had it done later.

Went on to have later


Intend to have later

Had all when due 72%

More likely if... •Male •One child only •Not with partner •Child not in childcare •Non-white

Did not have when due 27%

13%

Postponed: 19%

3%

Not sure whether to have later

2%

No plans to have later

2%

Refused: 9%

Don't know 2%

Refusal

6%

Base: 2010 - all parents of 0-4s (1730), male (217), 1 child only (556), not with partner (360), 0-2 not in childcare (805), 3-4 not in childcare (117), non-white (262) Based on all respondents

38

Q60/63 Which immunisations decided not to give to child / Q62 which refused but would give to a future child

Swine flu was the immunisation most frequently refused or put off with no plans to ever have it. Those who missed the MMR immunisation were more likely to have it later than not have it at all. 9%

ANY

19% 7% 5%

Swine flu MMR Five in one Second dose MMR

1% 6% 1% 3%

1% have refused the swine flu vaccine but would give it to another child in future 2008: 4% of parents of 0-2s had refused MMR or delayed indefinitely and 12% had delayed but since had (Note: Question not directly comparable)

1% 2%

Tuberculosis

1% 1%

Pre-school booster

1% 1%

Meningitis C

1% 1%

Refused / no plans to have Postponed but may have / have had since

Base: All parents of 0-4s: 2010 (1730) Based on all respondents

39

Q61/64 Reasons why did not have immunisations when due

Concerns about safety and lack of information led to both permanent and temporary delays. Needs more research

Not enough information Worry about safety Disease not serious Advice/experience of family, friends

Objection to vaccine

31%

13%

May relate to the perception that swine flu was not adequately tested

13%

8%

6%

6%

2010: only 1 parent of 02s mentioned autism 2008: autism mentioned by 1 in 5 of those refusing/delaying indefinitely Immunisations refused or no plans to have

Base: All parents of 0-4s who refused or delayed and have no plans to immunise: 2010 (160)

41%

Child was ill at the time Had concerns about going

ahead

12%

More information needed

11%

Concerns about side effects

8%

Forgot or missed appointment

7%

Child is too young

7%

Parent busy, unwell or on holiday

6%

Wanted more time between vaccinations

5%

Similar to reasons given by parents of 0-2s in previous years

Immunisations postponed but may have or have had since

Base: All parents of 0-4s who postponed but may have or have had since: 2010 (325)

Based on all who refused / postponed immunisations

All mentions by at least 5%

40

Q53/54 Immunisations would refuse in future / Q55 Immunisations refused that have previously allowed

Swine flu has led to an increase in the proportion of parents who would refuse an immunisation in the future. Fewer parents of 0-2s than ever before would refuse MMR for a future child.

18%

ANY

Any

13%

Swine flu

MMR

Seasonal flu

3%

1% already had MMR and 1% already had swine flu but 1% would refuse in future – mainly due to concern about side effects and not knowing enough about the vaccine

18%*

Second dose of MMR

MMR

9% 4%

8% 6%

10% 8%

11% 8%

9% 6%

7% 4%

10% 4%

9%

12%

4%

4%

2%*

1%





41

Summary: Uptake, refusals and delays

Seven in ten parents had all of their children’s immunisations done when they were due and only one in ten refused or delayed indefinitely Refusals, delays and future refusals of MMR are at their lowest recorded levels Swine flu is now the vaccine most likely to have been refused or which would be refused in the future and has led to increased levels of planned refusals among parents The main concerns leading to refusals are a lack of research, worries about safety and a lack of information

42

The immunisation process: Discussions about immunisation Childhood Immunisation Tracking

Q58 Trust advice on immunisation given by… Health professionals and the NHS remain the most trusted sources of advice on immunisation. Parents recognise that family and friends may not give them the most accurate information.

Pharmacist

Government

Family/friends

86%

42%

NHS

58%

18%


NHS

Pharmacist

Government

Media

55%

55%

43% 37% 39% 34% 24%

10% Nov 03

21%

51%

49%

44%

49%

14%

4%

GP*/HV/PN

66%

19%

Strongly agree Slightly agree Media

% Strongly agree

92%

54%

GP, HV or PN

12%

15%

Nov 04

Nov 05

32% 16% Nov 06

43% 20%

42% 19%

17% 5%

19%

Nov 07

Nov 08

18% 4%

3%

Feb 10

* GP only prior to 2007 Base: 2010 - parents of 0-4s (1730)



44

Q33/37 Which health professionals discussed

immunisations for 0-2/3-4 with

Most parents discussed 0-2s immunisations with a HP, but less so for 3-4s. HV in particular much less used by parents of 3-4s 85%*

ANY HP

Any

52% *

PN

Midwife 85%*

77%

80% 74%

79% 74%

77%

76%

78%

79%

53%

52%

50%

49%

27%

Practice nurse/ Nurse in GP clinic

34%* 28%

61%

57%

60% 53%

29%* 22%

GP/ Own doctor

Midwife

GP

65%

Health visitor

Nurse at child clinic

HV

11% *

0-2s 3-4s

6% 12%* 2%

23%

13%

All selected by at least 5% of either group

Base: 2010 - parents of 0-2s (1142), parents of 3-4s (1007)

26%

11%

29%

14% 14%

17%

26% 17%

56%

28%

30% 23%

18%

18% 13%

9%

9%

25% 21%

15% 10%

15%

52% 34%*

26% 29% 19% 15%

12% *


Asked about any child prior to 2010 Base: Parents of 0-2s - 2010 (1142), previous years c.1000


45

Q34/38 When discussed immunisations before 0-2/3-4 was due to be immunised Immunisation discussions take place on a variety of different occasions 85%

ANY DISCUSSION 32%

At a health visitor home visit At an immunisation appointment

29%

At a post-natal check up

65%

At another immunisation appointment for 3-4 year old

15%

At previous set of baby vaccinations

14%

25%

Soon after baby was born At the 6 weeks GP appointment

ANY DISCUSSION

At the most recent check up with a Health visitor

16%

At the 18-24 month check up with a health visitor

10% 0-2s

At a GP appointment NOT for an immunisation

8%

At an ante-natal appointment

6%

At an immunisation appointment for a younger child


9% 3-4s

At a GP appointment but NOT for an immunisation


11%

8%

5%

Base: 2010 - parents of 3-4s (1007) All selected by at least 5%

46

Q35/39 Topics discussed with health professionals A similar array of topics are discussed in relation to 0-2s and 3-4s immunisations, albeit at a slightly higher level for 0-2s, with side effects being the main area of concern for both 24%* 19%

Possible reactions and side effects

17%* 12%

Timings and scheduling

“Possible side effects and how to deal with any reaction”

12% 10%

Safety and risks

9%* 5%

Which immunisation(s) child due to have

9%* 4%

Purpose of immunisation

“Pros and cons, he explained there was slight risk maybe about 1 per cent, the advantages out weighed the disadvantages”

7%* 2%

Explanation of the process

7% 5%

Information about diseases

5%* 3%

Recommendation of what to do

5%* 3%

Which immunisations available

5%* 1%

Benefits

0-2s 3-4s



47

Q40a Whether HPs advised to give paracetamol to child Most parents were advised to give paracetamol to their child if they had a reaction to an immunisation, mostly to be given after the visit but almost 1 in 4 were advised to give it before the visit 88% * 84% 76% * 70%

0-2s 3-4s

24%

At all

To give it after immunisation visit

22%

To give it before immunisation visit


48

Q36/40 Which other people asked for or shared advice with about 0-2s/3-4s immunisations Parents were more likely to discuss immunisations for 0-2s than 3-4s with nonprofessionals, particularly with their partner, friends and parents 77%*

ANY DISCUSSION

68% 48%*

Partner/ husband/ wife

37% 43%* 38%

Friends

26% 23%

Other family members

25% 23%

Other parents

24% *

Own parents or partner's parents Staff at child's school or nursery

0-2s 3-4s

17%

No difference for parents of 0-2s if have another child

3% 3%


49

Summary: Attitudes and discussions about immunisation Health professionals remain the most trusted sources of advice about immunisations, and most parents have discussions with them, making them ideally placed to deal with parental questions and concerns • Side effects are most likely to be discussed. As this is a known concern of parents, health professionals’ trusted status is vital to allay fears Parents of 0-2s are more likely to talk with health professionals, particularly Health Visitors and Midwives • There may be more obvious opportunities for discussions for this age group Parents are just as likely to talk to friends and family as they are to talk to health professionals, with parents of 0-2s again more likely to have such conversations, even those who also have older children • Parents are, however, less likely to trust advice from family and friends than from health professionals

50

The immunisation process: Attitudes and the decision process Childhood Immunisation Tracking

Q57 Attitudes towards immunisation

Attitudes towards immunisations are largely positive. Attitudes do not appear to be affected by the age of the child. 7% disagree

% Agree

% Agree

76%77%75% Children are immunised against too many diseases at one time Immunisation weakens the child's natural immune system

0-4s 0-2s 3-4s

31% 30%

42%

34% * 27%26%

35%

29%

39%

41%

40% 33%

34%

33%

15% Nov 06

30%

30%

15%

16%

13%*

Nov 07

Nov 08

Feb 10

13%13%13% 16%

Children are given Immunisation Children are Vaccinations are weakens the too many immunised adequately tested child's natural against too many immunisations at before being given to children diseases at one age 2-4 months immune system time

15%

14%

16%

Nov 01

Nov 02

Nov 03

Nov 04

12% Nov 05



52

Base: 2010 - parents of 0-4s (1730), parents of 0-2s (1142), parents of 3-4s (1007)

Nov 00

13%

Q41/45 Whether automatically had 0-2/3-4 immunised or weighed up the pros and cons Parents of 0-2s are increasingly likely to automatically have their child’s immunisations done when they are due. Similar levels for parents of 3-4s I automatically had all my child's (preschool) immunisations done when they were due

68% 75%

72%

72%

75%

Automatically had when due

61% 57%

I weighed up the pros and cons before deciding whether to have my child immunised

Immunisations not due yet (unprompted)

70%

73%

41%

Weighed up pros and cons

38% 30%

17% 22% *

29%

26%

28% 22%*

10% 3% 0-2s

3-4s


Nov-03 Nov-04 Nov-05 Nov-06 Nov-07 Nov-08 Feb-10

Base: Parents of 0-2s - 2010 (1142),previous years c.1000


53

Q41/45 Whether automatically had 0-2/3-4 immunised by demographics Younger and C2DE parents are more likely to automatically go ahead with immunisations. Similar pattern for 0-2s and 3-4s 83% 75%

82%

80% 75%

72%

72%

70%

69%

78%

69% 62%

0-2s 3-4s

All

16-24

25-34

35+

ABC1

C2DE

Base: 2010 parents of 0-2s/3-4s – all (1142/1007), 16-24 (201/117), 25-34 (589/463), 35+ (350/426), ABC1 (552/452), C2DE (590/555) Based on all respondents

54

Q42/46 What made parents go ahead with immunisations for 0-2/3-4 when due

Benefits of immunisation, particularly prevention of diseases and to be safe, are the main reasons parents give for automatically having immunisations done when due 24% 23%

Protect child / Prevent disease

Benefits outweigh risks

13% 11%

Have to have them

9% 8%

Advice from HPs

11% 11%

No problems with past experience

9% 11%

Normal/Right thing to do

8% 9%

For child's health

7% * 4% 5% 5%

Had no concerns/worries

5% 6%

Because the health visitor told me and I knew it was the safest thing to do

0-2s 3-4s

Because immunisation is very important


Because it was the sensible thing to do and I wanted my daughter to be protected

To be safe

13% 10%


Based on all who automatically had immunisations done when due

55

Q43/47 Immunisations for which weighed up pros and cons (0-2s/3-4s)

Swine flu has partially displaced MMR as the vaccine for which parents are likely to weigh up the pros and cons % of all parents of 0-2s/3-4s 91% 16%

2nd dose of MMR Pre-school booster

45%

MMR

88%

87%

85%

91% 87%

88%

8% 63%

14%

63%*

MMR

Swine flu

48%

5 in 1 vaccine

25%

10%

Swine flu

5%

5 in 1 vaccine

48%

Men C

18%

4%

Hib/MenC

17%

4%

Pneumo TB

29%

14% 11%

Pneumococcal

Meningitis C

3%

18% 12%

18% 12%

13%

22% 22%

19%

25% 18%

17%

14%

12%

2%

0-2s 3-4s

16%

20%

28%

Seasonal flu

6%

1%

Base: 2010 - parents of 0-2s (249), parents of 34s (167)

Nov-03

Nov-04

4% Nov-05

Nov-06

Nov-07

Nov-08

Feb-10


Based on all who weighed up pros and cons of immunisations

56

Q44/48 Issues taken into consideration when making decision about whether to have 0-2/3-4 immunised

Concern about side effects is the greatest factor parents take into account; more so this year than in the past. Fears of autism have further receded in 2010 – displaced by swine flu? 46% 44%

Danger/risk of side effects

Danger/risk of side effects 12% 19%

1%

39%

8% 5%

Needed more information

5% 3%

6% 4%

0-2s 3-4s

2% 5%

33% 25% 22% 16%

22% 16%

28% 20%

19%

16%

17%

28% 22% 12% 10%

14%

12%* 12% 8%*

2% 5%

31%

31%

Benefits of immunisation

46%

11% *

Statistics/ research

Family history of diseases

Danger/ risk of diseases that being immunised against

Danger/ risk of diesases that being immunised against

Inadequate evidence for safety of vaccine

Risk of disease vs risk of side effect

12% 9%

Risk of disease v risk of side effects

Specific mention of autism

Specific mention of autism


Base: 2010 - parents of 0-2s (249), parents of 34s (167)

4% Nov-03

Nov-04

Nov-05

2%

1%

3%

Nov-06

Nov-07

Nov-08

Feb-10

Base: 2010 - parents of 0-2s (249), previous years c.250

Based on all who weighed up pros and cons of immunisations

57

Summary: The decision process

Attitudes towards immunisation remain positive and an increasing number of parents are automatically having their children immunised, particularly younger and C2DE parents • 3 in 10 have concerns about too many immunisations being given at any one time • 3 in 10 have concerns that children are given too many immunisations aged 2-4 months Concerns about the swine flu vaccine are high for parents and it is likely that this has gone some way to displace fears about MMR Autism is much less of a concern than in the past, with parents now much more worried about side effects generally (possibly related to swine flu)

58

The immunisation process: Satisfaction Childhood Immunisation Tracking

Q50 Satisfaction with the immunisation process Overall levels of satisfaction are high. Parents are least likely to be totally satisfied with getting information prior to the visit and how side effects are dealt with. Parents aged 16-24 were less satisfied, both overall and with getting information. Totally satisfied

41% 49% 66%

Fairly satisfied

Neither satisfied nor dissatisfied

36% 33%

Fairly dissatisfied

10%

33%

26%

25%

Very dissatisfied

No differences by age of child

58%

69%

8% 4%

3% 3% 2%

Getting information before the immunisation was due

Making the appointment*

2% 2% 1%

11% 2% 2%

The immunisation visit* How any side effects were dealt with after the visit*

4% 2% 1% The immunisation process as a whole

Base: 2010 - parents of 0-4s (1686/1669/1674/806/1730)

Based on all respondents (* whose child had been immunised) excluding those who answered ‘Not applicable’ 60

Q51 Why not totally satisfied with the immunisation process

A need for more information is the main reason parents are not totally satisfied

32% 30% 34%

Wanting more information

Concern about side effects / overloading

Unhappy about when information is given or when consent is requested: 8%

13% 14% 13%

Problems with appointment scheduling

Issues with health professionals

Not enough information provided or effort made to explain: 24%

8% 8% 10%

0-4s 0-2s 3-4s

0-2s: similar themes to previous years

6% 6% 6%

Base: 2010 - parents of 0-4s (727), parents of 0-2s (498), parents of 3-4s (402) Based on all respondents who were not totally satisfied with the immunisation process

61

Q51 Why not totally satisfied with the immunisation process “Complete lack of choice and the unavailability of unbiased information from more than one source and a feeling as a parent that you're being pushed to take up all of the immunisation programmes on offer and the levy of guilt by the health professionals if you don't take up what's on offer” (Female, 25-34, ABC1, 0-2 and 3-4)

“I would have liked the information before the immunisation visit in the form of leaflets about each immunisation from the Department of Health” (Female, 35-44, C2DE, 3-4)

“Staff at clinic very unhelpful when it comes to making appointment” (Female, 25-34, ABC1, 0-2 and 3-4)

“Should be given full information including side effects of all immunisations and details of the various illnesses” (Female, 25-34, C2DE, 0-2)

“Didn't get any information about the injections he was having” (Female, 18-24, C2DE, 3-4)

34, ABC1, 3-4)

“Was assumed that I should not question whether they should immunise my child” (Female, 18-24, C2DE, 0-2)

“There could have been more information provided in terms of a personal consultation with a health professional prior to the immunisation visit” (Male, 25-

“The staff were not very friendly - it felt like a production line - not very personal” (Female, 25-34, ABC1, 02)

Based on all respondents who were not totally satisfied with the immunisation process

62

Summary: Satisfaction

Overall satisfaction with the immunisation process is high • Lower levels of satisfaction with information gathering before the visit, and how side effects are dealt with A need for more information is the main driver of why parents may not be totally satisfied • May be related to fears/concerns about side effects

63

Conclusions and implications Childhood Immunisation Tracking

Swine flu has displaced MMR as the key concern

Swine flu is the greatest concern for parents this year • High levels of publicity recalled – displacing MMR • Worries about safety – seen as less safe than other immunisations, particularly relative to the risk of the disease, and is the immunisation parents are most likely to weigh up and refuse

Scare stories about MMR have receded and MMR is now seen as being as safe as other childhood immunisations • Parents are decreasingly likely to weigh up the pros and cons of MMR and there are lower levels of refusals and delays than in the past

While there are still concerns about side effects, and a desire for more information in this area, this is no longer driven by autism

• Possibly as a result of the switch in focus from MMR to swine flu where fears may centre on a lack of research and information

65

Parents of 3-4s Parents of 3-4s are largely similar to parents of 0-2s in their attitudes towards immunisation and awareness of publicity • They are affected by similar issues, although it is important to bear in mind the high profile of swine flu recently which cuts across both age groups • A different picture may emerge in future if the swine flu vaccine is no longer an issue

The key difference between parents of 0-2s and 3-4s is that parents are less likely to have used information or spoken to health professionals about immunisations for their 3-4s than for 0-2s HOWEVER, parents are just as likely to want more information about immunisations for their 3-4s, particularly first time parents • Parents may well be less engaged with the process as their child approaches school age BUT there is evidence of gaps in opportunities to talk to health professionals or access to information, reflecting the findings of the qualitative research

66

Childhood Immunisation Tracking Parents of 0-4s

Q22/23 Perceived safety of immunisations – completely safe/slight risk

86%

86%

86%

83%

78% 74%

70% 67%

68%

65%

82% 73% 69%

82%

85%

81% 73% 75%

85%

88% 81% 78%

83% 81%

73% 69%

68% 63%

84%

63%

Pre-school booster 5 in 1 vaccine 2nd dose MMR MMR Pneumo Hib/MenC Swine flu

Nov 00

Nov 01

Nov 02

Nov 03

Nov 04

Nov 05

Nov 06

Nov 07

Nov 08

Feb 10

Base: Parents of 0-2s - 2010 (1142), previous years c.1000 Based on parents of 0-2s

79