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Abstract

Background
Immunisation is the most significant intervention to influence global health, and is a proven tool for controlling and eliminating life threatening infectious diseases. Parental immunisation decision-making is influenced by many factors: location and access to services; relationships with health professionals; sources of information; social class; ethnicity; and other health care issues.

Practice nurses have substantial contact with parents of young children requiring vaccination, and are a key group of health professionals involved in the UK national immunisation programme. Despite this, there is a lack of understanding pertaining to how practice nurses can influence parents’ immunisation decision-making concerning the MMR vaccine. This study is designed to fill that gap.

Aims
The three aims of this study were to:
1) conduct an integrative review to ascertain the beliefs and perceptions of practice nurses’ influence about the uptake of the MMR vaccine;
2) explore the perceptions of practice nurses concerning their role and strategies used to promote MMR vaccine uptake;
3) explore how practice nurses engaged with parents during their consultations about the MMR vaccine.

Design
The design of this three phase study consisted of an integrative review (Phase 1) and two exploratory descriptive qualitative designs (Phases 2 and 3).

Method
In Phase 1, data were analysed using integrative review processes. Convergent qualitative synthesis was used to draw the data together. During Phases 2 and 3, thirty practice nurses (principally practising in London) took part in semi-structured interviews that were audio recorded and transcribed verbatim. Qualitative content analysis was used to systematically manage, analyse, and identify themes.

Findings
Phase 1 findings identified four themes: parental immunisation influencing factors, practice nurse characteristics, information and communication, and personal views and concerns. The integrative review provided an excellent baseline to ascertain the beliefs and perceptions of practice nurses’ influence on the uptake of the MMR vaccine. However, the majority of the 12 articles were at least 10 years old and may not have reflected current practice nurses’ views and perceptions. This led to the need for further research as identified in the Phase 2 and 3 studies.

The findings of the Phase 2 study provided an understanding of how practice nurses perceived the most important aspects of their role in immunisation, and the strategies they implemented to promote the MMR vaccine. These strategies were wide ranging to include the provision of contemporary immunisation information to parents, and to dispel myths and misconceptions concerning the MMR vaccine. Practice nurses sought to explore parental health beliefs, endeavoured to understand the parents’ perspective, and alerted parents to local outbreaks of measles. By effecting these strategies, practice nurses sought to inform parents and assist their MMR immunisation decision-making.

Practice nurses in the Phase 3 study explored how they engaged with parents during their MMR consultations. They sought to provide parents with tailored sources of information to supplement their immunisation decision-making. Practice nurses described the need for a robust evidence base concerning the MMR vaccine, which they believed enabled them to address parental questions relating to vaccine content and side effects. Furthermore, practice nurses reassured parents who had safety concerns about the MMR vaccine, in so doing promoting this vaccine.

Conclusion
The key findings in this study illustrate the ways in which practice nurses engage with parents to promote the uptake of the MMR vaccine. This demonstrates the leading role that practice nurses play in advocating for and promoting the uptake of the MMR vaccine.

Publication Type:	Thesis (Doctoral)
Subjects:	R Medicine > RT Nursing
Departments:	Doctoral Theses School of Health & Psychological Sciences School of Health & Psychological Sciences > Nursing

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