August 1998
NEW ORLEANS - How to educate parents about the choices for poliovirus immunization has been a concern for pediatricians since the harmonized schedule was implemented in 1997. A Michigan State University group may have a solution.
A team from the university produced a videotape to help with the implementation of the three poliovirus immunization schedules and to study the impact of an educational videotape about polio vaccination on parent knowledge and decision making.
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The video emphasized a discussion between a provider and a parent about which of the three poliovirus vaccination choices might be appropriate for their infant, said Ruth Ann Dunn, MD, assistant professor, departments of pediatrics and human development and epidemiology, Michigan State University, East Lansing, Mich.
The results of the study indicated that a videotape on polio vaccination and choices of schedules was effective in increasing knowledge and facilitating decision making for parents/guardians. The sequential schedule was the most popular choice after either intervention.
As immunization schedules increase in complexity, videotaped information may make the offering of informed choices feasible and more readily adopted by practitioners.
In January 1997, the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics and the American Academy of Family Physicians recommended that parents and providers choose from among three poliovirus immunization schedules: a sequential schedule of two doses of inactivated poliovirus vaccine (IPV) followed by two doses of oral poliovirus vaccine (OPV); four doses of IPV; or four doses of OPV.
The ACIP stated a preference for the sequential schedule, but indicated all three were acceptable.
The videotape, entitled "Polio Vaccine: New Choices for Your Baby," is available for purchase for $15 by calling Michigan State University Extension Office at (517) 353-2596.
The prospective, randomized, non-blinded cohort study was conducted in six offices: two in university-based practices, two HMO staff model offices, a private practice and a health department immunization clinic. Parents of 2-month-olds were randomized to see either the videotape plus a vaccine information statement (VIS) or only the VIS, which is required by law to be given to parents before immunization.
Each group completed questionnaires before and after the intervention.
A total of 287 parents/guardians participated; 143 saw the videotape plus the VIS and 144 saw only the VIS. The two groups had similar demographics and pre-test scores. Both interventions resulted in increased knowledge; however, the videotape plus the VIS group had significantly higher post-test scores (p<0.001).
Fifty-three of 54 undecided (98%) parents who watched the videotape chose a schedule after the intervention compared with 40 of 47 undecided parents in the group that saw only the VIS (p=0.02).
"Parents can make decisions if the information is effectively provided," Dunn said.
In a separate study conducted in an inner-city clinic in Philadelphia, the results indicated that despite concerns regarding parental resistance to the implementation of the sequential schedule, this inner-city population overwhelmingly accepted the sequential poliovirus immunization schedule upon recommendation from the physician.
Following implementation of the sequential schedule in the inner-city clinic, data were collected regarding 152 children beginning their infant polio immunization series. Overall, 151 of 152 children due for the first polio vaccination received IPV. Of the 145 patients who returned to the clinic, 144 received a second dose of IPV.
Of the 291 evaluable polio vaccination visits to the clinic, IPV was administered as recommended for 159 of 160 visits during which three immunization injections were indicated, and at 130 of 131 visits during which four immunization injections were indicated.
The study was conducted through Allegheny University of the Health Sciences, Philadelphia.
For more information:
- Dunn RA, Shenouda PE, Martin DR, et al. Videotape about choices of polio vaccination schedule increases parent knowledge and facilitates decision making. Abstract 362. Presented at the Pediatric Academic Societies Meeting. May 1-5. New Orleans.
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