Report of Findings Pennine Lancashire - Immunisation ...€¦ · This Report of Findings summarises their responses and outlines MLCSU’s conclusions and recommendations. Please

Report of Findings

Pennine Lancashire -

Immunisation Programmes

for Under 5s

MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 2

Introduction

• MLCSU undertook activities in order to gain insight on behalf of NHS England to

the opinions and feedback from parent/carers of children aged under 5 on childhood

immunisation programmes in the East Lancashire and Blackburn with Darwen areas.

• An online survey was developed and promoted to capture the views of

those parents/carers. The survey was live between Monday 12 February 2018 and

Wednesday 14 March 2018.

• Two face-to-face focus groups were run on 19 March and 21 March.

• Overall, 79 individuals completed the survey and 12 people attended the focus groups.

This Report of Findings summarises their responses and outlines MLCSU’s conclusions

and recommendations.

Please note that where percentages do not total 100%, this is due to rounding or participants being able to select more than

one answer.


Aims and objectives

• Understand current views of parents/carers of children aged under 5 around:

• the uptake for childhood vaccinations for under 5s

• motivating factors for having/not having the vaccinations

• information provided and communication channels

• accessibility of the services

• any potential barriers

• Explore methods to increase uptake and raise awareness of the immunisation

programmes.

Online survey







Survey findings


Area participants liveOver two thirds of participants live with the East Lancashire area.

67%(53)

33%(26)

East LancashireBlackburn with

Darwen

Within which area of Lancashire or South Cumbria do you live? Base: 79


Parent/carer of a child under the age of 5 years old

Are you a parent/carer of a child under the age of 5 years old? Base: 79

Yes

No


Informed about child(ren) due for vaccinations

Other comments verbatim:

Method of informing Number Percentage

GP surgery letter 56 80.00%

Friends/family 1 1.43%

Read information in red book 19 27.14%

Healthcare professional advises 7 10.00%

Appointment card/letter in post 19 27.14%

Other (please specify) 2 2.86%

"School also" and "To advert"

How are you informed your child(ren) are due for vaccinations? Base: 70


Main reasons for getting your child vaccinated

What are the main reasons for getting your child(ren) vaccinated? Base: 70

Main reasons Number Percentage

To protect my child(ren) from illness/disease 66 98.5%

Healthcare professional recommendation 21 31.3%

Had other child(ren) vaccinated 18 26.9%

Recommendation from family/friends 6 9.0%

Other 2 3.0%

Other comments verbatim:

“I'm a scientist who understands

the public health implications”

“To protect those in the greater

population that are unable to be

vaccinated”


Information provided to aid decision making

What information did your school/nursery or a healthcare professional provide to assist you in deciding whether to have

your child(ren) vaccinated? Base: 70


Other comments

What information did your school/nursery or a healthcare professional provide to assist you in

deciding whether to have your child(ren) vaccinated?

“None whatsoever”

“Information leaflet within appointment letter”

“Not enough information has ever been given. I

sought information from research available. Along

with peer reviewed research.”

“Not of school age yet”


Research to aid decision-making

What research did you do before deciding on whether to allow your child(ren) to be vaccinated? Base: 70


Other comments

“Peer reviewed published research available

online. Plus non peer reviewed. No research has

been done on true placebos.”

“I am a nurse, vaccination is something I do as

part of my job & passionate about”

“My profession is healthcare”

What research did you do before deciding on whether to allow you child(ren) to be vaccinated?

“I'm a health professional and have a working

knowledge of immunisations and vaccinations”

Demographic profiling


Demographic profilingPostcodes

What is your postcode? Base: 70

Additional postcodes

1.4% - BB8, BBB, B10, BL1, B12, B18,

B19, L32, M25, M26, M29, M62, OL1,

PR2, WN6, WN7


Demographic profilingEthnicity, religion or belief

What is your ethnicity? Base: 69. What is your religion or belief? Base: 69.

Christianity

Atheist, no

religion

English, Welsh,

Scottish, Northern

Irish, British

Other ethnicities include Irish and White &

Black Caribbean


Demographic profilingAge

What is your age? Base: 70


Demographic profilingGender

What is your gender? Base: 70

100%Female


Demographic profilingSexual orientation

What is your sexual orientation? Base: 69


Demographic profilingRelationship status

What is your relationship status? Base: 70


Demographic profilingDisability

Do you consider yourself to have a disability? Base: 69

Focus groups


Area participants liveTwo thirds of participants live in the Blackburn with Darwen area.

67%(8)

33%(4)

Blackburn with Darwen East Lancashire

Base: 12

Group Date Participants

1. 19 March 2018 4

2. 21 March 2018 8

Breakdown of focus groups


Participants in support of having their child/children vaccinated

100%(12)

Yes

Do you intend to have your child/children vaccinated? Base: 12

33MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT

What words/thoughts do you associate with childhood immunisations?

Blackburn with Darwen:

• Meningitis

• General illness

• Prevention

• Children’s screams

• Protection

East Lancashire:

• Side effects

• Disease

• Protection

• Immunity

• Pain/screams of child

• Statistics – those who are

vaccinated versus those who are

not

• Nervousness, but know they have

to have them

• Reactions to vaccine



• Peace of mind that children are

protected against disease.

• Protection for children against other

children that haven’t had the vaccination.

• Trust that the medical advice is right,

(sometimes hard to understand the

information that is shared).

East Lancashire:

• Just go with it.

• NHS recommendation.

• Trust in the vaccinations.

• Knowing what the risks/effects of

diseases are.

• If you’ve had them yourself as a child.

• Exhausted with a new born child so

easier to go with the flow.

• Something to have planned and done.

• Experience of family or others around

you is very influential.

What are your motivating factors for having your child/children immunised?

“In Asian heritage it’s very important that

we have certain types of vaccinations as

we don’t have the same chromosomes as

other ethnic groups”

“A recommendation

from a trusted

authority goes a

long way”


What, if any, research did you undertake when making a decision about

having your child/children vaccinated?Blackburn with Darwen

• source.

“I researched the

flu injection”

“Research is key but knowing the

correct place to get easy to read

and understandable information is

hard”

“I stay away from

Google as every child is

different and the

responses aren’t always

right”

Google - to see

comments

which people

have left on

groups; these

can be helpful

Facebook to

see the

community

questions

NHS

website

GP

advised to

use NHS

Choices


What, if any, research did you undertake when making a decision about

having your child/children vaccinated?East Lancashire

• Combination of online research and Health Visitor advice.

• Social media is a big driver but caution needed over the qualifications of the person

writing the post as ‘people make things up’.

• Use Google to look for NHS or NICE guidance/recommendations.

• Advice from friends.

• Use the book provided by healthcare.

“If the doctors say I should

vaccinate then I will follow

their instructions”

“A kick-boxer on YouTube claims to

tell the truth about vaccinations but

you must subscribe to find out more”


Trusted sources of information


• Patient.co.uk

• Babycentre.co.uk

• NHS Choices

• Facebook communities

East Lancashire:

• NHS Choices website

• NICE guidance

• GP

• Health visitor

• Friends

• Red book

• Facebook/Twitter/YouTube

• Mumsnet

• Netmums

• NHS Immunisations webpage

• BBC articles on health

“Rarely do I follow ‘official’ groups on

social media e.g. NHS England or Clinical

Commissioning Groups”

“NHS is a trusted source of information

but not a popular channel for messages”


• People are worried and scared about the side effects of the injections.

• Low uptake could be a result of language and the person not understanding English.

• A lot of media coverage about autism being caused by the vaccinations which can put

some people off.

• Social media: one parent could post something and others see this, share it and the

information might not be correct but it puts people off having vaccinations.

• People are much more aware about what they are taking these days but it’s really hard to

understand what the ingredients are within the vaccinations.

Opinions about childhood vaccinations(self/family/friends/wider community)

Blackburn with Darwen

“Eggs are in the flu vaccination which makes

you wonder what’s in all vaccinations”

“We went private two years ago and

haven’t had any problems”


Opinions about childhood vaccinations(self/family/friends/wider community)

East Lancashire

• People complain after the flu jab that children will

fall ill.

• A rule imposed by a breastfeeding group forum

admin that vaccinations will not be talked about as

they are so controversial.

• The NHS is trying to make people poorly.

• Speculation that there’s a link between MMR and

autism.

• Campaigners who have had a bad experience

can make a lot of noise online, despite the risks

being small.

• It is difficult to tell who is right and who is wrong.

“I read in the paper that smallpox is

coming back”

“A mum I know would not let her

daughter be immunised (at school)

without her being there – as this

couldn’t happen, the immunisation

didn’t take place”

“My sister is dead against her children

having these”


Personal experience of having child/children vaccinatedBlackburn with Darwen

“My son is 15 years old and has just had

a booster but after he had this I learnt

the booster contained animal fat. They

need to be clearer about ingredients and

if they have alternatives they should

offer them well in advance.”

“I was sent for injections when my son didn’t need

them, as he had already had them at the hospital

(Manchester Royal) as he has a kidney disorder. I knew

he didn’t need them so I was able to speak with the GP

and resolve it but it still took time and shouldn’t have

happened. The GP should have been aware my son

had already received the vaccinations.”

(GP: Barbara Castle Way)

“When my son was 2 weeks old he had to go for

his TB vaccination. This was carried out at the

birthing centre (Burnley). They were really

welcoming and said I could arrive at any point

from 10am-12pm and not to worry if I was feeding

him; they could wait.”

“The only thing I don’t like is the reaction from the

children when they are having the injections, as

the screaming is upsetting”

“Little Harwood GP surgery is very good”


Personal experience of having child/children vaccinatedEast Lancashire

“We were reassured that all we needed to deal with

side effects was Calpol but they (side effects) were

much worse than I was led to believe by doctors”

“It was not made

clear what to

expect”

“I made one decision for one of my children and

another for the other”

“I still have the scar

from TB”

“I had a devastating experience of vaccinations – my young sibling collapsed at 13 months old and

was left with brain damage”

“My experience was worse than

expected due to too many

injections in one day”


Information received about immunisation programmes/when vaccinations

are dueBlackburn with Darwen

“A lot of jargon is

used and you feel

silly asking what

this word and that

word means”

“My GP gives me the

time to ask questions,

and leaflet for

information on side

effects was provided”

(GP surgery: Little

Harwood)

“When you make your

appointment for the

vaccinations you don’t

receive a letter

confirming it”

“I received letters from

the school each time

each of my children

have a vaccination but

I pay for private

healthcare”

One participant

received a white slip

but never a yellow

one

One

participant

never received

a yellow slip

Two participants

received a yellow

slip but didn’t know

what to do with

it/couldn’t

understand what it

was for.

Two participants

received a lot of letters

and said it was hard to

keep track, especially

when you have more

than one child.


Information received about immunisation programmes/when vaccinations

are dueBlackburn with Darwen (continued)

“My health visitor gave me her

personal number which I can call

whenever I have a question, which

is really great”

“I called my health visitor, but

no-one ever came back to me. I

know they are so busy.”

“Health visitors are so busy, as

are midwifes”

“I received information from my

health visitor who I have a great

relationship with so I feel I could

ring her if I had any vaccination

questions, but they are so busy I

don’t like to trouble them”

East Lancashire

“We are bombarded with letters –

I need time to consider the

implications”

“Invitations for the flu jab come at

the wrong time of the year (in

summer) and I am more likely to

have my jab in winter”


• Hard to keep track when receive lots of letters.

• More difficult to keep on top of all appointments when

have more than one child.

• Easy to forget appointment as don’t receive a letter confirming it.

Availability/access to appointmentsBlackburn with Darwen

“I had to rearrange my son’s vaccination

appointment two days before the appointment. I

was told to call the GP to do this who then had to

contact the company that provided the

vaccinations. I had to wait for a letter in the post

with my new appointment. It would have been

much easier if I could have rearranged it straight

away.” (Shifa surgery)

“In my experience the GP

practice is very flexible around

appointments which is a positive

thing” (Surgery: Little Harwood)

Multiple letters

Appointment

letter


Have you experienced any barriers?Blackburn with Darwen

“Even if I did seek out

reports on the vaccinations,

I’m not sure I would

understand what they said

because of the terminology

used in them.”

“Communication between NHS providers is

sometimes muddled and you get told different

things by different people. This is confusing

especially when you’ve just had a baby.”

“Language could be barrier not just

for Muslim people but Eastern

European. I know people that can’t

read English who receive letters and

if no-one reads them for her she

throws the letters in the bin.”

“It seems all surgeries are

so different. Some like

mine (Little Harwood) try

their very best to rearrange

appointments for

vaccinations whereas

others don’t seem to want

to help – this could mean

people don’t attend.”

“I wanted to take my son swimming once he’d had

his injections but as we had a delay with the

injections it meant that I had to delay starting his

lessons. It’s only a small thing but when your baby

is so small you look forward to those things.”


Availability/access to appointments/other barriersEast Lancashire

“I always rely on health visitors – I rarely go

anywhere as I can’t drive – I don’t have money

for a taxi or bus.”

“Nowhere was made available for

breastfeeding at appointments and if you miss

your slot by even a few minutes, you have to

rearrange and that can be hard with a child.

Some people might not bother.”


What types of communication do you prefer?Blackburn with Darwen

• Leaflets on the wall in the

room during focus group at

Little Harwood Children’s

Centre were voluntarily

pointed out and rated by the

group as examples of

good/bad use of imagery

when it comes to getting a

message across to people

when English isn’t their first

language.

“Image is good as you

can understand it’s

about feeding your baby

even if you don’t speak

English”

“Image is poor as I

wouldn’t understand

what it’s about unless I

could read”


What types of communication do you prefer?


• Clear, concise, image-led, plain English leaflets.

• Not everyone has smartphones, so posted letters needed as well.

• Letters can be wordy, so a simple text will be easier to understand

and help with the language barrier.

• Face to face information seen as really important.

East Lancashire:

• Leaflet.

• Appointment confirmation letter.

• Face to face discussion with Health Visitor.

“Text or email would work for

me, as it’s handy to have the

details on my phone”

“I prefer face to face but if I got

the information I could read and

then discuss it face to face, I

would like that”

“Little Harwood Children’s

Centre promote their website

a lot and I use it”

Face to face

Letters - simple

text

Leaflets - clear,

concise,

image-led


What could improve the uptake of vaccinations in your area?Blackburn with Darwen

“Make sure that the language used to

communicate with the patient’s parent is the

language that they speak and understand”

“Leaflets should be left in popular spots, such

as, supermarkets, children’s centres,

community halls, public notice boards, boots,

childcare places etc”

“A lot more information needs to be shared

during pregnancy so that you are prepared for

what you need to do once the baby arrives”

Word of mouth

Leaflets that are sent

out with vaccination

reminder letters

Campaigns with

leafletsSocial media

PostersFace to face

information

Workshops


What could improve the uptake of vaccinations in your area?Blackburn with Darwen (continued)

• Vaccination drop in sessions each week (similar to health visitor sessions).

• Vaccinations given at the weigh-in clinics by health visitors.

• Workshops on childhood vaccinations to educate during pregnancy and then reminder

workshops afterwards.

• More information as child gets older – plenty of information when leaving hospital with

a new born, but not much as child gets older.

• Accompany the appointment letter with a detailed information leaflet about side effects

and full ingredients list.

“The NHS puts an

importance for weigh in

clinics (drop in) so why

don’t they do it for

vaccinations?”

“Drop in clinics for vaccinations work best. With a new baby

you can try your very best to be on time to your appointment,

but it only takes a dirty nappy as you’re leaving the house to

make you late and then you have missed your appointment

and need to start all over again.”


What could improve the uptake of vaccinations in your area?East Lancashire

• Clearer information. Lack of transparent information leads to

surprises when having an immunisation, which puts people off for

subsequent occasions e.g. more injections than expected or

harsher side effects.

• Clear labelling and branding of messages (NHS or NICE) is very

important.

• Use social media for getting the correct information out there.

• Use celebrities to promote vaccinations.

• Leaflet should be provided listing the ingredients in each vaccine

and their possible side effects.

• Handy timetable of childhood immunisation programme

should be provided – something durable that can be kept in case

invite letter gets lost.

“Branding and labelling of

the source is more

important than what I read

in blogs and on forums”

“The NHS should myth

bust – monitor online and

social media channels for

incorrect information and

dispute it”


the source is more




the source is more



Conclusions


Conclusions

• Healthcare professionals, other parents and friends/family are most trusted for advice.

• Healthcare visitors are heavily relied upon by new parents for any

information/reminders.

• Face to face conversations are very popular – especially when followed up with

information to take away, digest and keep.

• Parents/carers worry about the health implications/side effects that have been linked

to vaccinations and due to the variety of places to go for advice/research, find it confusing

to know what and who is correct, especially on online channels.

• An inconsistent amount of information is provided to parents living in different

areas/different GP practices.


Conclusions

• Not enough is done by healthcare professionals to explain the side effects (short-term

and long-term) of vaccinations or exactly what ingredients the vaccinations contain –

driving parents/carers to do their own research and finding inaccurate information (at

times).

• Not enough is done proactively to engage with those whose first language is not

English.

• NHS Choices website is a popular source for finding information but NHS social media

channels are not well known or used.

• Flexibility and access to appointments (days/times/ability to change appointment)

varies across different GP practices.

• Parents/carers (especially those with more than one child) struggle with the amount of

communications/information they are given – not just healthcare related.

Recommendations


Recommendations

• Hold workshops during pregnancy to educate parents about childhood vaccinations.

• Provide all parents/carers with a durable, high quality leaflet (more likely to be kept) for

childhood immunisations - use clear imagery and include dates and full ingredients list.

• Display leaflets in popular public spots e.g. supermarkets (nappy aisle), children’s

centres, community halls, chemists, shopping centres – places that parents/carers visit.

• Provide merchandise that is more likely to be kept – provide after birth of a child e.g. a

fridge magnet of vaccinations and ages they’re due at.

• Offer vaccination drop-in sessions as an alternate to a set time appointment.

• Offer vaccinations at the weigh-in clinics.

• Allow parents the option to be present during vaccinations that take place at school.

• Use celebrities in campaigns – telling their own personal stories/experiences.


Recommendations

• Engage with parents/carers online – go to where they are rather than expecting them to

find your channels e.g. monitor online forums and Facebook community groups to

provide advice and correct information. Ensure that it is clear the person is speaking on

behalf of the NHS e.g. use appropriate username on forums, ‘blue tick’ verification on

Twitter, and verified badges on Facebook and Instagram pages/profiles, which allow

users to know they’re authentic.

• Use plain English in communications – be clear, concise and avoid jargon/too many

acronyms.

• Post a reminder letter when vaccinations due and follow up with a reminder SMS.

• Post a confirmation of appointment letter and follow up with a confirmation SMS.

• Proactively provide the leaflet/letter/SMS in first language of the parent/carer.

• Send SMS reminder the day before an appointment.

Documents

Report of Findings Pennine Lancashire - Immunisation ...€¦ · This Report of Findings summarises their responses and outlines MLCSU’s conclusions and recommendations. Please