A review of the evidence surrounding interventions for vaccine hesitancy in primary care

In the past five years, the rate of children in British Columbia who have been fully immunized by the age of two has ranged between 65% to 71%. This statistic remains far below the coverage rate required to ensure herd immunity and to suppress communicable diseases. Correspondingly, outbreaks of pertussis and measles in the province are occurring with alarming frequency. Caregivers who are philosophically or conscientiously opposed to routine infant and childhood immunizations have been blamed for the re-emergence of these diseases, and for the low coverage rate of vaccination both provincially and federally. Among this group of caregivers for children are those who are vaccine-hesitant'"those who are uncertain about vaccine safety and have yet to decide if they will immunize their child. Evidence shows that primary care providers, like family nurse practitioners, continue to be considered as a key source of immunization information for these philosophically opposed caregivers, regardless of whether or not they proceed to vaccinate their children. The goal of this project is to present the results of an integrative literature review that addresses the question '~What interventions can primary care nurse practitioners employ in communicating immunization safety to increase vaccine uptake in hesitant caregivers?' A Medline literature search produced 10 research articles for analysis. The Fuzzy-Trace Theory was employed to provide the theoretical framework for this paper and to inform the rationale applied to the findings identified by the review literature. Major findings emphasize the necessity for research that evaluates interventions aimed at increasing vaccine uptake in hesitant caregivers, the importance of child-centered communication using narrative and storytelling to explain vaccine risk and benefits, and the need for more education with respect to vaccination during pregnancy. --Leaf ii.