MKG222 Task 2

Social Cause Synopsis:Immunisation

Prepared for Dr. Maria Raciti

Course CoordinatorMarketing of Social Causes

Prepared byAmber Tucker

University of the Sunshine CoastQueensland, Australia

September 2015

Date Submitted: 11 September 2015

Referencing Style: Harvard

Word Count: 2026

Table of Contents1.0 Introduction.................................................................................3

1.1 Authorisation............................................................................31.2 Limitations................................................................................31.3 Scope........................................................................................3

2.0 Immunisation & Behavioural Changes.........................................3

3.0 Critical Table, Key Themes, Gaps & Target Audience of Interest.5Table 1 Critical Table – Academic Journals.....................................5Table 2 Critical Table – Internet Sources......................................13

4.0 Conceptual Framework..............................................................19Figure 1 Conceptual Framework...................................................19

5.0 Proposed Interventions..............................................................19

6.0 Conclusion.................................................................................20

7.0 References.................................................................................21

8.0 Appendices................................................................................24

Amber Tucker 1084646 MKG222 Task 2

1.0 Introduction1.1 AuthorisationThis report has been authorised by Dr. Maria Raciti, Course Coordinator for Marketing of Social Causes MKG222.The purpose of this report is to explore the social cause of immunisation refusal in relation to theories and possible interventions.

1.2 LimitationsThis report is limited to secondary information about immunisation and the theories discussed. Academic literature and other references were sourced from the Internet.

1.3 ScopeThis report will analyse the social cause of immunisation, identifying the problem behaviour, antecedents, market segments, past interventions and common misconceptions. A critical table explores the literature surrounding the issue and a synthesis of information is collated. A conceptual framework depicts the relationship between the antecedents of the problem behaviour and the Health Belief Model. Interventions relating these issues are proposed.

2.0 Immunisation & Behavioural ChangesImmunisation is the process in which people are protected against illness and infections caused by contact with micro-organisms (Australian Academy of Science 2015; World Health Organisation 2015). Immunisation is proven to be the safest and most effective way to prevent the spread of infectious diseases (Australian Government Department of Health 2015). Prior to the major vaccination campaigns of the 1960’s onwards, thousands of children were killed each year from preventable diseases (see appendix one) (Australian Government Department of Health 2015). This cause is extremely important as if enough people are immunised, an infection or disease can be eradicated altogether

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(Australian Government Department of Health 2015). However, only 92.3% of the Australian population below five years of age are fully vaccinated (Australian Government Department of Human Services 2015). The Australian Government estimates that 39,000 children below the age of seven are not immunised due to their parent’s objections towards vaccines. It is therefore the behaviour of parents who refuse to immunise that puts their children and the community at risk of potentially acquiring and transmitting vaccine preventable diseases.

The refusal to immunise is a potentially dangerous behaviour that could seriously risk the health of a child and the community. Vaccination is not compulsory in Australia, however, recent upstream actions imposed by the Federal Government are supporting the cause (Australian Vaccination-skeptics Network Inc. 2015). The Australian Federal Government has recently intervened by announcing a ‘no jab, no pay’ plan that will revoke childcare and welfare benefits of parents who refuse to vaccinate their children – with further hopes that pre-schools will require immunisation to enrol, as they do in New South Wales (The Australian 2015). However, with an online petition against compulsory immunisations in Australia receiving over 3000 signatures in five days, the Australian Medical Association President Brian Owler has stated his concerns that the policy won’t affect parents that don’t require welfare benefits (The Australian 2015). The American Journal of Public Health reports two antecedents of anti-vaccination behaviour to be fear of harm and informed consent (i.e. voluntariness) (Braunack-Mayer et al. 2015). Reasons for refusal are generally due to concerns with vaccine manufacturing, the immune system, the need to vaccinate and safety concerns (Australian Government Department of Health and Ageing 2013). For example, ‘vaccines are not adequately tested’, ‘vaccines weaken the immune system’, ‘diseases are virtually eliminated so vaccination is not necessary’ and ‘mercury in vaccines can cause autism’ (Australian Government Department of Health and Ageing 2013). It is essential that the segment of parents who refuse to vaccinate their children change their behaviour. The behavioural change required would result in the action of vaccinating

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their children. As the most influential entities, health professionals must inform and provide scientifically valid advice to parents to incite this behavioural change (Australian Government Department of Health and Ageing 2013). Consequently, more children will be immunised against preventable diseases.

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3.0 Critical Table, Key Themes, Gaps & Target Audience of InterestTable 1 Critical Table – Academic Journals

Source Document Reference

Number of people sampled

Summary of MethodologySummary of key themes and any gaps identified in the source

document

Meszaros, J.R, Asch, D.A, Baron, J, Hershey, J.C, Kunreuther, H & Schwartz-Buzaglo, J

(1996)

294 Surveys were mailed to 500 randomly selected subscribers of Mothering magazine.

Investigate the decision-making process of parents – both for and against.

Perceived dangers and susceptibility are well-recognised factors in decision-making, however, other antecedents are recognised as:

Ability to control child’s susceptibility/disease outcome

Ambiguity/doubts about reliability of vaccine information

Preference for errors of omission rather than errors of commission

Recognition that if many other children are vaccinated than the risk to their child may be lowered

Traditional risk-benefit analysis/arguments are unlikely to persuade parents to reassess their decision.

Increasing childhood immunisation must incorporate an understanding of the cognitive processes that drive these decisions.

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Gellin, B.G, Maibach, E.W & Marcuse, E.K

(2000)

1,600 United States telephone survey. Parents of children six years of

age and under, including expectant parents.

Incidence of vaccine preventable diseases has declined; concern about vaccine safety has increased.

87% of respondents deemed immunization extremely important.

25% of respondents believed their child’s immunise system could be weakened.

23% of respondents believed their children get more vaccines than good for them.

Health care providers identified as the most important source of information.

Systematic educational effort addressing common misconceptions is needed.

Sporton, R.K & Francis, S.A

(2000)

13 Qualitative study using semi-structured interviews.

Parents who have chosen not to have their children immunised.

Inner city area with a high level of deprivation.

All parents identified the risk of side effects as the reason for not immunising.

Proposed model of the decision making process. Parents response to immunisation: a routine response, an

emotional response and delaying the decision by entering a questioning stage followed by a cyclical process of seeking and evaluating information.

Stage of reflection irrespective of their initial action/response.

Parental responsibility in terms of health consequences. Parents perceived health professionals to provide

unbalanced information.

Szilagyi, P, Vann, J, Bordley, C, Chelminski, A, Kraus, R, Margolis, P & Rodewald, L

41 Systematic search using MEDLINE and four other bibliographic databases.

Randomised controlled trials. Health care professionals who

deliver immunisations and children/adults who receive immunisations.

Patient reminder/recall systems were effective in improving immunisation rates in 33 of 41 cases.

Postcards, letters, telephone calls and autodialed calls are all effective; telephone being the most effective.

Reminders were most effective in academic settings. Also highly effective in private practices and public heath

clinics.

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(2002)

Raithatha, N, Holland, R, Gerrard, S & Harvey I

(2003)

In depth interview study of parents who fully immunised their children.

Conducted with parents in two Norfolk nurseries: one urban and one rural.

Little is known about the risk perception of parents who immunised their children.

Certain known risk characteristics were attributable to specific diseases, including feelings of dread, lack of control and doubt in scientific knowledge.

Lack of trust in government agencies and doubts in the medical profession as the managers of vaccine risk.

Urgent need to address concerns amongst parents who immunize to prevent them from changing their practice/behaviour.

Smailbegovic, S.M, Laing, G.J & Bedford H

(2003)

76 Children born between 1 January 1999 and 15 February 1999 were identified from the child health database.

Questionnaires were sent to the parents of 129 children who defaulted on one or more primary immunisation by 18 months of age.

Ten respondents from this sample were interviewed.

Eight parents stated that their children had been immunised, leaving 68 questionnaires for further analysis.

Measles, mumps, rubella (MMR) and meningococcal C were most frequently omitted usually due to vaccine safety.

23 out of 68 respondents perceived that having their child immunised against a particular disease was riskier than non-immunisation; particularly MMR and meningococcal C vaccines.

Interviewees were concerned with the MMR vaccine rather than immunisation in general.

Information from health professionals was perceived as poor.

Decision-making process around childhood immunisation is complex – parents require up-to-date information that is tailored to their needs from well-informed health professionals.

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Alfredsson, R, Svensson, E, Trollfors, B & Borres, M.P

(2004)

300 Birth cohorts in Göteborg, Sweden.

Postal questionnaire to the parents of 300 vaccinated and unvaccinated children.

Children born in 1995 and 1996.

Documented vaccine coverage was recorded to be higher than official statistics.

For parents who vaccinated their children, the reason was to strengthen their child’s immune system.

Parents with children unvaccinated against MMR generally declined immunisation against other vaccine preventable diseases.

One third of the parents with a child unvaccinated against MMR had not yet made their final decision three years after the vaccine offer.

Both groups identified insufficient time for information and discussion at the Child Health Centre.

Parental concerns need to be addressed professionals at paediatric health institutions.

Hamilton, M, Corwin, P, Gower, S & Rogers, S

(2004)

76 70 general practitioners (GPs) in Christchurch (who kept record of the children whose parents declined immunisation) recruited 76 parents to take part in the study.

21 of these parents completed a structured questionnaire.

Parents in this sample were highly educated and had used a variety of sources of information in their decision not to immunise.

Almost half of these parents had not discussed immunisation with their lead maternity carer.

Viewed information from the ministry of Health as biased (distrust).

Concerned about vaccine safety and efficacy. Concerns pertaining to the side effects and complications of

immunisation. Concerns regarding their child’s immune system. Beliefs regarding the diseases immunised against to be rare

and not life threatening. GPs are the main source of information; hence, they need to

be able to provide accurate and unbiased information regarding the risks and benefits of immunisation.

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Jelleyman, T & Ure, A

(2004)

Paper-based questionnaires were circulated to health professionals involved in promoting/administering scheduled childhood immunisations.

Rotorua District of New Zealand.

85% responded.

94% of surveyed health professionals supported vaccinations.

91% considered science the most important basis for recommendation and that current scientific support is adequate.

11% thought immunisations held unacceptable dangers; 17% were unsure.

41% of nurses, 45% of midwives and 21% of doctors were unsure whether the MMR vaccine is associated with autism or Crohn’s disease.

Professional training, reading and personal experience were identified as having an influence on opinions.

Media and the Internet are considered least influential. Ethical tensions between community protection and

perceived individual risk were identified.

Diekema, D.S & the Committee on Bioethics

(2005)

10 Periodic survey of fellows of the American Academy of Pediatrics.

10 pediatricians were surveyed.

MMR vaccine is refused most frequently. Almost all pediatricians reported that they attempt to

educate parents on the importance of immunisation and document the refusal on their medical record.

A small number of pediatricians tell parents that they will no longer serve as the child’s physician, if after educational efforts, they continue to refuse immunisation.

Issues raised of withholding immunisation pertaining to: Risking harm to the child constituting medical

neglect – should this be reported to child protective agencies?

Refusing immunisation puts others at risk of harm – is this sufficient to justify public health intervention?

The manner in which pediatricians and health professionals should respond to parents who refuse to immunise their children.

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Leask, J, Chapman, S, Hawe, P & Burgess M

(2006)

37 Six groups of six mothers (approx. focus group size).

Demographically varied yet middle-class areas across metropolitan Sydney.

Those who clearly opposed to immunisation were excluded.

Middle-class mothers are more likely to question immunisation and can have a disproportionate influence on others opinion formation.

Support for vaccination due to fear of disease. Mitigating anti-vaccination impact. Regret from omission and commission. Core influences: doctors, social networks and seeing the

diseases. Self-reassurance revolved around a desire for mothers to

protect their children from infectious diseases. Stories of disease affected children need to re-enter the

public discourse via health professionals.

Omer, S.B, Salmon, D.A, Orenstein, W.A, Patricia deHart, M & Halsey, N

(2009)

United States citizens. Geographic clustering of

refusals that result in outbreaks.

Children with exemptions from school immunisation requirements.

Vaccine refusal increases the individual’s risk of disease as well as the whole community.

Substantial gain in reducing vaccine-preventable diseases has resulted in the memory of infectious diseases fading from public consciousness.

Risk-benefit calculus has shifted in favour of perceived risks for some.

Major reasons for refusal are: vaccine safety and low levels of disease concern in the community.

Matter of maintaining the benefits we have already gained from immunisation – need for increased efforts in educating the public.

Health clinicians have the ability to influence parental decision-making.

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Kata, A

(2009)

Web searches (via Google.com and Google.ca) on 21 May 2009 for the following terms:

Vaccine Vaccination Immunization Immunisation

Misinformation is the principle obstacle/barrier for vaccination, however, providing better education has not been effective.

More consideration must be given to the underlying social discourses.

Reasons for refusal involve alternative understandings of health, different perspectives on parental responsibilities and questioning legitimacy of traditional authorities.

Vaccine objectors reject the facts that could persuade them. Ant-vaccinators project their version of information –

misinformation – or arguments that are not easily dismissible.

Chatterjee, A & O’Keefe C

(2010)

Review of the most prevalent vaccine safety controversies.

Vaccines were discovered in the 20th Century, hence parents and healthcare providers of the 21st Century have limited or no experience with the devastating effects of diseases such as polio, measles or smallpox.

Fear of disease has shifted to concerns of vaccine safety. Scientific evidence refutes common misconceptions, yet

parental refusal to immunise is increasing. Prevalent vaccine controversies and behavioural

antecedents include: Proposed relationship between MMR and autism. Thimerosal (antiseptic) as a potential trigger for

autism. Religious objections. Human papillomavirus vaccine may lead to youth

promiscuity. Fears regarding adverse neurological outcomes. Vaccines overload and weaken the infant immune

system.

Smith, P.J, Humiston, S.G,

11,206 Parents of children aged 24-36 Psychosocial factors suggested by the Health Belief Model.

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Marcuse, E.K, Zhao, Z, Dorell, C.G, Howes, C & Hibbs B

(2011)

months. 2009 National Immunization

Survey interview.

60.2% neither delayed or refused immunisation. 25.8% delayed immunisation. 8.2% refused immunisation. 5.8% delayed then refused immunisation. Parents who delayed and refused were significantly less

likely to believe that: Vaccines were necessary to protect the health of

children. Their child might get a disease if they aren’t

vaccinated. Vaccines are safe.

Parents who delay and refuse perceive fewer benefits from immunisation.

Psychosocial domains of HBM – increased hesitancy associated with decision to delay or refuse vaccinations.

Parental hesitancy across HBM associated with higher level socioeconomic status (suburban and high annual income).

HBM is understood by clinicians and facilitates constructive dialogue with hesitant parents.

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Nyhan, B, Reifler, J, Richey, S & Freed, G.L

(2014)

1759 Two-wave survey experiment of US parents.

Conducted in June-July of 2011. Randomly assigned to receive

an intervention.

Interventions were as follows:1. Information from the Centres for Disease Control and

Prevention explaining the lack of evidence related to the MMR vaccine causing autism.

2. Textual information from the Vaccine Information Statement about the dangers of the diseases prevented by the MMR vaccine.

3. Images of children who have diseases prevented by the MMR vaccine.

4. Dramatic narrative from a Centres for Disease Control and Prevention fact sheet about an infant who almost died of measles.

None of the interventions increased parental intent to immunise future children.

Refuting claims of any link between MMR/autism successfully reduced misconceptions, however, did not increase intent.

Images increased expressed belief in a vaccine/autism link. The narrative increased self-reported belief in serious

vaccine side effects. Current public health communications regarding

immunisations are not effective, rather counterproductive: increase misconceptions and reduce vaccination intention.

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Table 2 Critical Table – Internet SourcesInternet Source

ReferenceTopic of website/article Summary of key themes and any gaps identified in the source document

World Health OrganisationImmunization(2015)

Explanation of immunisation.

Purpose of immunisation.

Process in which someone is made resistant to an infectious disease via a vaccine.

Vaccines stimulate the immune system to protect against the subsequent disease.

Controls and eliminates life-threatening diseases. Estimated to avert between two and three million deaths a year. Cost-effective health investment with clearly defined target groups.

World Health OrganisationModule 3: adverse events following immunization(2015)

Mass vaccination campaigns.

Safety issues and concerns with immunisation campaigns.

Involves administering vaccine doses to a large population over a short period of time.

Common safety issues and concerns: Staff unfamiliar with vaccine –> increases in immunisation

errors. Age differs from routine –> lead to adverse reactions such as

fainting and unfamiliarity with treatment. Interest groups fuel concerns –> rumours jeopardize

justification of campaign. Rumours rapidly damage the campaign –> need dealing with

immediately to be counteracted. Adverse events can be minimised with proper planning aimed to

reduce immunisation errors by the use of: thorough staff training; monitoring and responding to issues and engaging the community.

Limit negative publicity.

World Health OrganisationModule 6: communication

Risks of immunisation. The use of effective

communication in educating parents on immunisation.

Vaccines are designed to provoke an immune response in the body. Inevitable that this reaction carries a small attributable risk to a tiny

minority of recipients. Hugely outweighed by the significant benefits of immunisation. Explaining the risks and benefits to parents requires effective

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(2015) communication and interpersonal skills from trained health professionals.

Parents view infectious diseases as a thing of the past, however, if herd immunity falls, diseases may re-emerge and spread throughout the population.

Only communicate reliable information to the public. Refrain from over-simplifying or withholding information.

Australian Government Department of Human ServicesProposed changes to immunisation requirements(2015)

Changes to immunisation requirements.

Conscientious objection. Medical exemption.

Immunisation requirements will apply to Child Care Benefit, Child Care Rebate and the Family Tax Benefit as of 1 January 2016.

Conscientious objection will be removed as a reason for vaccination exemption.

Parents with unvaccinated children, and without medical exemption, cannot access welfare payments.

Immunisation not only protects individuals, but the whole community by reducing the spread of disease.

The choice not to vaccinate on the grounds of vaccine objection is not supported by the public health policy or medical research.

Queensland GovernmentBenefits of immunisation(2015)

Benefits on immunisation. Immunisation safety. Funded vaccines. Researching and deciding

to immunise.

Immunisation works by triggering the immune system to fight against certain diseases.

Immunisation protects your family and others by helping control serious diseases in the community.

All vaccines used in Australia undergo extensive research and must be approved for use by the Therapeutic Goods Administration (the monitoring body of medicine safety).

Before a vaccine is licensed, it is rigorously tested in clinical trials of thousands of people over several years.

Any concerns should be raised with your doctor or immunisation provider.

Serious reactions are rare whilst mild side effects (e.g. pain, swelling and redness) resolve quickly.

Vaccines on the National Immunisation Program Schedule are funded for eligible children and adults – the Australian Government is

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responsible for deciding which vaccines will be included. Risks of side effects are far less than the risk of severe complications

associated with vaccine preventable diseases. 90% of people unimmunised against whooping cough will catch the

disease. Always seek credible and scientifically sound research.

Queensland Government Department of HealthTrack your family vaccinations with the VacciDate app(2014)

App that helps parents to keep track of vaccinations.

Queensland only.

Tool for Queensland parents that help to manage a child’s vaccination schedule.

Profiles, appointment dates, reminders and stores a record of vaccinations.

Provides access to the VacciDate website containing information about vaccinations.

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The target segments of previous campaigns are outlined within the extant academic literature. Consequently, gaps in the target market emerge and form the basis for proceeding interventions. With the Australian Government recently proposing an upstream intervention to change immunisation requirements, the target market is restricted. In the proposal, ‘conscientious objection to immunisation’ is removed as a reason for vaccination exemption (Australian Government Department of Human Services 2015). Consequently, parents who refuse the immunisation of their children will no longer be eligible for welfare benefits such as the Child Care Benefit, Child Care Rebate and the Family Tax Benefit as of 1 January 2016 (Australian Government Department of Human Services 2015). However, this intervention will not target parents who do not require welfare benefits. Additionally, research has revealed that middle-class mothers are more likely to question immunisation and concurrently have a disproportionate influence on others opinion formation (Leask et al. 2006). Therefore, it can be said that the target audience for further study are Australian parents of middle to upper socio-economic class who have negative perceptions that result in the refusal to immunise their children against vaccine preventable diseases.

The behaviour of this concise target market can be explained using the Health Belief Model (HBM). The HBM is based on an understanding that people will take a health related action, in this instance, towards immunising their children (University of Twente 2012). Such actions take place if a person feels that a negative health condition can be avoided, have a positive expectation of the recommended action and believe that they can successfully partake in the action (University of Twente 2012). The psychosocial factors of the model include: perceived susceptibility, perceived seriousness, perceived benefits versus perceived barriers, perceived threat and cues to action.

A 2009 National Immunisation Survey analysed the behaviour of parents who refused to immunise their children (Smith et al. 2011). It was evident that those hesitant to immunise were of a higher-level socioeconomic

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status and lived in suburban areas with high annual income (Smith et al. 2011). The psychosocial factors of the model were explored in accordance with parental responses to delay or refuse immunisation (Smith et al. 2011). There are four reoccurring antecedents of the problem behaviour: beliefs regarding vaccine safety, concerns that vaccines weaken the immune system, low levels of concern and information reliability and misinformation.

Parents will be cued to act depending on the perceived seriousness and susceptibility of their child being infected with a disease. It is evident that the parents in this target segment are less likely to believe that their child may develop a vaccine preventable disease (Smith et al. 2015). It can also be suggested that the lack of perceived threat decreases the likelihood of immunisation. This is due to the notion of perceived benefits versus perceived barriers – being immunity to disease versus possible vaccine side effects. According to a 1996 study published in the Journal of Clinical Epidemiology, traditional risk-benefit analysis is unlikely to persuade parents to immunise their children (Meszaros et al. 1996). One of the barriers that defuse the benefits of immunisation is belief regarding vaccine safety (Hamilton et al. 2004). It is apparent that parents identify the risk of vaccine side effects as a reason for not immunising (Sporton & Francis 2000). Such side effects include adverse neurological outcomes such as the proposed relationship between the MMR vaccine and autism (Chatterjee & O’Keefe 2010). The World Health Organisation (WHO) states that the inevitability of a small attributable risk associated with vaccination is grossly outweighed by the significant benefits (World Health Organisation 2015). Additionally, all vaccines used in Australia undergo extensive research and clinical trials before being approved by the governing body of medicine safety (Queensland Government 2015). Another barrier of immunisation are concerns that vaccines weaken a child’s immune system (Gellin, Maibach & Marcuse 2000). As vaccines are designed to provoke an immune response to fight against certain diseases, some parents believe that this overloads and effectively

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weakens their child’s immune system (World Health Organisation 2015; Chatterjee & O’Keefe 2010).

Vaccines were discovered in the 20th Century, hence parents of the 21st Century have limited or no experience with the devastating effects of diseases such as polio (Chatterjee & O’Keefe 2010). Due to substantial gains in reducing the spread of vaccine-preventable diseases, parents no longer perceive their children to be susceptible to such infections (Omer et al. 2009). As the memory of infectious diseases have faded from public consciousness there is now a lack of concern for disease prevention. Consequently, fear of disease has shifted to fear of vaccine consequences (Chatterjee & O’Keefe 2010).

Due to the low level of concern throughout the community, parents no longer perceive vaccine preventable diseases to be serious, rather rare and not life threatening (Omer et al. 2009; Hamilton et al. 2004). Contributing to the lack of perceived seriousness is the reliability of information and misinformation (Kata 2009). Throughout the decision-making process, parents perceived the information provided by health professionals to be unbalanced and poor (Sporton & Francis 2000; Smailbegovic, Laing & Bedford 2003). Misinformation provided by ant-vaccination networks requires mitigation in order to reduce the negative impacts linked with vaccine refusal (Leask et al. 2006). Additionally, there is a lack of trust in the government to provide accurate, unbiased and reliable information (Raithatha et al. 2003; Hamilton et al. 2004).

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4.0 Conceptual FrameworkA conceptual framework had been developed from the synthesis of academic literature. The framework is derived upon the HBM and depicts the association between the psychosocial factors and the antecedents of the problem behaviour.

Figure 1 Conceptual Framework

5.0 Proposed InterventionsIntervention 1: The extant academic literature indicates that information reliability and misinformation are barriers of the desired behaviour (Kata 2009). It is apparent that information provided by health professionals, the government and anti-vaccination networks are distrusted and doubted (Sporton & Francis 2000; Raithatha et al. 2003). Therefore, a potential intervention may be framed upon creating an up-to-date government application for smartphones with links to a vast variety of sources such as WHO webpages, recent academic journals, scientific research and upcoming information seminars. This will give parents the ability to control their research whilst providing information that is tailored to their needs from well-informed organisations (Smailbegovic, Laing & Bedford 2003).

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Intervention 2: It is evident from the extant academic literature that a low level of concern for disease prevention is a barrier for the desired behaviour (Omer et al. 2009). Due to the lack of concern, parents no longer perceive the threat of vaccine preventable diseases to be serious, nor their children to be susceptible. Rather, there is a belief that such diseases are rare and not life threatening (Hamilton et al. 2004). Thus, a potential intervention would entail a campaign that puts into perspective the seriousness of diseases by graphically displaying the number of people killed by diseases in third world countries as a proportion of a first world country. For example 145,700 people died of measles in 2013 – almost the population of Cairns (World Health Organisation 2015; Cairns Regional Council 2015). Additionally, comments from families who have suffered the devastating effects of diseases would generate empathy and a greater understanding of the severity of vaccine preventable diseases.

Intervention 3: The extant academic literature denotes that vaccine safety is a barrier for the desired behaviour (Omer et al. 2009). It is evident that the fear of vaccine preventable diseases has shifted to a fear of vaccine side effects (Chatterjee & O’Keefe 2010). However, the risks of side effects are far less than the risks of the severe and devastating effects of vaccine preventable diseases (Queensland Government 2015). Hence, a possible intervention may be centred on educating parents of immunisation by effectively communicating the benefits (World Health Organisation 2015). This may take the form of re-entering stories of affected children into the public discourse via health professionals to generate awareness and provide a cue to action (Leask et al. 2006).

6.0 ConclusionIt is clear that immunisation is extremely important as if enough people are immunised, an infection or disease can be eradicated altogether (Australian Government Department of Health 2015). However, there is an apparent segment of Australian parents of middle to upper socioeconomic status that refuse to immunise their children against vaccine preventable diseases (Leask et al. 2006; Smith et al. 2011). Academic literature

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suggests the application of the Health Belief Model in accordance with the cause of immunisation (Smith et al. 2011). The conceptual framework developed depicts the relationship between the model and the four antecedents of the problem behaviour. Possible interventions were framed upon this relationship in order to decrease the problem behaviour, and hence increase immunisation rates in Australia.

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7.0 ReferencesAlfredsson, R, Svensson, E, Trollfors, B & Borres, M.P 2004, ‘Acta Paediatrica’, Why do parents hesitate to vaccinate their children against measles, mumps and rubella?, vol. 93, no. 9, pp. 1232-1237.

Australian Academy of Science 2015, How are vaccines shown to be safe, viewed 6 August 2015, <https://www.science.org.au/publications/scienceofimmunisation-q-and-a-2012/safe>.

Australian Academy of Science 2015, What does the future hold for immunisation, viewed 6 August 2015, < https://www.science.org.au/6-what-does-future-hold-vaccination>.

Australian Academy of Science 2015, What is immunisation, viewed 6 August 2015, <https://www.science.org.au/publications/scienceofimmunisation-q-and-a-2012/what>.

Australian Academy of Science 2015, Who benefits from vaccines, viewed 6 August 2015, <https://www.science.org.au/publications/scienceofimmunisation-q-and-a-2012/benefits>.

Australian Government Department of Health and Ageing 2013, Myths and Realities: Responding to arguments against vaccination. A guide for providers, 5th edn, Commonwealth of Australia 2013.

Australian Government Department of Health 2015, Immunise Australia Program – Why Immunise, viewed 6 August 2015, <http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/why-immunise>.

Australian Government Department of Human Services 2015, Australian Childhood Immunisation Register, viewed 6 August 2015, <http://www.humanservices.gov.au/customer/services/medicare/australian-childhood-immunisation-register>.

Australian Government Department of Human Services 2015, Australian Childhood Immunisation Register (ACIR) statistics, viewed 6 August 2015, <http://www.humanservices.gov.au/corporate/statistical-information-and-data/australian-childhood-immunisation-register-statistics/>.

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http://www.humanservices.gov.au/customer/services/medicare/australian-childhood-immunisation-register

http://www.humanservices.gov.au/customer/services/medicare/australian-childhood-immunisation-register


Australian Government Department of Human Services 2015, Proposed changes to immunisation requirements, viewed 3 September 2015, <http://www.humanservices.gov.au/customer/news/proposed-changes-to-immunisation-requirements>.

Australian Vaccination-skeptics Network Inc. 2015, Make an informed vaccination choice, viewed 7 August 2015, <http://avn.org.au/making-an-informed-choice/make-an-informed-vaccination-choice/>.

Braunack-Mayer, A, Skinner, R, Collins, J, Tooher, R, Proeve, C, O’Keefe, M, Burgess, T, Watson, M & Marshall, H 2015, ‘American Journal of Public Health’, Ethical challenges in school-based immunisation programs for adolescents: a qualitative study, vol. 105, no. 7, pp. 1399-1403.

Cairns Regional Council 2015, Facts, figures & history, viewed 10 September 2015, <http://www.cairns.qld.gov.au/region/facts>.

Chatterjee, A & O’Keefe C 2010, ‘Expert Review of Vaccines’, Current controversies in the USA regarding vaccine safety, vol. 9, no. 5, pp. 497-502.

Diekema, D.S & the Committee on Bioethics 2005, ‘Journal of the American Academy of Pediatrics’, Responding to parental refusals of immunization of children, vol. 115, no. 5, pp. 1428-1431.

Gellin, B.G, Maibach, E.W & Marcuse, E.K 2000, ‘American Journal of Pediatrics’, Do parents understand immunizations? A national telephone survey, vol. 6, no. 5, pp. 1097-1102.

Hamilton, M, Corwin, P, Gower, S & Rogers, S 2004, ‘New Zealand Medical Journal’, Why do parents choose not to immunise their children?, vol. 117, no. 1189, pp. 1-6.

Jelleyman, T & Ure, A 2004, ‘New Zealand Medical Journal’, Attitudes to immunisation: a survey of health professionals in the Rotorua District, vol. 117, no. 1189, pp. 1-12.

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8.0 AppendicesNumber of deaths recorded from vaccine preventable diseases (Australian Academy of Science 2015).

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