Nursing Review talks to paediatrician Cameron Grant about some of the take-home messages around childhood immunisation in the longitudinal Growing Up in New Zealand study.
The Growing Up in New Zealand study found that children of fathers (or partners) who receive discouraging information about immunisation during their partner’s pregnancy are 50 per cent more likely to have delayed immunisations.
Cameron Grant, a Starship Hospital paediatrician and associate director of the major longitudinal study, says the messages given to partners are a really important issue. “I worry that partners are a wee bit excluded from some of the conversations that happen during pregnancy.”
The study interviewed 6,172 of the pregnant women enrolled in the study, along with 4,158 partners (mainly the biological fathers of the babies) about their immunisation intentions prior to the birth and where they had received their information on immunisation from.
It found that expectant parents who received information discouraging them from immunising their child were twice as likely not to get their baby vaccinated on time as those who didn’t. (Timely vaccination was defined as babies receiving their six-week, three-month and five-month vaccinations within 30 days of the due date).
The impact was greater if mothers were discouraged, with 60 per cent of their babies receiving timely vaccinations compared with 73 per cent of babies of mothers who didn’t receive discouraging information. But ‘discouraged’ partners also had an impact on timely vaccination, with 64 per cent of their babies not being vaccinated on time, compared with the 74 per cent of babies whose fathers had not been given discouraging information.
In all, 14 per cent of mothers and 13 per cent of fathers reported being aware of discouraging information, compared with 39 per cent of mothers and 30 per cent of fathers who reported receiving encouraging information.
The ‘encouraged’ mothers were most likely to get their information from a midwife (62 per cent) and the fathers also, but to a lesser extent (44 per cent), followed by the would-be parents’ GP. Fathers were more likely than mothers to be informed – for or against – by what they hear, read or see from family, friends, antenatal classes, television and the internet.
Cameron Grant believes the findings show that it is important to give fathers an opportunity to express their concerns and give them the chance to be informed by people who are knowledgeable.
“This is an area where nurses could make a significant contribution.”
Are healthcare professionals positive or negative role models?
Some of the study’s findings of concern included finding out that more than half of the pregnant women interviewed had received no information – good or bad – about immunising their baby.
Healthcare professionals were the most common source of encouraging information but – for a minority of parents – some healthcare professionals were the source of a negative message.
Midwives were described as the source of discouraging information by 11 per cent of pregnant women and 8 per cent of their partners, and GPs were cited by 3 per cent of parents.
“Healthcare providers are a source of a negative message for about one in six of the parents who said they got a negative message,” said Grant.
“I think healthcare professionals need to behave as healthcare professionals and, even if they have got personal opinions on these things, it is inappropriate for them to express them in a professional context.”
The study shows that while discouraging information had a negative impact on the timeliness of vaccination, receiving encouraging information had no positive effect at all on babies receiving that important first vaccination on time.
“The whole reason vaccinations start so early is you don’t get much immunity from your mum against whooping cough,” says Grant.”So you are very, very vulnerable early on and the babies that we see who die from whooping cough are in the first couple of months of life.
“Breastfeeding certainly helps against some infections but some of these vaccine-preventable ones it doesn’t.
“So I think we need to be doing better at selling the positive immunisation message. And that is somewhere that nurses can make a positive contribution.”
Just remember to include the dads too.
Growing up in New Zealand
- 6,822 pregnant women and 4,401 of their partners living in the Auckland, Counties-Manukau and Waikato district health board areas were recruited into the longitudinal Growing Up in New Zealand study.
The study cohort is made up of around 7,000 of the resulting babies born between Anzac Day 2009 and 25 March 2010.
Of the children, 24 per cent identify as Māori, 21 per cent as Pacific Island, 16 per cent as Asian and 66 per cent as European (or other).
The study is following the growth and development of the children until they are at least 21 years old.
More information on the study’s initial findings can be found at www.growingup.co.nz