Digital Projects Presentation

Author: Lucas Smith

Increasing Pediatric Vaccination Rates

Strategies for health care providers to implement to increase pediatric vaccination rates in outpatient clinics

Healthy People 2030: Reduce the proprotion of children who get no recommended vaccines by the age of 2 years - IID02

Start

Table of Contents

04

01

Why is change needed?

Learning Objectives

Outcomes of Presentation

Necessity of this change project

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02

Parental/Caregiver Hesitancy

Vulnerability

Infants as a vulnerable population

What it is & How to address it

Increasing Vaccination Rates

06

03

Importance of Infant Vaccination

Evidence-based strategies providers can use to increase vaccination rates in outpatient clinics

Why are vaccinations vital to infant health?

Learning Objectives

After reading presented material, subjects will be able to...

• Define parental/caregiver vaccine hesitancy and identify why it exists
• Recognize why vaccination is important for infants
• Identify why change is needed
• Explain how infants are a vulnerable population
• List strategies providers and outpatient clinics can utilize to increase pediatric and infant vaccination rates
• Address parental/caregiver hesitancy
• Understand the need for enhancing access to vaccination services
• Address the presented Healthy People 2030 objective

Parental / Caregiver Vaccine Hesitancy

What is parental/caregiver vaccine hesitancy?

The World Health Organization (WHO) defines vaccine hesitancy as the delay in the acceptance of safe vaccines desipte their availability (2015).

Why does it exist?

• False claims that vaccination causes autism
• Fear of adverse reactions
• 2020 COVID-19 pandemic and vaccine media coverage
• Cultural and religious beliefs
• Cost of healthcare and poor access to vaccination services

Importance of Infant Vaccination

Why are vaccinations vital to infant health?

According to the Centers for Disease Control and Prevention (CDC), vaccines can prevent common diseases that used to harm and kill infants, children, and adults (2023).

• Vaccines help teach the immune system learn how to defend against germs
• Vaccination protects babies by building up their natural defenses, as their immune systems are not fully developed at birth
• Vaccination can decrease sickness and hospitalization rates in infants
• Vaccinations are important for those who rely on herd immunity to avoid contracting a virus

The Need for Change

The state of West Virginia is one of the bottom five states for child vaccination rates

Legislators in WV introduced House Bill 5105 in January 2024 with the goal of eliminating vaccine requirements for public virtual schools The passing of HB 5105 will further decrease childhood vaccination rates, thus increasing the risk of illness for WV infants UPDATE: On March 27, 2024, Governor Jim Justice vetoed the Bill Vaccination rates remain low compared to the national average

Infants as a Vulnerable Population

What is a vulnerable population?

• Those who experience greater risk factors for poor health outcomes due to race, ethnicity, or sexual preferences
• Children
• Elderly
• Socioeconomically disadvantaged
• Underinsured individuals
• Those with certain medical conditions

Children are considered a vulnerable population because they lack autonomy and are subject to the care of those around them

Vulnerability in relation to vaccines

Infants and children are at decreased risk for vaccination, as they lack autonomy and are unable to receive vaccinations without proper parental decision-making and medical care

Vulnerability in relation to geographical area

18.2% of individuals in Jackson County are living in poverty, which places them at increased risk for health disparities and classifies them as a vulnerable population

Strategies to Increase Vaccination Rates

How can providers and outpatient clinics increase vaccination rates?

• Become a Vaccines for Children (VFC) Provider
• Text-message and phone-call reminders to parents before appointments
• Face-to-face training
• Tech-based training
• Educational handouts

• Standing orders
• Provider reminders such as notes posted in charts, alerts in electronic medical record, or letters sent by mail or email
• Surveys to assess how parents feel about vaccines to tailor interventions towards preventing and addressing hesitancy
• Immunization Information Systems

Educating providers of these interventions is vital, as they are only useful if providers are aware of them and implement them into practice

Table of Contents Cont.

04

07

Addressing Hesitancy

Test Your Knowledge

How to address parental/caregiver vaccine hesitancy

Final Quiz

08

Enhancing Access

Recognize the need for enhancing access to vaccination services

09

Final Thoughts

How the Healthy People 2030 objective was addressed

Addressing Vaccine Hesitancy

How to address parental/caregiver vaccine hesitancy

Providers should be aware of reasonings behind hesitancy and address them accordingly

• Families of various cultures may refuse vaccines because of a belief-system; it is vital to respond to these individuals with ethically appropriate responses
• Explain to parents the misinformations about vaccines
• Listen to parents' concerns and approach them in a non-confrontational manner
• Stress the number of lives saved by immunizations
• Provide parents of children in clinics with surveys to assess their vaccination beliefs and tailor conversations toward those beliefs
• Provide educational handouts and resources about specific vaccines

Enhancing Access to Vaccinations

The need for enhancing vaccination services for children comes from the concept of vulnerable populations

Children are among the most marginalized and vulnerable members of society and are rarely consulted on decisions that directly affect them

West Virginia is a rural state, and mortality among children in rural states is approximately 25% higher than urban children

What can providers do to combat these issues?

• Become a VFC Provider
• Volunteer in free clinics and in high-risk areas
• Be aware that everyone has a voice and the power to make a difference when it comes to advocating for infant health

Healthy People 2030 - IID02

Reduce the proportion of children who get no recommended vaccines by the age of 2 years

This online learning tool addresses this objective by

• Defining parental/caregiver vaccine hesitancy and identify why it exists
• Recognizing why vaccination is important for infants
• Identifying why change is needed in this geographical area
• Explaining how infants are a vulnerable population
• Listing strategies providers and outpatient clinics can utilize to increase pediatric and infant vaccination rates
• Addressing parental/caregiver hesitancy
• Understanding the need for enhancing access to vaccination services

Congratulations! Thank you for completing this online educational tool on childhood vaccinations Author: Lucas Smith West Virginia University at Parkersburg RN-BSN Program 2024

References

Düzgün & Dalgiç (2022)

found that text-message reminders of vaccines before appointments, face-to-face training, tech-based training, and educational handouts were all effective interventions in reducing parental vaccine hesitancy and increasing vaccination rates.

Evidence they collected showed educational tools to be a large factor in increasing vaccination rates and decreasing hesitancy.

Approximately 18.2% of individuals in Jackson County, WV live in poverty according to the United States Census Bureau (n.d.).

The Community Preventive Services Task Force (n.d.a) lists standing orders as an intervention to increase vaccination rates; in which nurses, pharmacists, and other healthcare providers can assess immunization status and administer vaccines according to a protocol approved by an institution, physician, or other authorized provider.

Children living in rural areas experience increased health disparities compared to nonrural children; this is evidenced by comparing mortality rates between the two groups, where the mortality rate among rural children is approximately 25% higher than urban children (Bettenhausen et al., 2021).

Kroger et al. (2023) stresses the importance of Immunization Information Systems (IISs), in which computerized information systems collect and consolidate vaccination data from multiple healthcare providers and generates reminder and recall vaccination notices for each person (Kroger et al., 2023, p. 174).

According to Columbia Mailman School of Public Health (2021), herd immunity describes a situation in which a large part of a population is immune to a disease due to vaccination or previously contracting the illness and developing antibodies; this is important because not everyone in a population is able to be vaccinated (immunocompromised, babies, newborns, undergoing chemotherapy treatments) and rely on herd immunity to avoid contracting a virus.

He et al. (2022) used a survey in their research to assess how parents feel about vaccines, and this is a great way to tailor interventions towards preventing and addressing hesitancy.

According to Columbia Mailman School of Public Health (2021), herd immunity describes a situation in which a large part of a population is immune to a disease due to vaccination or previously contracting the illness and developing antibodies; this is important because not everyone in a population is able to be vaccinated (immunocompromised, babies, newborns, undergoing chemotherapy treatments) and rely on herd immunity to avoid contracting a virus.

A study performed by He et al. (2020) proved that the greatest change during the pandemic for childhood vaccine hesitancy can be attributed to increased risk perception and the concern for safety of all vaccines.

Children under eighteen years old account for almost one-third of the world’s population; they are also among the most marginalized and vulnerable members of society and are rarely consulted on decisions that directly affect them (United National Global Impact, n.d.).

According to Columbia School of Nursing (n.d.), vulnerable populations include those who experience greater risk factors for poor health outcomes due to their race, ethnicity, or sexual preferences; also included are children, the elderly, socioeconomically disadvantaged, underinsured individuals, or those with certain medical conditions.

The CPSTF (n.d.b) also recommends the use of provider reminders where reminders are delivered to providers in various ways such as notes posted in client charts, alerts in the electronic-medical records, or letters sent by mail or email to remind them when clients are due for specific vaccinations.

American Academy of Pediatrics (2024).

Children living in rural areas experience increased health disparities compared to nonrural children; this is evidenced by comparing mortality rates between the two groups, where the mortality rate among rural children is approximately 25% higher than urban children (Bettenhausen et al., 2021).

Data collected by the State Health Access Data Assistance Center shows West Virginia as one of the bottom five states for child vaccination rates in 2021 at 56.6%, where the national average is 72.1% (Hest 2024).

Stocksy. (n.d.). Happy baby smiling [Photograph]. https://www.stocksy.com/1347611/happy-baby-smiling Adobe Stock. (n.d.). West Virginia map with capital city [Photograph]. https://stock.adobe.com/images/west-virginia-map-with-capital-city/354526458 American Academy of Pediatrics. (2024). Talking with vaccine hesitant parents. https://www.aap.org/en/patient-care/immunizations/communicating-with-families-and-promoting-vaccine-confidence/talking-with-vaccine-hesitant-parents/ Bettenhausen, J., Winterer, C., & Colvin, J. (2021). Health and poverty of rural children: An under-researched and under-resourced vulnerable population. Academic Pediatric, 21(8), S126-S133. https://doi.org/10.1016/j.acap.2021.08.001 Centers for Disease Control and Prevention. (2023a). Making the vaccine decision: Addressing common concerns. Vaccines for Your Children. https://www.cdc.gov/vaccines/parents/why-vaccinate/vaccine-decision.html#:~:text=Vaccines%20can%20prevent%20common%20diseases,as%20measles%20and%20whooping%20cough. Centers for Disease Control and Prevention. (2023b). About the vaccines for children program (VFC). https://www.cdc.gov/vaccines/programs/vfc/about/index.html Columbia Mailman School of Public Health. (2021). The relationship between vaccines and herd immunity. https://www.publichealth.columbia.edu/news/relationship-between-vaccines-herd-immunity Columbia School of Nursing. (n.d.). High risk, underserved, or vulnerable populations. https://www.nursing.columbia.edu/research/research-areas-focus/high-risk-underserved-and-vulnerable-populations#:~:text=These%20include%20individuals%20who%20experience,those%20with%20certain%20medical%20conditions. Community Preventive Services Task Force. (n.d.a). Vaccination programs: Standing orders. https://www.thecommunityguide.org/findings/vaccination-programs-standing-orders.html Community Preventive Services Task Force. (n.d.b). Vaccination programs: Provider reminders. https://www.thecommunityguide.org/findings/vaccination-programs-provider-reminders.html Doctor Ana. (n.d.). Newborn checkup schedule [Photograph]. TopLine MD Alliance. https://www.toplinemd.com/ana-hpmd/newborn-checkup-schedule/ Düzgün, M. V. & Dalgiç, A. (2022). The effect of interventions on the prevention of parental vaccine refusal and hesitancy: A systematic review and meta-analysis of randomized controlled trials. Journal of Current Pediatrics / Guncel Pediatri, 20(3), 379-391. https://doi.org/10.4274/jcp.2022.13334 He, K., Mack, W. J., Neely, M., & Anand, V. (2022). Parental perspectives on immunizations: Impact of the COVID-19 pandemic on childhood vaccine hesitancy. Journal of Community Health, 47(1), 39-52. https://doi.org/10.1007/s10900-021-01017-9 Hest, R. (2024). Revised childhood vaccinations measure on state health compare shows vaccination rates vary by state, race/ethnicity, and insurance coverage. State Health Access Data Assistance Center. https://www.shadac.org/news/childhood-vaccinations-rate-by-state-ethnicity-insurance#:~:text=For%20example%2C%20in%202021%2C%20the,high%20as%2087.9%25%20in%20Iowa. Kroger, A., Bahta, L., Long, S., & Sanchez, P. (2023). General best practice guidelines for immunization: Best practice guidance. Vaccine Recommendations and Guidelines of the ACIP. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/downloads/general-recs.pdf Northwoods Pediatric Center. (n.d.). What to expect at your child’s first appointment to the pediatrician [Photograph]. https://www.northwoodspediatric.com/2021/09/17/what-to-expect-at-your-childs-first-appointment-to-the-pediatrician/ Seisay, M. (2023). How multiracial families can preserve black culture for their children [Photograph]. https://www.parents.com/kindred/how-multiracial-families-can-preserve-black-culture-for-their-children/ Sinch Message Media. (2021). How to reduce no shows with text reminders for patients [Photograph]. https://messagemedia.com/us/blog/reduce-no-shows-text-reminders-patients/ Tiptipot Library. (n.d.). Your infant has a cold but no fever – Are they sick? [Photograph]. https://www.tiptipot.com/?CategoryID=461&ArticleID=486 UNCAS Health District. (2024). National infant immunization week: Protecting our littlest ones [Photograph]. https://uncashd.org/national-infant-immunization-week-protecting-our-littlest-ones/ United Nations Global Impact. (n.d.). Children’s rights. https://unglobalcompact.org/what-is-gc/our-work/social/childrens-rights University of Maryland School of Public Health. (2021). Redefining ‘health and well-being’ in Healthy People 2030 [Photograph]. https://sph.umd.edu/news/redefining-health-and-well-being-healthy-people-2030 West Virginia Legislature. (2024). House Bill 5105. https://www.wvlegislature.gov/Bill_Status/Bills_history.cfm?input=5105&year=2024&sessiontype=RS&btype=bill World Health Organization. (2015). Vaccine hesitancy: A growing challenge for immunization programmes. https://www.who.int/news/item/18-08-2015-vaccine-hesitancy-a-growing-challenge-for-immunization-programmes ZaggoCare. (2021). 10 tips to communicate better with doctors [Photograph]. https://zaggocare.org/communicate-better-with-doctors/

In 1994, the Vaccines for Children Program (VFC) became operational; this program provides free vaccines for eligible children at no cost to VFC Program-enrolled providers and eliminates vaccine cost as a barrier to encourage vaccination (Centers for Disease Control and Prevention, 2023b).