Why Parents Miss Their Children's Immunization Visits

"We know that approximately 20 percent of our nation's young children are under-immunized, and previous research has identified many sociodemographic factors, such as lacking insurance or a usual source of care, that may lead to under-immunization. What we wanted to look at were families who actually had a place to go — their child has a health care provider — but they missed one or more immunization appointments," said the lead investigator, Melissa Stockwell, M.D., M.P.H., assistant professor of clinical pediatrics and population family health at Columbia University's College of Physicians & Surgeons and Mailman School of Public Health, medical director of the NewYork-Presbyterian Hospital Immunization Registry (EzVAC) and a pediatrician at NewYork-Presbyterian Morgan Stanley Children's Hospital.

"What we have identified are small steps that health care providers can take to improve keeping immunization appointments — such as talking with parents about the importance of immunizations, having open lines of communication with them, and making it easier for parents to schedule/reschedule appointments. We believe that the first step is making providers aware that how their clinic or office is set up can affect compliance with appointments — such as how long it takes to make an appointment or how rescheduling requests are processed," added Dr. Stockwell.

Dr. Stockwell and her research team surveyed the parents of 705 children under the age of three about immunization experiences. The interviews (conducted in both English and Spanish) took place at community health centers, hospital-based clinics, private practices, and community-based organizations in the Washington Heights, Harlem, Bronx, Upper East Side, and Upper West Side areas of New York City.

Parents who had to reschedule an appointment were found to be nearly four times as likely to miss their child's immunization appointment; those who had problems scheduling an appointment were also more likely to miss an appointment. Doubting the importance of vaccines made a parent more than three times as likely to miss appointments. Parents who reported difficulty communicating with their child's healthcare provider were nearly three times as likely to miss their child's scheduled immunization appointment.

A significant association was found between missed visits and under-immunization. Children whose parents reported missing an immunization visit were 2.5 times more likely to have been under-immunized (confirmed by parent-held immunization records, medical record or immunization registry).

"To remedy this situation, educational campaigns about the importance of immunization could help counter misperceptions about the benefits of these important protections against these potentially life-threatening, communicable diseases," said Dr. Stockwell. "Another possible solution may be the availability of online tools to help parents track their child's immunizations and give parents personal information about what immunizations their child needs and when they are due."

The findings were reported in a platform presentation on May 5, 2009, at the Pediatric Academic Societies (PAS) annual meeting in Baltimore, MD.

Online Management Tool Designed to Facilitate Immunizations

One example is an online immunization management tool that will be available to patients and their families through NewYork-Presbyterian Hospital's new personal health record portal, myNYP.org. (Introduced earlier this month, myNYP.org gives patients the ability to select and store personal medical information generated during their doctor and hospital visits at NewYork-Presbyterian.) Dr. David Vawdrey, from the Department of Biomedical Informatics at Columbia, Dr. Stockwell and colleagues at the Hospital worked with Microsoft to create the myNYP.org Immunization Management Tool, a personal immunization tracking and reminder program.

"This technology will give parents a powerful tool to ensure their child is current on their immunizations, making it easy to learn about the timing of various immunizations and their importance. In addition, using the myNYP.org Immunization Management Tool, they will also be able to print their child's immunization records — something that can be useful for fulfilling school requirements," says Dr. Stockwell.

Additional researchers involved in the missed immunization visit study were Sally E. Findley, Ph.D., professor of clinical population and family health and clinical sociomedical sciences, Columbia University Mailman School of Public Health; Matilde M. Irigoyen, M.D., chair, Department of Pediatrics, Albert Einstein Medical Center, Philadelphia, Pa.; and Raquel Andres Martinez, Ph.D., associate research scientist, Department of Pediatrics, Columbia University College of Physicians and Surgeons.

The research study was funded by the National Center for Immunization and Respiratory Diseases of the Centers for Disease Control and Prevention.