Identifying factors behind the general practice use of the term ‘decline’ for the childhood immunisation programme in New Zealand
Nikki Turner 1 , Lynn Taylor 1 , Angela Chong 1 , Barbara Horrell 11 Department of General Practice and Primary Care, University of Auckland, Private Bag 92019, Victoria Street West, Auckland 1142, New Zealand
Correspondence to: Nikki Turner, Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Victoria Street West, Auckland 1142, New Zealand. Email: n.turner@auckland.ac.nz
Journal of Primary Health Care 9(1) 69-77 https://doi.org/10.1071/HC16031
Published: 17 February 2017
Journal Compilation © Royal New Zealand College of General Practitioners 2017.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: The role of healthcare providers and their use of systems is one of the most important factors in vaccination uptake.
AIM: To identify reasons and find patterns behind why immunisation providers code the word ‘decline’ in their system for childhood immunisation events.
METHODS: A qualitative study involving face-to-face semi-structured interviews with staff members involved in immunisation delivery. General practices were purposively selected for having either high or low rates of registered children coded on the electronic practice management system as having declined immunisation events. Thematic analysis was undertaken using an inductive approach to link themes to the data.
RESULTS: A total of 35 interviews were conducted with practice nurses; 21 were from practices with high rates of registered children recorded as having declining immunisation events, and 14 practices with low rates of declining. Common themes were: effective use of systems, early and ongoing engagement, adequate health care practitioner time and practitioner experience. Practices with low rates of coded decliners had stronger approaches for early and ongoing engagement, and were less likely to use formalised decline forms. As practice immunisation coverage rates improved over time, there was perceived to be less expressed vaccine hesitancy from families.
CONCLUSIONS: The reasons for coding individuals as ‘decliners’ are a complex mixture of individual, community, practitioner and practice systems. Front-line providers need adequate tools, time and resourcing to support effective and ongoing engagement with families. Community factors have influence but can change over time.
KEYWORDS: Immunisation, Immunisation coverage, Primary care, Systems
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