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Participation in and attitude towards the national immunization program in the Netherlands: data from population-based questionnaires.

Mollema L, Wijers N, Hahné SJ, van der Klis FR, Boshuizen HC, de Melker HE - BMC Public Health (2012)

Bottom Line: Ninety-five percent of parents reported that they or their child (had) participated in the NIP.Groups with a lower income or educational level or of non-Western descent participated less in the NIP than those with a high income or educational level or indigenous Dutch and have been less well identified previously.Particular attention ought to be given to these groups as they contribute in large measure to the rate of nonparticipation in the NIP, i.e., to a greater extent than well-known vaccine refusers such as specific religious groups and anthroposophics.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Infectious Disease Control Netherlands, RIVM, Bilthoven, The Netherlands. Liesbeth.Mollema@rivm.nl

ABSTRACT

Background: Knowledge about the determinants of participation and attitude towards the National Immunisation Program (NIP) may be helpful in tailoring information campaigns for this program. Our aim was to determine which factors were associated with nonparticipation in the NIP and which ones were associated with parents' intention to accept remaining vaccinations. Further, we analyzed possible changes in opinion on vaccination over a 10 year period.

Methods: We used questionnaire data from two independent, population-based, cross-sectional surveys performed in 1995-96 and 2006-07. For the 2006-07 survey, logistic regression modelling was used to evaluate what factors were associated with nonparticipation and with parents' intention to accept remaining vaccinations. We used multivariate multinomial logistic regression modelling to compare the results between the two surveys.

Results: Ninety-five percent of parents reported that they or their child (had) participated in the NIP. Similarly, 95% reported they intended to accept remaining vaccinations. Ethnicity, religion, income, educational level and anthroposophic beliefs were important determinants of nonparticipation in the NIP. Parental concerns that played a role in whether or not they would accept remaining vaccinations included safety of vaccinations, maximum number of injections, whether vaccinations protect the health of one's child and whether vaccinating healthy children is necessary. Although about 90% reported their opinion towards vaccination had not changed, a larger proportion of participants reported to be less inclined to accept vaccination in 2006-07 than in 1995-96.

Conclusion: Most participants had a positive attitude towards vaccination, although some had doubts. Groups with a lower income or educational level or of non-Western descent participated less in the NIP than those with a high income or educational level or indigenous Dutch and have been less well identified previously. Particular attention ought to be given to these groups as they contribute in large measure to the rate of nonparticipation in the NIP, i.e., to a greater extent than well-known vaccine refusers such as specific religious groups and anthroposophics. Our finding that the proportion of the population inclined to accept vaccinations is smaller than it was 10 years ago highlights the need to increase knowledge about attitudes and beliefs regarding the NIP.

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Overview of the number of invited persons and the number of questionnaires (response rates) per sample and per survey.
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Figure 1: Overview of the number of invited persons and the number of questionnaires (response rates) per sample and per survey.

Mentions: Two independent population-based cross-sectional serosurveillance surveys were carried out in the Netherlands between October 1995 and December 1996 (the first survey) and between February 2006 and June 2007 (the second survey) to establish a serum bank for the general population. The serum bank was to be used to estimate age-specific antibody levels against all vaccine preventable diseases in the (future) NIP and also of other diseases. Both surveys had a similar design, which has been described previously [11,12]. Briefly, the Netherlands were divided into five geographical regions of approximately equal population size. In each of the five regions a random sample of eight municipalities was drawn, proportional to the number of inhabitants. Within each municipality, an age-stratified sample (0, 1-4, 5-9, . . ., 75-79 years) of 380-500 persons (males and females) was drawn from the municipal health registers. In addition to the nationwide sample (NS), an age-stratified sample (similar as for the NS) from eight municipalities with low vaccination coverage (LVC) was drawn to assess the seroprevalence of groups of persons in sociogeographic clusters who refuse vaccination for religious reasons (known locally as the "Dutch Bible Belt"). The municipalities in the LVC sample were chosen on the basis of consistently low vaccination coverage (in the first survey for DTP-IPV for the years 1982-1993 and in the second survey for MMR and DTaP/IPV for birth cohorts 1997-2001) and the condition of representation of several provinces. The Dutch Bible Belt stretches from the southwest of the Netherlands to just above the centre in the northeast. In the second survey (2006-07), an extra sample from non-Western migrants was drawn from 12 of the 40 municipalities in the NS. We distinguished twelve migrant groups according to country of birth (1. Morocco and Turkey, 2. Suriname, Aruba and Netherlands Antilles and 3. Other non-Western countries), age (0-9 years, 10-49 years and 50-79 years) and first and second generation (only for 0-9 year-olds). A first-generation migrant was defined as somebody who was born abroad, immigrated to the Netherlands and whose parents (one or both) were born abroad. A second-generation migrant was defined as somebody who was born in the Netherlands and whose parents (one or both) were born abroad. The distribution of migrants per degree of urbanization (i.e., the number of addresses per km2) in the Netherlands was used to select the municipalities in which the oversampling of migrants took place. Figure 1 shows the number of invited persons per sample and per survey.


Participation in and attitude towards the national immunization program in the Netherlands: data from population-based questionnaires.

Mollema L, Wijers N, Hahné SJ, van der Klis FR, Boshuizen HC, de Melker HE - BMC Public Health (2012)

Overview of the number of invited persons and the number of questionnaires (response rates) per sample and per survey.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3298495&req=5

Figure 1: Overview of the number of invited persons and the number of questionnaires (response rates) per sample and per survey.
Mentions: Two independent population-based cross-sectional serosurveillance surveys were carried out in the Netherlands between October 1995 and December 1996 (the first survey) and between February 2006 and June 2007 (the second survey) to establish a serum bank for the general population. The serum bank was to be used to estimate age-specific antibody levels against all vaccine preventable diseases in the (future) NIP and also of other diseases. Both surveys had a similar design, which has been described previously [11,12]. Briefly, the Netherlands were divided into five geographical regions of approximately equal population size. In each of the five regions a random sample of eight municipalities was drawn, proportional to the number of inhabitants. Within each municipality, an age-stratified sample (0, 1-4, 5-9, . . ., 75-79 years) of 380-500 persons (males and females) was drawn from the municipal health registers. In addition to the nationwide sample (NS), an age-stratified sample (similar as for the NS) from eight municipalities with low vaccination coverage (LVC) was drawn to assess the seroprevalence of groups of persons in sociogeographic clusters who refuse vaccination for religious reasons (known locally as the "Dutch Bible Belt"). The municipalities in the LVC sample were chosen on the basis of consistently low vaccination coverage (in the first survey for DTP-IPV for the years 1982-1993 and in the second survey for MMR and DTaP/IPV for birth cohorts 1997-2001) and the condition of representation of several provinces. The Dutch Bible Belt stretches from the southwest of the Netherlands to just above the centre in the northeast. In the second survey (2006-07), an extra sample from non-Western migrants was drawn from 12 of the 40 municipalities in the NS. We distinguished twelve migrant groups according to country of birth (1. Morocco and Turkey, 2. Suriname, Aruba and Netherlands Antilles and 3. Other non-Western countries), age (0-9 years, 10-49 years and 50-79 years) and first and second generation (only for 0-9 year-olds). A first-generation migrant was defined as somebody who was born abroad, immigrated to the Netherlands and whose parents (one or both) were born abroad. A second-generation migrant was defined as somebody who was born in the Netherlands and whose parents (one or both) were born abroad. The distribution of migrants per degree of urbanization (i.e., the number of addresses per km2) in the Netherlands was used to select the municipalities in which the oversampling of migrants took place. Figure 1 shows the number of invited persons per sample and per survey.

Bottom Line: Ninety-five percent of parents reported that they or their child (had) participated in the NIP.Groups with a lower income or educational level or of non-Western descent participated less in the NIP than those with a high income or educational level or indigenous Dutch and have been less well identified previously.Particular attention ought to be given to these groups as they contribute in large measure to the rate of nonparticipation in the NIP, i.e., to a greater extent than well-known vaccine refusers such as specific religious groups and anthroposophics.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Infectious Disease Control Netherlands, RIVM, Bilthoven, The Netherlands. Liesbeth.Mollema@rivm.nl

ABSTRACT

Background: Knowledge about the determinants of participation and attitude towards the National Immunisation Program (NIP) may be helpful in tailoring information campaigns for this program. Our aim was to determine which factors were associated with nonparticipation in the NIP and which ones were associated with parents' intention to accept remaining vaccinations. Further, we analyzed possible changes in opinion on vaccination over a 10 year period.

Methods: We used questionnaire data from two independent, population-based, cross-sectional surveys performed in 1995-96 and 2006-07. For the 2006-07 survey, logistic regression modelling was used to evaluate what factors were associated with nonparticipation and with parents' intention to accept remaining vaccinations. We used multivariate multinomial logistic regression modelling to compare the results between the two surveys.

Results: Ninety-five percent of parents reported that they or their child (had) participated in the NIP. Similarly, 95% reported they intended to accept remaining vaccinations. Ethnicity, religion, income, educational level and anthroposophic beliefs were important determinants of nonparticipation in the NIP. Parental concerns that played a role in whether or not they would accept remaining vaccinations included safety of vaccinations, maximum number of injections, whether vaccinations protect the health of one's child and whether vaccinating healthy children is necessary. Although about 90% reported their opinion towards vaccination had not changed, a larger proportion of participants reported to be less inclined to accept vaccination in 2006-07 than in 1995-96.

Conclusion: Most participants had a positive attitude towards vaccination, although some had doubts. Groups with a lower income or educational level or of non-Western descent participated less in the NIP than those with a high income or educational level or indigenous Dutch and have been less well identified previously. Particular attention ought to be given to these groups as they contribute in large measure to the rate of nonparticipation in the NIP, i.e., to a greater extent than well-known vaccine refusers such as specific religious groups and anthroposophics. Our finding that the proportion of the population inclined to accept vaccinations is smaller than it was 10 years ago highlights the need to increase knowledge about attitudes and beliefs regarding the NIP.

Show MeSH
Related in: MedlinePlus