Parental empowerment in the MMR vaccination decision-making. Exploration and measurement
Deciding about whether or not to perform a vaccination on one’s child is among the first health-related decisions parents have to confront with after the baby’s birth. Since, like most countries in Europe (Haverkate et al., 2012), Switzerland does not have any mandatory vaccinations, parents are expected to possess the relevant and accurate information regarding both the risks and the benefits of the vaccination compared to the disease, the skills to judge what is more appropriate for their child, and the motivation to engage autonomously in such a decision. In other words, they should be knowledgeable and empowered in order to make their choice. Seen the suboptimal MMR coverage that Switzerland currently displays (FOPH, 2014), we speculated that the MMR vaccination refusal may be due to a lack of parental knowledge on the one hand, and an excess in their empowerment on the other. This combination results in parents making a decision driven by inaccurate information and an excessive desire to be autonomous in deciding without the guidance of the relevant health professionals. Since health empowerment is currently advocated as one of the key elements of the new health care consumer model, it is crucial to have a standardized measurement instrument to empirically assess the empowerment construct in different health-related contexts, including parental vaccination decision-making.
Our aim is to develop an empowerment measurement scale to be used in the context of the MMR vaccination decision-making. To do this, we first plan to conduct a qualitative exploration of the concept of the empowerment among a sample of parents residing in a low MMR coverage area. Considered that Ticino has a relatively high MMR coverage (FOPH, 2014), we chose the Autonomous Province of Bolzano (Italy) to sample our participants, where MMR vaccination coverage is only at 71.5% (Italian Ministry of Health, 2013), the lowest in Italy.
The project will follow three main steps: a qualitative exploration of the concept of psychological empowerment with parents sampled from an Italian province with a low MMR vaccination coverage (A.P. of Bolzano), the development of a scale to measure psychological empowerment in the context of the MMR vaccination using the data from the qualitative study, and the administration of the scale to a bigger sample of parents (location to be defined, most likely A.P. of Bolzano).
Step 1. We aim at conducting three focus groups with ten participants each. Inclusion criteria will be being a mother or a father of at least one child between six months and six years-old, being resident in the Province of Bolzano and being fluent in Italian. Each focus group will last about one hour and will be conducted by the main researchers. Participants will be recruited through local health authorities and will be offered a reward for their participation. At the end of each focus groups, a questionnaire will be administered to each participant containing a validated vaccination literacy scale (Zingg & Siegrist, 2012) and a number of socio-demographic questions (gender, age, origin, education, marital status, employment status, number and age of children). Participant will be given an ID to match data from the interview with questionnaire results. Focus group interviews will be tape-recorded and transcribed, and transcriptions will be analyzed thematically employing an inductive approach on the basis of a pre-defined coding scheme grounded in the empowerment conceptualization by Schulz and Nakamoto (2013), that defines empowerment as a motivational construct made by four sub-dimensions (self-determination, self-efficacy, meaningfulness and impact).
Step 2. The results from the qualitative focus groups will shed new light on the operationalization of the concept of psychological empowerment in the context of the MMR vaccination decision-making. A new scale will be developed at this stage to include items used in previous surveys and new questions based on themes arisen from the interviews. The vaccination empowerment scale will be administered together with a general empowerment scale made by available validated measurements (e.g.: General Self-Efficacy Scale by Schwarzer et al., 1995).
Step 3. The last step envisages the administration of the MMR vaccination empowerment scale and the general empowerment scale to a sample of 250 parents with at least one child under the age of ten from the Province of Bolzano. The scale will be included in an online questionnaire together with a vaccination literacy scale (Zingg & Siegrist, 2012) and socio-demographic questions (gender, age, origin, education, marital status, employment status, number of children, their age and vaccination status). The survey results will yield insights for a final version of the scale which will be employed in a later experimental study.