Characteristics of 5-year-olds who catch-up with MMR: findings from the UK Millennium Cohort Study

Objectives To examine predictors of partial and full measles, mumps and rubella (MMR) vaccination catch-up between 3 and 5 years. Design Secondary data analysis of the nationally representative Millennium Cohort Study (MCS). Setting Children born in the UK, 2000–2002. Participants 751 MCS children who were unimmunised against MMR at age 3, with immunisation information at age 5. Main outcome measures Catch-up status: unimmunised (received no MMR), partial catch-up (received one MMR) or full catch-up (received two MMRs). Results At age 5, 60.3% (n=440) children remained unvaccinated, 16.1% (n=127) had partially and 23.6% (n=184) had fully caught-up. Children from families who did not speak English at home were five times as likely to partially catch-up than children living in homes where only English was spoken (risk ratio 4.68 (95% CI 3.63 to 6.03)). Full catch-up was also significantly more likely in those did not speak English at home (adjusted risk ratio 1.90 (1.08 to 3.32)). In addition, those from Pakistan/Bangladesh (2.40 (1.38 to 4.18)) or ‘other’ ethnicities (such as Chinese) (1.88 (1.08 to 3.29)) were more likely to fully catch-up than White British. Those living in socially rented (1.86 (1.34 to 2.56)) or ‘Other’ (2.52 (1.23 to 5.18)) accommodations were more likely to fully catch-up than home owners, and families were more likely to catch-up if they lived outside London (1.95 (1.32 to 2.89)). Full catch-up was less likely if parents reported medical reasons (0.43 (0.25 to 0.74)), a conscious decision (0.33 (0.23 to 0.48)), or ‘other’ reasons (0.46 (0.29 to 0.73)) for not immunising at age 3 (compared with ‘practical’ reasons). Conclusions Parents who partially or fully catch-up with MMR experience practical barriers and tend to come from disadvantaged or ethnic minority groups. Families who continue to reject MMR tend to have more advantaged backgrounds and make a conscious decision to not immunise early on. Health professionals should consider these findings in light of the characteristics of their local populations

The Effect of a Voice-Centered Psycho-Educational Program on Maternal Self-Efficacy: A Feasibility Study

This study examined the effect of a brief psycho-educational program, Time Together, on maternal self-efficacy, mother-infant bonding, and mood/anxiety for community-based mothers. This program centered on maternal voice, timing of interplay, and recognition of infant cues. A convergent parallel mixed-methods design included quantitative measures: the Karitane Parenting Confidence Scale, the Mother-Infant Bonding Scale, Edinburgh Postnatal Depression Scale and State & Trait Anxiety Inventory, and a sequential qualitative analysis to elaborate on the quantitative findings. Significant changes on the Karitane Parenting Confidence Scale were found. Qualitative analysis of the participant interviews and reflective diaries from the two weeks following the psycho-educational program confirmed that participation enhanced mothers’ ability to understand their infant, to soothe their infant when distressed, to play and to establish an effective bedtime routine. This feasibility study indicated that this is a promising approach to improve early mother-infant interaction and maternal self-efficacy

Health visitors’ perception of their role in the universal childhood immunisation programme and their communication strategies with parents

Aim: This study explored health visitors’ perception of their role in the universal childhood immunisation programme with particular emphasis on influencing factors and communication strategies. Background: The majority of parents’ consent to immunisation, but some find decision-making in this area difficult and have unmet information needs. In the United Kingdom, health visitors routinely provide immunisation information for parents, whereas general practitioners (GPs) and practice nurses tend to administer vaccines and respond to parents/carers’ questions. Research has investigated health professionals’ views and knowledge about immunisation, but less is understood about health visitors’ role and how they communicate with parents. Method: Following the Local Research Ethics and Research Governance permissions, all health visitors (n5120) working in one county in the United Kingdom were invited to participate in the study. Semistructured interviews (n522) were undertaken using a prompt guide. The interviews were transcribed verbatim. Thematic analysis using an iterative approach was used to explore the data facilitated by NVIVOTM software. Findings: Five themes emerged from the interviews. These were health visitors’professional role; identity and perceived barriers and communication strategies, parents’ right to choose, confidence in measles, mumps, and rubella (MMR) vaccination and communicating with migrant families about immunisation. There were differences between the health visitors in their perceptions of their roles, skills and knowledge and communication strategies. Health visitors perceived that GPs and practice nurses took a paternalistic approach to the provision of immunisation information, while they used a parental decision making model. Health visitors reported a loss of professional confidence following the MMR crisis. Conclusion: Given the evidence that some parents find it difficult to gain the information they need about immunisation and health visitors’ acknowledgement that their usual communication models were not effective during the MMR crisis, we feel specific communication skills training is needed to enable health professionals to provide parents with appropriate decision support

Promoting influenza vaccine for children

This autumn influenza vaccine will again be offered to all 2- and 3-year-olds in general practice. In addition, all children in clinical risk groups aged 6 months and above should be offered the vaccine. Children in primary school years from reception class to year 4 will also be offered the vaccine as part of the on-going extension of influenza vaccination to healthy children. Since the start of the paediatric programme, transmission of influenza has reduced across all age groups in those parts of the country vaccinating all children of primary school age. Children under 5 years of age have the highest rate of hospital admissions for influenza. However, many parents do not think that influenza is a serious illness and it is the vaccine they are most likely to decline. Health professionals are the most trusted source of advice and information about vaccination, so staff in general practice have a crucial role to play in recommending this vaccine to parents. Health professionals are the most trusted source of advice and information about vaccination, so practice nurses have a crucial role to play in recommending the influenza vaccine to parents and increasing uptake </jats:p

Evaluating the use of a population measure of child development in the Healthy Child Programme Two Year Review

Aims and Objectives The overall aim of this study was to inform the use of ASQ-3™ and of ASQ:SE in the Healthy Child Programme two year review which in turn is intended to contribute to overall improved outcomes for children and their families. Aim To explore the acceptability and understanding of the ASQ-3 and ASQ:SE as measures of child development as part of the Healthy Child Programme two year review among health professionals and parents. Objectives 1. To determine the acceptability of ASQ-3 and ASQ:SE among parents of children who have had a HCP a two year review. 2. To investigate parents’ understanding of ASQ-3 and ASQ:SE used as part of the 2 year review. 3. To determine the acceptability of ASQ-3 and ASQ:SE among health professionals using the measures as part of the HCP two year review. 4. To investigate health professionals’ understanding of ASQ-3 and ASQ:SE as part of the two year review. Methods Four study sites known to be currently using ASQ-3 as part of the HCP two year review were selected to reflect differences in geography and in socio-demographic characteristics of the population. A mixed methods approach was taken and data were collected from 153 parents of children who were due their HCP two year review and 126 health professionals conducting two year reviews using survey questionnaires. Twelve focus groups involving 85 health professionals were conducted, 40 parents interviewed individually and 12 HCP two year reviews observed. Findings The key findings were: ? In general, most parents and HPs accepted the ASQ-3 as a measure that provides useful information about a child’s development at two years. ? Parents and HPs were less certain that ASQ:SE could provide an accurate assessment of social and emotional development. ? Parents enjoyed and found it valuable to observe their own child and make their own observations prior to an assessment visit either in a clinic or at home. ? Parents and HPs were positive about the opportunity to work in partnership in relation to the child’s development. ? There was wide variation both across and within the areas studied as to how the ASQ-3 was used (home, clinic, with parents, put to one side, scored differently, health visitor or community nursery nurse, referrals and re-reviews etc.) ? There was considerable variation around the preparation and training for the ASQ-3 and ASQ:SE amongst HPs. ? There was some evidence of confusion about the purpose of the ASQ-3, namely whether it was for screening developmental delay or for use as an assessment tool. ? There was misunderstanding and criticism of some of the individual questions, especially where there was use of American vocabulary or activities that did not make sense to parents or HPs and also misunderstanding of the possible responses. ? There was evidence of misunderstanding of the scoring of the ASQ-3, potentially leading to over- or under- reporting of developmental delay. ? There were problems in the reporting of the scores and the assessment related to time availability, access to a suitable electronic record system such as RIO, access to computers and internet, over-reliance on hard copy and reporting scores in the Personal Child Health Record (PCHR). ? There was some evidence of variation in practice in making referrals for speech and language or paediatric assessment

Decision-making about HPV vaccination in parents of boys and girls:A population-based survey in England and Wales

BACKGROUND School-based HPV vaccination in the UK will soon be extended to boys. Based on other countries’ experience, uptake may initially be lower in boys than girls. We assessed HPV vaccine attitudes and decision-making in parents of boys and girls, to explore sex differences and inform public health messages. METHODS We carried out a cross-sectional population-based survey using home-based interviews in spring 2019. Participants were adults in England and Wales, with a child in school years 5–7 (aged 9–12 and eligible for HPV vaccination within 3 years). Measures included awareness of HPV and the vaccine, demographic factors, previous vaccine refusal and (after exposure to brief information) whether participants would allow their child to have the HPV vaccine (decided to vaccinate; decided not to vaccinate; undecided). We also assessed vaccine attitudes. Data were weighted to adjust for non-response. Multinomial logistic regression was used to explore predictors of deciding to (or not to) vaccinate compared with being undecided. RESULTS Among 1049 parents (weighted n = 1156), 55% were aware of HPV and the girls’ vaccination programme, but only 23% had heard of plans to vaccinate boys. After information exposure, 62% said they would vaccinate their child, 10% would not, and 28% were undecided. Parents of girls were more willing to vaccinate than parents of boys (adjusted odds ratio: 1.80 (1.32–2.45)). Positive attitudes and HPV/vaccine awareness were significantly independently associated with deciding to vaccinate. Previous vaccine refusal for a child was the strongest predictor of not wanting the HPV vaccine. CONCLUSIONS Our findings suggest a need for public health campaigns to raise awareness of plans to extend HPV vaccination to boys. Reassuringly only 10% of all parents were unwilling to vaccinate and our data suggest further information, including about safety and efficacy, may be important in supporting undecided parents to make the decision to vaccinate

Bridging the digital divide: Bringing e-literacy skills to incarcerated students

Incarcerated students face a number of additional challenges to those faced by most other students studying at a distance. Lack of internet access is especially problematic for those studying in a sector that is increasingly characterised by online course offerings. This paper reports on a trial project that will attempt to address the digital challenges that hinder access to higher education by incarcerated students, and to provide them with inclusive learning experiences. The trial utilises Stand-Alone Moodle (SAM) and eBook readers with a small sample of incarcerated students participating in the Tertiary Preparation Program (TPP) at the University of Southern Queensland (USQ). This project potentially addresses the digital divide experienced by incarcerated students as compared to the general student population. It is anticipated that students will participate in learning experiences more closely related to those experienced by students who study in online environments, that and they will acquire relevant e-literacy and e-research skills

Co-occurrence and clustering of health conditions at age 11: cross-sectional findings from the Millennium Cohort Study

OBJECTIVES: To identify patterns of co-occurrence and clustering of 6 common adverse health conditions in 11-year-old children and explore differences by sociodemographic factors. DESIGN: Nationally representative prospective cohort study. SETTING: Children born in the UK between 2000 and 2002. PARTICIPANTS: 11 399 11-year-old singleton children for whom data on all 6 health conditions and sociodemographic information were available (complete cases). MAIN OUTCOME MEASURES: Prevalence, co-occurrence and clustering of 6 common health conditions: wheeze; eczema; long-standing illness (excluding wheeze and eczema); injury; socioemotional difficulties (measured using Strengths and Difficulties Questionnaire) and unfavourable weight (thin/overweight/obese vs normal). RESULTS: 42.4% of children had 2 or more adverse health conditions (co-occurrence). Co-occurrence was more common in boys and children from lower income households. Latent class analysis identified 6 classes: 'normative' (57.4%): 'atopic burdened' (14.0%); 'socioemotional burdened' (11.0%); 'unfavourable weight/injury' (7.7%); 'eczema/injury' (6.0%) and 'eczema/unfavourable weight' (3.9%). As with co-occurrence, class membership differed by sociodemographic factors: boys, children of mothers with lower educational attainment and children from lower income households were more likely to be in the 'socioemotional burdened' class. Children of mothers with higher educational attainment were more likely to be in the 'normative' and 'eczema/unfavourable weight' classes. CONCLUSIONS: Co-occurrence of adverse health conditions at age 11 is common and is associated with adverse socioeconomic circumstances. Holistic, child focused care, particularly in boys and those in lower income groups, may help to prevent and reduce co-occurrence in later childhood and adolescence

Women's experiences of perinatal depression: symptoms, barriers and enablers to disclosure, and effects on daily life and interaction within the family

Objective: Nearly half of all cases of perinatal depression are not detected, despite routine appointments with healthcare professionals (HCP) during pregnancy and after childbirth. Early identification of perinatal depression is crucial to provide the required support and offer timely treatment. This study aimed to explore women’s experiences of perinatal depression to help identification and management of perinatal depression by HCPs. Design: Theoretical perspective of symbolic interactionism and methodological design of ethnography was adopted. Face-to-face individual interviews were used. Thematic analysis was conducted to analyse interview data. Participants: Fifteen women who had experienced perinatal depression in the last five years were interviewed. Findings: Three themes were identified: 1) Getting closer to the perinatal depression; 2) Decision to disclose or hide real feelings; 3) Hidden face of perinatal depression. Key conclusions and implications for practice: Findings demonstrate the importance of HCPs’ attitudes towards women, as if women perceive they being dismissed or neglected by HCPs, may have an impact on women refraining from disclosing their feelings