Every year in the U.S., an estimated 4,400 to 52,500 people die from influenza, according to the CDC. In 2012-2013, 149 children, 90% of whom were unvaccinated, have died from influenza, and an estimated 200,000 individuals are hospitalized annually with influenza complications. Seasonal influenza vaccination coverage rates remain low at 42%, about half of the Healthy People 2020 80% goal. Parental decision making for themselves and for their children concerning preventive health care services, like seasonal influenza vaccination, remains an area in need of exploration. Parents have cited a desire for their influenza vaccination decisions to be better informed. Further, influenza vaccination occurs most frequently in clinic/medical settings, making these ideal sites to offer parents decision support concerning influenza vaccination. My long term goal is to determine how parents make preventive health decisions both for themselves and for their children, focusing on vaccination. Understanding these decision processes permits more effective targeting of health communication and the development of optimal decision support. The objective of this application is to use a multi-method approach to develop decision support instruments for use in a clinic setting that deliver clear, accurate material about seasonal influenza vaccination. The goals of this research are to empower parents to make informed decisions about, and ultimately increase rates of, influenza vaccination, thereby improving herd immunity. The central hypothesis is that carefully-developed decision support instruments can be successfully used in a clinic setting and result in parents reporting that their influenza vaccine decisions are informed by the instruments. The rationale for this work is to 1) address gaps in research on parents' influenza vaccination decisions, and 2) develop needed influenza vaccination decision support instruments for clinic use, ensuring opportunities are not missed to inform parents about the importance of seasonal influenza vaccination. I plan to accomplish this research with three primary aims: 1) via semi- structured interviews with parents, assess their decision making processes concerning influenza vaccination for themselves and their children; 2) develop and test several videographic decision support instruments via an online national survey to determine their impact on influenza vaccine decision making; 3) conduct a pilot field- assessment to evaluate the use of videographic decision support instruments in a clinic setting. I propose a course of training, study, and mentorship in qualitative investigation, epidemiology and infectious diseases, and decision support instrument development, as well as exposure to clinic settings. The research and training outlined in this proposal will enable me to succeed on my path to becoming: 1) a leading global expert in immunization decision making and health communication, as well as 2) a successful independent investigator who offers a multidisciplinary perspective to preventive health services delivery.
By focusing on the critical need to better understand parents' influenza vaccination decisions for themselves and their children, this work is important to public health. The proposed studies will result in the development and evaluation of videographic decision support instruments to inform parents' influenza vaccination decisions for themselves and their children. The ultimate goals of this work are to empower parents in their decision making process and to increase influenza vaccination rates by providing decision support instruments that convey the importance of influenza vaccination.
