Addressing Issues of Vaccination Literacy and Psychological Empowerment in the Measles-Mumps-Rubella (MMR) Vaccination Decision-Making

A Qualitative Study

Marta Fadda; Miriam K. Depping; Peter J. Schulz


BMC Public Health. 2015;15(836) 

In This Article


Our results yield a number of implications at multiple levels. A first level is more concerned with the medical encounter between parents and pediatrician, where the vaccination issue is addressed and discussed. Building on the needs that parents articulated in this study, there are a number of practical implications for pediatricians. Pediatricians should involve both parents in the decision-making, providing the proper information, motivating them to be active actors in this choice, and highlighting the importance of parental role in managing their children's health as a way to reach empowerment. However, attention should be paid to their communicative style during vaccination recommendation.[42] They should also stress that the importance of their decision lies in the non-compulsoriness of the vaccination, a policy that can be justified neither by a low risk of measles nor by a high risk of experiencing MMR-related side effects, but which is aimed at increasing their sense of responsibility and empowerment. Strategies to empower parents might include discussing the impact of the decision at the child, family and collective level, highlighting possible negative consequences of non-immunization. Concerning vaccination literacy in the specific, pediatricians are urged to provide clear, concise and tailored information regarding the risks and benefits of the MMR vaccination in a format that parents can understand and process. They should be able to counter-argue inaccurate arguments regarding the risks posed by the vaccination and those posed by the diseases that the vaccination aims at preventing, highlighting the disadvantages of missed or late pediatric immunizations. Lastly, they should be prompt in directing parents to reliable, accessible and clear information sources, before they fall victim of inaccurate information disseminated by anti-vaccination advocates, which is usually preferred for its narrative style. However, it should be stressed that following these recommendations may represent a challenging task for pediatricians, as being more actively engaged would inevitably require more work time – a limited resource.

Further implications of our results rest at a policy and institutional level. Policy-makers are urged to explicitly disclose the rationale behind the non-compulsoriness of pediatric vaccinations. This could be done by stressing the democratic and ethical character of the country's health related policies, or the thrust to positively engage parents and make them responsible for their children's health.

At a research level, further exploratory or conclusive research is needed to better understand the extent to which being literate and empowered contribute to the MMR vaccination decision-making. In particular, psychological empowerment deserves a deeper investigation in a population where vaccination rates are low, and measurement issues should be addressed to provide tools to quantitatively assess parental empowerment in making a MMR vaccination decision for their children.

Since parents are expected to make an informed and autonomous decision regarding their children's immunization, successful communication with respect to childhood vaccinations, and the MMR vaccination in particular, should take into account both issues of vaccination literacy and psychological empowerment. Healthcare providers and health authorities should promote parental empowerment as a process through which parents gain control and responsibility over the health decisions they make for their children, especially with regards to their immunization schedule. This could be done by highlighting the significance and the potential impact of the decision, and the importance of being literate on the topic to feel competent and autonomous. Efforts should be made, on the one hand, to give parents the proper information about the vaccination and the target disease(s), but also the skills to find more information, to assess its reliability and, ultimately, to understand it. This can in turn increase parents' perception of being competent and thus make an empowered decision.