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Staff and Parents Perceptions of Barriers to Immunization for African American Children: A Study from PROS and NMAPEDSNET

Paul M Darden, MD
1, Amy V Blue, PhD 1, Dennis A Brooks, MD 2, James A Taylor, MD 3, J W Hendricks, MD 4 and Alison B Bocian, MS 5. 1 Pediatrics & Coll of Med, Med Univ of SC, Charleston, SC; 2 Pediatrics, Johns Hopkins Univ, Baltimore, MD; 3 Pediatrics, Univ of Washington, Seattle, WA; 4 Tulsa, OK and 5 Pediatric Research in Office Settings (PROS), Dept of Prac & Rsrch, Cntr for Chld Hlth Rsrch, Amer Acad of Pediatrics, Elk Grove Village, IL.

Background: Even controlling for socio-economic status and source of care, African-American (AA) children are less likely to receive all of their recommended immunizations.

Objective: To understand AA parent and pediatric office staff perspectives of barriers to immunization for AA children.

Design/Methods: Four pediatric practices with high AA patient populations from CA, FL, GA and MD were selected to achieve a geographic and socio-economic mix. Four focus groups of AA parents who had children between the ages of 1-3 were held. Separate focus groups were held with each practice's non-physician office staff. A professional AA focus group facilitator conducted the sessions using guides developed by the research team. Findings from the sessions were transcribed, and content analysis used to develop common themes.

Results: Parent focus groups had a mean of 10 (6-14) participants. Parent groups in each site differed dramatically from 100% Medicaid in CA to 80% private insurance in MD, family income 65% < $20K in CA to 30% > $75K in MD and marital status 67% single in CA to 90% married in MD. Staff focus groups had a mean of 4 (3-8) participants. Several themes emerged including: lack of trust of the medical care system in general (although mothers trusted their child's doctor); delaying immunization because of mild illness; low priority on immunizations, including the perception they are only necessary for school or daycare entry; desire for parental control of the child's health care; family composition issues such as single parent and blended families; and parental perception that some diseases are natural and need not be immunized against. A theme not supported by the parent focus group was a perception by staff of grandparent's control of health care.

Conclusions: Identification of immunization barriers based upon AA parental and pediatric office staff perspectives provided critical information for an ongoing development of effective office-based interventions to address immunization disparities among AA children. These interventions will be tested in office practice.

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