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  • Subject Name : Public health

Immunization, Beliefs and Myths 

Question 1a. From the background information provided above relating to immunisation, develop a researchable question. Type the question below:

What are the challenges faced by the nursing staff in education expecting mothers about the risk and harms involved, for expecting mothers and their child, that can arise from the practice of non-vaccination?

Question 1b: Identify the elements of (words relating to) PICO or PICo in the research question that you have formulated (delete irrelevant table


Quantitative

Question 2a. What type of research methodology do you think should be used to answer the research question that you have formulated?

Qualitative

Mixed methods

Ans 2a. Qualitative method of research will be followed to collect the data for this research.

Question 2b. Justify why this methodology was chosen to answer the question

Qualitative research is a market-based research that focuses on a particular group of people. This type of research helps in obtaining data through open-ended conversations and communication between the participants. This helps in evaluating the questions as to how and why people think the way, they do about a certain issue(Hall 2019, pp. 61-69). The research also allows the participants to be selected on random basis and this allows the researcher to have an option to chose from a bigger pool, allowing the required diversity in the study. It also allows the researcher to have an in-depth view regarding the topic and probe in to the questions that might arise from the responses given by the participants (Rust 2017, pp.1304-1310). It is also an appropriate choice as it is fruitful method in solving complex issues, such as the one chosen for our study, to be evaluated. This type of research also helps the researcher in breaking down the complex issues into much simpler forms, which can be easily interpretated by the readers. It is also a good choice as it will allow the researcher to consider a larger focus group to be surveyed (Nyumba 2018, pp.20-32). He can also have multiple choices of research tool to opt out from, such as, interviews, observations, one-on-one focus group interactions with the participants etc.

Question 3a. List 3 places/sources of information that can be used to obtain reliable evidence to answer the research question that you have formulated:

  1. Research journals
  2. Research Articles
  3. Websites and online portals

Question 3b. Using one of the resources listed above, provide the details of a specific resource/publication that is an example of best available evidence to assist you in answering your research question. Complete the table below: 

Provide the full reference/title for the resource/publication

Gofen, A., Blomqvist, P., Needham, C.E., Warren, K. and Winblad, U., 2019. Negotiated compliance at the street level: Personalizing immunization in England, Israel and Sweden. Public Administration97(1), pp.195-209.

Provide the URL

https://onlinelibrary.wiley.com/doi/pdf/10.1111/padm.12557

Question 3c. Explain why the information source chosen is an example of best available evidence for answering the research question that you have formulated. Refer to the Levels of Evidence and Hierarchy of Evidence tables in Topic 2 (Approx 75 words - reference/s used to support your response should be written below your answer and are not included in the word count).

The chosen research is appropriate for selection as it reflects on the importance of empowerment of citizens and also provides a strong foundational ground for new public services module (Aguilar 2018, pp. 26-49). This approach helped in analysing for three main areas of concern including, trend of non-vaccination in the population, the efforts made in compliance and the level of street-work involved in the process. All these factors were analysing the situation from a deeper impact. It also provided a direct interaction with the population that largely helped in evaluating the situation in a profound manner.

Question 4a: List three key words that will assist in finding suitable literature in a library database to answer the research question that you have formulated. For each of the search terms, suggest an alternate word for which the Boolean function “or” could be used and truncations and wildcards.

Keyword

Search term/s for Boolean ‘or’ ‘and’ ‘not’

Truncation/s

Wildcards

1

Street-level negotiation

‘street-level negotiation’

‘ ‘

2

Immunization

Immunization?

?

3

Citizen-agent

‘Citizen-agent’

‘ ‘

Question 4b: What actions could be taken to extend or limit the number of articles found or improve the quality/relevance of the articles found in the search? (Approx 75 words - reference/s used to support your response should be written below your answer and are not included in the word count).

In order to streamline the research done, the challenges in the policy making should be analysed first (Kern 2018, pp.102-117). These challenges have to be recognized in a scientific way to approach to resolve them. This will help the policy makers largely in defining the roles of the agencies involved in this process and will also assist in strategy management in a more profound manner, for future implementations.

Question 5 (25 marks - 500 word equivalent)

Complete the template below by providing the requested information relating to some of the specific components of the research articles listed. IBNU students only need to complete the two articles that are for ‘IBNU students only’ and IMBW students only need to complete the two articles that are for ‘IBMW students only’.

Table 1.

IBNU students only:

 

 

 

 

IBMW students only:

Li‐Kim‐Moy, J.P., Yin, J.K., Heron, L., Leask, J., Lambert, S.B., Nissen, M., Sloots, T. and Booy, R., 2017. Influenza vaccine efficacy in young children attending childcare: A randomised controlled trial. Journal of paediatrics and child health53(1), pp.47-54.

https://doi.org/10.1111/jpc.13313

McMillan, M., Clarke, M., Parrella, A., Fell, D.B., Amirthalingam, G. and Marshall, H.S., 2017. Safety of tetanus, diphtheria, and pertussis vaccination during pregnancy. Obstetrics & Gynecology129(3), pp.560-573.

https://insights.ovid.com/crossref?an=00006250-201703000-00025

Type of study (e.g.: meta-analysis, systematic review, cohort, RCT, ethnography, phenomenology, etc)

Double- blind, randomised controlled trial.

Issue/Topic (what was being studied)

Efficacy of trivalent influenza vaccine was evaluated in the study. The efficacy in the study was evaluated against polymerase chain reaction- confirmed influenza, by making use of parent-collected nose and throat swabs, mainly when the child had influenza-like-symptoms.

Purpose/aims of the study (why was the study being undertaken?)

The main aim of the study was to analyse for vaccine efficacy in a limited age group of children, Aged between the age group of 6 to less than 48months.

Inclusion/exclusion criteria

Fifty-seven children well allocated for influenza vaccine and 67 children were selected for control group. The children aged from six months to fort-eight months. All of these children were recruited from Sydney Childcare centre in 2011. All of these children had influenza like symptoms.

Search strategy/data collection (how was the study set up and implemented; what intervention was used)

Children were given influenza vaccine on the basis of randomized selection. The influenza attack rate was mainly studied for the research purpose.

Results (main findings)

The attack rate of influenza was 1.8% in the group that received trivalent influenza vaccine and it was noted as 13.4% in the control group. Vaccine efficacy was 87%. For the age group of 24 to les than 48 months, 0 infections occurred in trivalent influenza vaccine group and 8 in control group, in total giving a vaccine efficacy of almost 100%

Conclusion/recommendations

The study concluded the efficacy of influenza vaccine in sub group of children between the age of 24 to 48 months. The study recommended caution during application of the vaccine to smaller group. Vaccine in childcare can be very valuable and helpful for a larger group of community.

Table 2.

IBNU students only

 

 

 

IBMW students only:

Enkel, S.L., Attwell, K., Snelling, T.L. and Christian, H.E., 2018. ‘Hesitant compliers’: Qualitative analysis of concerned fully-vaccinating parents. Vaccine36(44), pp.6459-6463. https://doi.org/10.1016/j.vaccine.2017.09.088

O'Shea, A., Cleary, B., McEntee, E., Barrett, T., O'Carroll, A., Drew, R. and O'Reilly, F., 2018. To vaccinate or not to vaccinate? Women’s perception of vaccination in pregnancy: a qualitative study. BJGP open2(2), p.bjgpopen18X101457.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6184095/

Type of study (e.g.: meta-analysis, systematic review, cohort, RCT, ethnography, phenomenology, etc)

Qualitative study was used in this research to analyse for the interview transcripts used in the study.

Issue/Topic (what was being studied)

The study mainly aimed at recognizing the behaviour, knowledge and hesitant attitude of parents towards vaccination. The study also evaluated for the cultural, geographical variations that affect these decisions.

Purpose/aims of the study (why was the study being undertaken?)

The main purpose of the study was to identify for the behaviour, knowledge and hesitant attitudes of the parents in Perth, Western Australia.

Population (how many participants, age, gender, disease, etc)

Parents of the children who were below the age of 5 years were taken in to consideration for the study. These children had very hesitant parents for getting their children vaccinated.

Materials/Method

(how was the study set up)

Nine one-on-ones in-depth interviews were conducted. These interview transcripts were then evaluated on the basis of qualitative analysis.

Data analysis

Data analysis was done making use of analysing of the data through induction method and making use of constructivist paradigm.

Results (main findings)

Results indicated that vaccination is an important part of their community, despite the restricted knowledge about the role of vaccine in preventing the disease. Parents also duly reported the concerns about the potential side effects and safety measures related to MMR (Measles-mumps-rubella) vaccine and vaccines in place to treat for seasonal influenza.

Conclusion/recommendations

Parents were seen reporting the importance of vaccine as an inclusion in the community practises, but as per own choices. The study also revealed as to how vaccination left more scars and fears in various sect of the community. Study recommended further input in the current strategies in order to address to the current parental concerns regarding vaccination process. Further research is also required to note for the prevalence of hesitancy in parents and identify for current interventions to rectify the same.

Question 6 – (45 marks – 1000 words)

Discuss the reasons why the studies above would or would not be helpful in enabling a nurse/midwife to have an informed discussion with parents/a pregnant woman about immunisation for their children/themselves. Comment on the relative value of the studies to the argument. Identify any further information that may be useful in an informed discussion with parents/a pregnant woman about immunisation for their children/ themselves.

(Reference/s used to support your response should be written below your answer and are not included in the word count).

Ans- The process of immunization is an effective measure of public health in order to prevent for any disease from spreading from one individual to another (Saadatian 2016, pp.1139-1147). The main source of carrier can be a mother and the unborn child is thus, at a higher possible risk of catching and developing that infection. It is one of the most effective method through which, it can be made sure that pregnant women and their unborn children are protected from the serious consequences of the diseases (Perrett 2017, pp. 313-324).

These diseases are mostly to exacerbate by pregnancy. Pregnancy alters the changes in the immune system of the person. This alteration can lead to increased susceptibility of the women and foetus to catch infection and are therefore, at a higher risk of getting serious healthcare outcomes for these infections. There is also a lack of availability of information on the risk and safety measures for these vaccines to be administered on the pregnant women. The role of nurses is crucial here, in order to impart information to these expecting mothers about the serious outcomes that might be there, for not opting out for vaccination.

It is important for the healthcare workers to advice the pregnant females about the immunization programs. It is crucial from the point of view of bridging the gap between the educational disparity among the group (Lutz 2018, pp. 7445-7455). It will also help in narrowing down the gap between the vaccine recommendation and implementation of the same in these population group. Studies have shown that these interventions have been proven to be beneficial in improving the adherence to these immunization programs in pregnant women. In order to ensure smooth facilitation of the process, it is important for the nurses to be well informed themselves, about the various immunization plans in place.

They should also have a detailed knowledge about what all vaccines would be appropriate to give to these pregnant women, stage wise. It is an integral part of nursing ethics to impart knowledge to their patients about the interventions that they might be carrying out on them, for their benefits. Administering immunisation to the patients is a core ethic of nursing practise as well. This is important, as it will ensure positive attitude in patients about the repercussions of the immunization programs. The midwives and nurses can also work in a collaborative approach with the patients to provide them with antenatal care and advising them for role and importance of vaccines.

Vaccines are in place to work as a protector for pregnant women in the first place. Some of the infections such as influenza can bring about serious complications in pregnant women. The foetus can get infected by catching an infection from the mother, through the means of teratogenic effects. By administering vaccination to the mother, the foetus will also benefit largely from the passive immunity acquired through the medium of placenta from the mother. It is crucial for the foetus, to provide him immunity in the first few months, before being born (Sakala 2016, pp 3065-3071).

Maternal Tdap vaccine helps in protecting the infants, that are usually at a greater risk of developing the infection of pertussis. In sever cases it has been shown to be life-threatening for young infants. Vaccinations are important as babies, younger than the age of six months can’t have vaccinations, like influenza (Payakachat 2016, pp.179-186).

There are multiple myths and misconceptions that are present about various vaccines. These are not only major barrier in preventing the disease, but also increases the threat for infection by multiple folds. The second most important barrier can be lack of organized programs through which detailed information can be provided to the individuals (Boey 2018, pp. 3351-3358). These programs can also include easy access to immunization to people who are aware of the same, but lack the resources to get vaccines. This can also be facilitated by providing vaccines in all non-traditional places, such as work sites, walk-in clinics, by setting up awareness camps etc. another major barrier is the forgetfulness in some individuals, to either not take vaccines all together or not taking them on time. The healthcare providers in this process, can help by setting up reminders to increase the demand of vaccines and to ensure that remedies and strategies are developed to ensure safety of these individuals, at a higher risk.

Vaccines are safe and effective in nature. They are the first line of defence as a preventive measure, to disable the disease from occurring in first place. Getting vaccines although, stull remains one of the major concerns for people. There is a constant fear related to application of vaccines in individuals, as per the various surveys and researches recorded (Maisa 2018, pp. 111-117). In order to enhance the efficacy of vaccination, nurses should be up to date with the latest trends and researchers in this field. The must also be aware of all the risk and benefits of the same and should be able to answer the questions put up to them by the patient population. Continuous studies should be conducted in order to secure the confidence of the individuals in the process of vaccination and any safety precautions should be resolved in a transparent manner. While all these measures don’t reduce the harm that might come from application of vaccines, but it will drastically help in reducing the occurrence of diseases in individuals.

References-

Aguilar, O.M., 2018. Examining the literature to reveal the nature of community EE/ESD programs and research. Environmental Education Research24(1), pp.26-49.

Hall, H., 2019. An Application of Qualitative Marketing Studies in the Identification of the Consumer Decision-Making Process. Effects and Benefits. Humanities and Social Sciences24(26 (4)), pp.61-69.

Rust, N.A., Abrams, A., Challender, D.W., Chapron, G., Ghoddousi, A., Glikman, J.A., Gowan, C.H., Hughes, C., Rastogi, A., Said, A. and Sutton, A., 2017. Quantity does not always mean quality: the importance of qualitative social science in conservation research. Society & Natural Resources30(10), pp.1304-1310.

  1. Nyumba, T., Wilson, K., Derrick, C.J. and Mukherjee, N., 2018. The use of focus group discussion methodology: Insights from two decades of application in conservation. Methods in Ecology and evolution9(1), pp.20-32.

Kern, F. and Rogge, K.S., 2018. Harnessing theories of the policy process for analysing the politics of sustainability transitions: A critical survey. Environmental innovation and societal transitions27, pp.102-117.

Saadatian-Elahi, M., Horstick, O., Breiman, R.F., Gessner, B.D., Gubler, D.J., Louis, J., Parashar, U.D., Tapia, R., Picot, V., Zinsou, J.A. and Nelson, C.B., 2016. Beyond efficacy: The full public health impact of vaccines. Vaccine34(9), pp.1139-1147.

Perrett, K.P. and Nolan, T.M., 2017. Immunization during pregnancy: impact on the infant. Pediatric Drugs19(4), pp.313-324.

Sakala, I.G., Honda-Okubo, Y., Fung, J. and Petrovsky, N., 2016. Influenza immunization during pregnancy: Benefits for mother and infant. Human vaccines & immunotherapeutics12(12), pp.3065-3071.

Payakachat, N., Hadden, K.B. and Ragland, D., 2016. Promoting Tdap immunization in pregnancy: Associations between maternal perceptions and vaccination rates. Vaccine34(1), pp.179-186.

Boey, L., Bral, C., Roelants, M., De Schryver, A., Godderis, L., Hoppenbrouwers, K. and Vandermeulen, C., 2018. Attitudes, believes, determinants and organisational barriers behind the low seasonal influenza vaccination uptake in healthcare workers–a cross-sectional survey. Vaccine36(23), pp.3351-3358.

Maisa, A., Milligan, S., Quinn, A., Boulter, D., Johnston, J., Treanor, C. and Bradley, D.T., 2018. Vaccination against pertussis and influenza in pregnancy: a qualitative study of barriers and facilitators. Public health162, pp.111-117.

Lutz, C.S., Carr, W., Cohn, A. and Rodriguez, L., 2018. Understanding barriers and predictors of maternal immunization: identifying gaps through an exploratory literature review. Vaccine36(49), pp.7445-7455.

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Public Health Assignment Help

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