project

Running head: PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 1

Perceived Benefits and Barriers about the MMR Vaccine among the Parents of a Pediatric

Population in South Florida

Florida International University

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 2

Background

According to the Center for Disease Control and Prevention (CDC), about 1 in 4 people

in the United States will be hospitalized and one out of every 1,000 people with measles will

develop brain swelling that could lead to brain damage. Given the possible severity when

obtaining Measles, the CDC recommends to protect children against measles by obtaining a

vaccine that provides enduring insurance against all strains of measles (Measles, 2018). The

Measles, Mumps, and Rubella vaccine (MMR) is administered in two doses in order to prevent

an individual from obtaining one of those diseases. The first dose was given to children when

they are about 13 months old, which offers 90 to 95% protection against those diseases. The

second dose increases those protection odds to become 99%, which is administered before a

child turns five years old. In order for the vaccine to be immune in our system, we need to

achieve at least 95% of immunity to those diseases (Gardner, 2010).

Side effects of MMR vaccine

There is for all intents and purposes no medication without reactions. Gentle symptoms of MMR

vaccine include the following: fever, mild rash, and swelling of the glands in the cheeks or neck.

Moderate reactions include: febrile seizures, brief joint inflammation, and impermanent

thrombocytopenia. Serious side effects of MMR vaccine are amazingly uncommon, but can

include serious allergic responses. Other serious side effects are rare to the point that it is

difficult to recognize whether they are caused by the vaccine, which includes: deafness, long-

term seizures, coma, lowered consciousness, and lasting brain damage (Mahmić-Kaknjo, 2017).

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 3

Barriers

Obtaining immunization has been viewed as one of the best general wellbeing accomplishments

of the twentieth century for their job in killing smallpox and controlling polio, measles, rubella,

and different irresistible ailments in the United States. Regardless of their adequacy in

forestalling and destroying illness, routine youth vaccine take-up remains problematic. Parent

refusal of immunizations has added to flare-ups of vaccine preventable infections, for example,

measles and pertussis (Maglione, 2014). Late episodes of measles in the United Kingdom and

United States have awoken reestablished worry about vaccination dismissal. The rate of

vaccination take-up has fallen. Individuals' view of vaccine protection and effectiveness has

appeared to be an imperative factor for immunization take-up that, in the meantime, can spread

between people (Medus, 2014).

Research has shown that guardians' frames of mind towards health experts and the demeanors of

those giving social help may likewise have a role in parents’ choices about immunizing their

kids. Specifically, Evans et al did a focus group investigation of guardians and reasoned that

numerous guardians need trust in the suggestions of health experts as they realize that these

experts have vaccination targets to reach. This is in accordance with the ongoing accentuation on

the significance of trust in the doctor–patient relationship (Flynn, 2004).

Lack of informed decisions.

Research shows that few parents need trust in settling on a choice about MMR

vaccination for their kids. A research study conducted that spoke with 69 parents, uncovered that

many were unconvinced that the MMR vaccine is safe. Sixty-two percent did not think their

choice was informed, regardless of actually taking their kids to be vaccinated. This investigation

recommends that compelling intercessions are required to help guardians to settle on educated

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 4

choices about the MMR vaccine. Decision aids provide composed and graphical data pertinent to

healthcare choices. They are normally created to help people with the following: (i) comprehend

the plausible results of their choice by giving pertinent data, (ii) illuminate their qualities about

the advantages and dangers, (iii) feel bolstered in settling on their choices, (iv) experience the

support toward settling on a choice, and (v) effectively take an interest in choices about their

health (Jackson, 2010).

To date, two decision aids for child immunization choices have been created. Wroe et al

found that New Zealand parents who utilized a decision aid, a 20-page booklet, for child

vaccinations detailed lower uneasiness, higher certainty and saw the choice to be less

troublesome than 'common care’ parents. They were likewise bound to vaccinate their

youngsters on time. An online, intelligent decision aid for guardians settling on the MMR choice

has been produced and steered in Australia. Subsequent to utilizing this decision aid,

fundamentally more members were 'inclining towards' immunization and had increasingly

uplifting frames of mind towards the MMR vaccine. Members with an uplifting demeanor were

additionally bound to report feeling very much educated (Jackson, 2010).

Linked to autism.

A British report distributed in The Lancet in 1998 by Andrew Wakefield claimed a

conceivable connection between the MMR vaccine and autism. In spite of the fact that the

authors were all the while prescribing that parents vaccinate their kids against measles, the

specific relationship with MMR was in question. Writers attracted thoughtfulness regarding both

individual situations where stories in the media gave testimony regarding guardians' encounters

and furthermore to the multifaceted nature of immunization programs. It before long turned out

to be certain that MMR had been a developing worry for a long while among parents’ groups

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 5

previously Wakefield's examination was published. Parents professed to have seen a sensational

change in their children soon after they were vaccinated. The Medical Research Community

quickly made the fundamental strides from their perspective and assembled important research

results, enhanced their data battles to the health services, etc. The research results were

unequivocal, not one showed that there is an easygoing association among MMR and chemical

imbalance (Bragesjo, n.d.).

Risk perception

Risk perception can influence wellbeing related outlooks and actions. In the immunization

setting, people are bound to vaccinate when they see themselves to be in danger to a risk inside

their environment. Two critical aspects of risk perception lie in a person’s perceived probability

of being affected by a specific risk and the perceived seriousness of a specified risk (Lagoe,

2015).

Perceived probability.

Perceived probability is a person’s apparent likelihood of being impacted by a specific

sickness if no preventive move is made, which can be the case with no immunization. There has

been consistency in positive affiliations found between the view of infection probability and

immunization expectations. For example, Ziarnowski, Brewer, and Weber (2009) found that

parents’ evaluations of their kid’s probability of obtaining the human papilloma infection

anticipated vaccination aims and behaviors (Lagoe, 2015).

Perceived severity.

Perceived severity has also affected an individual’s risk perception. The severity is one’s

judgment about the damage a health hazard will cause. Meta-examination has determined a little

to direct pooled impact estimate (r = .16) among severity and immunization intentions. People

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 6

who saw the central illness to be extreme were bound to immunize. For instance, a positive

affiliation was recognized between apparent seriousness of the flu and immunization intent

among college representatives (Lagoe, 2015).

Anticipated regret

An extra factor that influences immunization plans is anticipated regret. Regret is the aversive

transaction of sentiments coming about because of the correlation of a chose decision and a non-

chose elective. Anticipated regret is the level of disappointment an individual believes to feel by

picking, or not picking, a specific plan to take action. Regret can result from activity or

inactivity. Foreseen inaction regret could happen if an individual trust they would feel regret for

neglecting to get the flu immunization. Here, the individual views immunization as good as it

could shield them from getting seasonal influenza. In this manner, foreseen inaction regret is

normal on the off chance that one does not get immunized (Lagoe, 2015).

Anticipated regret has been connected to immunization expectations in different examinations.

What’s more, a little assemblage of work has investigated whether anticipated regret intercedes

the connection between risk observations and immunization plans. This depends on the

supposition that more grounded sentiments of risk related with a specific condition may actuate

expanded sentiments of disappointment related with not following suggested wellbeing activities

(Lagoe, 2015).

To date, discoveries here have been conflicting. While Chapman and Coups (2006) found

anticipated regret to intercede the risk perceptions and immunization plans relationship among

American grownups, this finding was not recreated in a later examination on flu vaccination

expectations in Hong Kong (Lagoe, 2015).

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 7

Purpose of Study

The purpose of conducting this research was to identify what are the perceived benefits

and barriers about the Measles, Mumps, and Rubella (MMR) vaccine among the parents of a

pediatric population in South Florida. This study aimed to gain an understanding as to why

parents are either accepting or declining their children from obtaining vaccination. There have

been numerous studies to understand where parents are coming from before making a decision

on allowing their child to either get or not get their vaccines. However, studies were not found as

to what are the perceived benefits and barriers parents find that aid in them making a decision,

whether this decision is informed or not. For example, an article written by Mahmić-Kaknjo

revisits the benefits and risks of the MMR vaccine, but not in the perspective from the parents

(Mahmić-Kaknjo, 2017). Another study evaluated the perception of the MMR vaccine among

university students in England, again not in the perspective from the parents (Bolton-Maggs,

2012).

Research Question

What are the perceived benefits and barriers about the MMR vaccine among the parents

of a pediatric population in South Florida?

Statement of Problem

Measles keeps on being one of the main sources of death among youth children as it is a

very infectious illness. The infection can live in the air and contaminated surfaces for up to 2

hours, which implies that it tends to be broadly spread without direct contact. It is evaluated that

immunization avoided more than 20 million deceases in kids amid the 2000 to 2015 period,

which makes this immunization a standout amongst the most effective health care interventions.

An unvaccinated kid is not just in danger of coming down with the disease, yet the more

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 8

unvaccinated children are, the more fragile the crowd insusceptibility, and the more noteworthy

the dangers of getting the sickness and developing complications (Mahmić-Kaknjo, 2017). While

most parents apparently encounter immunization related concerns when settling on choices about

following the immunization schedule research has shown numerous parents later report feel

remorse for not maintaining these suggestions (Lagoe, 2015).

Global and United States Outbreaks.

In Korea, a noteworthy measles flare-up happened in 2001, yielding roughly 55,000 announced

cases. Thus, the National Board of Trustees for Measles Elimination executed the National

Measles Elimination Plan and ended up fruitful in fulfilling the WHO measles end criteria in

2006. Be that as it may, around 200 new measles cases were accounted for in youngsters in 2007.

Most of these new cases were distinguished in Seoul and Incheon city (Y. W. Jeong, 2011). In

2008, England and Wales had 1,348 affirmed measles cases and measles was proclaimed

endemic in the United Kingdom again in the wake of having been disposed of. From 2009 to

2014, the US had a median of 10 measles flare-ups every year contrasted with 4 episodes for

each year from 2001 to 2008 (Cataldi, 2016). In 2012, a foreign made case from Thailand

prompted the biggest measles flare-up in New South Wales since 1997, with 168 recognized

cases, 104 of which were children and teenagers. Of every one of those influenced, just 40 had a

background marked by getting one portion of the MMR vaccine. Ninety-five percent of the

remaining 128 cases were older than one year of age with indeterminate or no history of the

MMR vaccine, demonstrating that they had not be immunized appropriated for their age

(Dawson, 2015). In December 2014, a few instances of measles happened among ongoing guests

of Disney amusement parks in California. By April 2015, 111 cases connected to this flare-up

were recognized in seven US states, Mexico, and Canada. Practically 50% of cases were

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 9

unvaccinated humans and numerous others had obscure immunization status. Worldwide there

were 267,482 measles cases in 2014 and an expected 114,900 deaths (Caraldi, 2016).

Furthermore, there has been another measles outbreak in the United States. According to the

CDC, from January 1, 2019 to April 11, 2019, there have been 555 confirmed cases of measles

across 20 states (2019). These cases could have occurred due to an increase of travelers getting

measles abroad and bringing it to the United States and/or spreading measles in U.S.

communities where there are unvaccinated individuals (Measles Cases, 2019).

Significance of Study

This research was important to understand the perceived benefits and barriers about the

Measles, Mumps, and Rubella vaccine among the parents of a pediatric population in South

Florida. This study was necessary and relevant to gain a better understanding of what are the

perceived benefits and barriers in order to address how to intervene in this population to prevent

another measles, mumps, or rubella outbreak. Greater debate is continuously affecting the

perceived benefits and risks on the MMR vaccine on social media that may lead to false

information being shared among this population. Furthermore, this study would allow there to be

information on how to prevent the current outbreak in the United States from progressing over

time. According to the CDC, the United States already has 555 confirmed cases (Measles Cases,

2019).

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 10

Literature Review

Identifying the perceived benefits and barriers on the MMR vaccine among the parents of

a pediatric population in South Florida will be assessed through a comprehensive literature

review in order to gain a greater understanding on this topic. The following variables will be

researched: MMR vaccinations, perceived benefits, and barriers.

MMR Vaccinations

Maglione, Das, Raaen, Smith, Chari, Newberry, and Gidengil (2014) conducted their research

based on the concerns about vaccine safety that have driven a few parents to decay prescribed

immunization of their children, prompting the resurgence of diseases. Consolation of

immunization safety stays critical for population wellbeing. Among the systematic review of the

safety of vaccinations, it was found there is high proof for the MMR vaccine and febrile seizures.

The varicella vaccine was related with confusions in immunodeficient individuals. There is solid

proof that MMR immunization is not related with autism and there is moderate proof that

rotavirus antibodies are related with intussusception. However, this study had limitations as the

majority of studies they reviewed did not explore or find any risk factors for adverse events

(Maglione, Das, Raaen, Smith, Chari, Newberry, and Gidengil, 2014). Maglione, Das, Raaen,

Smith, Chari, Newberry, and Gidengil (2014) concluded that some vaccines are associated with

serious adverse events, but these episodes are extremely rare. With these rare serious adverse

events, the vaccine should be weighed against the benefits that vaccinations provide.

Comparably, Curtis et al piloted a study to inspect the safety of pediatric immunization schedules

in a non-human primate model. Curtis et al (2019) controlled antibodies to six gatherings of

newborn male rhesus macaques utilizing an institutionalized thimerosal portion where fitting.

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 11

Study groups incorporated the suggested 1990s Pediatric immunization plan, a quickened 1990s

Primate plan with or without the measles, mumps, rubella (MMR) antibody, the MMR

immunization only, and the extended 2008 timetable. They regulated saline infusions to age-

coordinated control creatures. Infant development was evaluated from birth to a year of age by

looking at the possession of neonatal reflexes, the development of object concept performance

(OCP), automated trial of segregation learning, and baby social conduct. Information was

investigated utilizing examination of variance, staggered demonstrating, and survival

examinations, where fitting (Curtis, 2019). It was found there was no group differences in the

obtaining of OCP. Amid separation learning, animals getting thimerosal-containing vaccines had

improved execution on inversion testing, albeit a portion of these equivalent animals

demonstrated more unfortunate execution in ensuing learning-set testing. Investigation of social

and nonsocial practices distinguished couple of occurrences of negative practices over the whole

outset period. Although some group differences in explicit practices were accounted for at 2

months of age, by a year all babies, regardless of immunization status, had built up the ordinary

collection of macaque practices. In conclusion, there was no reliable proof of

neurodevelopmental deficiencies or atypical conduct in immunized animal (Curtis, 2019).

Gardner, Davies, McAteer, and Michie (2010) conducted a study to remove hidden beliefs

towards measles, mumps, and rubella vaccination from United Kingdom parents' perspectives

towards potential inspirational and authoritative intercessions to support MMR immunization.

This study used an analysis of transcripts taken from five different focus groups and revealed

five basic themes based on the parents’ responses to potential MMR take-up intercessions.

Gardner, Davies, McAteer, and Michie (2010) identified the five themes to be the following:

requirements for information on the risks and advantages of MMR vaccination, doubt of

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 12

government, perceived reliability of different parents, attentional inclinations towards risk

information to the detriment of information on immunization advantages, and issues related with

accomplishing an ideal "balance" in the introduction of MMR information. Likewise, a study

conducted by Johnson and Capdevila (2014) did an investigation on mothers’ commitment with

guidance around the consolidated measles, mumps and rubella (MMR) immunization. A great

part of the past literature uses a 'decision-making' structure, in view of 'risk assessment' whereby

moms' choices are conceptualized as established in complex beliefs frameworks, and assumes

that that by picking up a comprehension of these frameworks, beliefs and behavior can be altered

and take-up improved. Nevertheless, less consideration has been paid to the manners by which

moms arrange such guidance or the manners by which exhortation is interceded by observations

and influences. Investigation of information from a center gathering with five moms recognized

three themes: sourcing exhortation and information, constructing 'Mother knows best' and

negotiating organization. In spite of the dependability of exhortation and information being

addressed, a consciousness of worries about the MMR, and healthcare professionals being built

as remote, and consistence with, the 'framework' and 'society' were depicted as deciding MMR

'choices' (Johnson, 2014).

Kennedy, Brunton, and Hogg (2014) examined vaccination views in Scotland among parents,

teenage girls, and health professionals regarding the Measles, Mumps, Rubella (MMR), the

Human Papilloma Virus (HPV), and the Influenza a (H1N1) vaccine. Kennedy, Brunton, and

Hogg concluded public health authorities ought to stay alert towards inescapable immunization

concerns. It is critical for experts to elucidate vaccine roles and responsibilities despite new and

existing immunizations and to recognize open concerns with respect to immunization safety. A

proposed solution to ensure public health authorities are cautiously looking at vaccination

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 13

concerns and properly educate Americans can be seen in a feasibility study conducted by

Jackson, Cheater, Peacock, Leask, and Trevena (2010). Jackson, Cheater, Peacock, Leask, and

Trevena (2010) conducted this feasibility study in order to assess the worthiness and potential

adequacy of an electronic MMR decision aid in supporting informed decision-making for the

MMR immunization. Thirty parents of children eligible to obtain the MMR vaccination were

recruited to participate in this study. Based off the twenty-six parents who actively participated,

Jackson, Cheater, Peacock, Leask, and Trevena (2010) found that the decision aid was observed

to be satisfactory to guardians and was viewed as helpful in supporting their educated decision-

making. There was a measurably huge increment in guardians' knowledge after some time and

factually noteworthy reduction in decisional struggle for the MMR choice. This feasibility study

concluded the decision aid can increase knowledge about the MMR vaccine and reduce

decisional misunderstands to a level where parents are able to make an informed decision

(Jackson, 2010). Utilizing a decision aid across the nation to allow parents make informed

decisions, can be useful as we see in a prospective questionnaire study conducted by Flynn and

Ogden (2004). Parents hold many mixed beliefs about the MMR vaccination that are not based

on an informed decision. The prospective study Flynn and Ohden (2004) led found most of

guardians trusted that measles, mumps, and rubella were not serious sicknesses and expressed

that they would feel regretful about any antagonistic outcomes of their choice about

immunization. Numerous responders had mixed feelings about the advantage of immunizations

and were uncertain whether to trust either the medical profession or the media. Similarly, it is

shown that the media has negative implication on the perception of obtaining the MMR vaccine

in a study conducted by Cataldi, Dempsey, and O’Leary (2016). Cataldi, Dempsey, and O’Leary

(2016) assessed and compared new mothers who are vaccine hesitant and non-hesitant with their

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 14

knowledge, attitude, vaccination plans, and social media usage after the 2014 to 2015 measles

outbreak that began in California. This study used a cross-sectional email survey among English-

speaking women in Colorado. Cataldi, Dempsey, and O’Leary (2016) came to the conclusion

new mothers had abnormal amounts of learning and good mentalities about immunization after

the 2014 to 2015 measles outbreak. Media sources utilized the most are not most trusted.

Correspondence about flare-ups of vaccine preventable maladies ought to incorporate spread of

precise information to new media sources and fortifying of existing trust in customary media

(Cataldi, 2016). Correspondingly, Dawson and Apte (2015) assessed the need for continuously

education on the benefits of obtaining vaccination after the measles outbreak in Australia. There

should be an emphasis placed on the safety of getting the MMR vaccination. Dawson and Apte

(2015) concluded to be effective; instruction should be coordinated at both healthcare providers

and parents. The explanations behind immunization hesitancy are different and a fitting reaction

needs to address the hidden issues. This involves healthcare providers being responsive of

concerns raised by guardians and guaranteeing that purposes behind vaccine hesitancy are tended

to through steady communication efforts, arrangement of resources to counter anti-vaccination

feeling, and techniques that give a security net to catch up children who miss routine

immunizations. This study also confirms that the decision aid would be useful to ensure parents

are making informed decisions, as there is a lot of lack of information and misunderstandings the

media portrays (Dawson, 2015). These studies show that it is imperative to educate parents on all

the available information out there that identifies the benefits and risks, which is confirmed by

data. Parents should be making an informed decision before deciding whether they vaccinate

their children. When they do, chances are they will vaccinate their child as indicated in the

research done by Jackson, Cheater, Peacock, Leask, and Trevena (2010). Given the recent

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 15

measles outbreaks, Walgreens was offering vaccination to protect individuals from measles,

mumps, and rubella at all of their locations in Tennessee, Arkansas, Kentucky, and Mississippi. It

is recommended to obtain vaccination, as it is the single most effective way to protect humans

from contracting measles, mumps, or rubella (United States, 2016). On the contrary, there is a

paper by Yeung (2018) that informs readers that the Samoan government has propelled an

investigation into the passing of two one-year-old babies after a normal inoculation

administration. The children were taken to Safotu Hospital in Savai'i, where they passed on

minutes after getting the MMR vaccination. However, there is no evidence that these two babies

died because of the MMR vaccine (Yeung, 2018).

Perceived Benefits

Although there is no literature on the perceived benefits from the perspective of the parents, there

is research on the benefits on obtaining the MMR vaccination. An article by Chang (2015)

informs readers about a new study that recommends the measles shot accompanies a reward. By

keeping that malady, the immunization may likewise enable your body to ward off different

sicknesses for a considerable length of time. It's for some time been realized that contracting

measles debilitates the invulnerable framework for quite a long time or months, putting

individuals, particularly kids, at expanded hazard for possibly deadly contamination by a large

group of germs. Presently, researchers find that this vulnerable period goes on any longer than

thought, as long as three years. Therefore, the advantage of keeping away from measles

additionally expands longer than was valued. Analysts likewise discovered that a drop in passing

for different irresistible illnesses trailed measles immunization battles. In conclusion, the MMR

vaccine is not only safe and effective against contracting measles, mumps, or rubella, but also

helping guard an individual’s body from other infections. Furthermore, Mahmić-kaknjo,

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 16

Rustempašić, and Hadžić (2017) did an evidence-based mini review of the benefits and risks of

getting the MMR vaccination. This review concluded the MMR vaccine is a safe, compelling,

and cheap counteractive action component for three viral diseases, measles being the most

infectious and carrying the most noticeably bad worldwide concern and dangers of

complications. The advantages of being immunized are gigantic and serious symptoms are

incredibly uncommon. Parents trust their child's doctor more than government authorities,

relatives, or celebrities, as the best source of information on immunization safety and it is

therefore significant that practicing doctors illuminate parents about the certainties and scatter

legends (Mahmić-kaknjo, 2017). On the other hand, Lagoe and Farrar (2014) looked to

investigate the impact of risk perceptions and anticipated regret on caregivers' immunization

intentions among American parents. They appropriated an online study to 110 parents with

unvaccinated youngsters somewhere in the range of 0 and 23 months of age. Lagoe and Farrar

(2014) distinguished anticipated inaction regret as an arbiter of the relationship between risk

perceptions and vaccination intentions. These discoveries both support and repudiate past

research. This investigation parallels the work finished by Chapman and Coups, which

recognized anticipated regret as an intervening component between perceived likelihood,

perceived severity, and vaccination intent among American adults. In any case, the present

discoveries repudiate ongoing work by Liao et al., which did not discover anticipated inaction

regret to intervene the connection between perceived likelihood of infection and vaccination

intent among Chinese adults (Lagoe and Farrar, 2014).

Barriers

One of the major barriers comes from the debate on the MMR vaccine and autism. Bragesjo and

Hallberg examines the dilemmas of the vaccination market by evaluating lessons learned from

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 17

the MMR vaccine and autism debate. A British research group that published in The Lancet in

1988 by Andrew Wakefield and others started the MMR debate. This article suggested there was

a possible link between the measles component in the MMR vaccine and autism. Despite the fact

that the authors still recommended children obtaining the MMR vaccination, there was an

association that influenced parents on not giving their children the vaccination. Bragesjo and

Hallberg concluded the MMR debate and its social results represent the multifaceted nature of

immunization policy. However, the issues are not limited to this specific case. Regardless of how

well antibodies are tested, how cautiously they are created, how well their applications are built

up in the public eye, if doubt, dithering, and thusly doubt happen, the delicate status of the

immunization advertise is threatened. Bragesjo and Hallberg does not propose a solution to this

dilemma, but identifies the vaccine market seems to be economically bolstering. It can be seen

that doubt and fear is a component that does influence a parent’s decision to do certain things for

the child, like being vaccinated in a study conducted by Jama, Ali, Lindstrand, Butler, and

Kulane (2018). Their study was designed to discover factors that will influence the decision of

Somali parents living in Sweden on regardless of whether to immunize their children with the

MMR vaccination. Immunization aversion and distrust among parents’ thwarts advance in

accomplishing full vaccination inclusion. Jama, Ali, Lindstrand, Butler, and Kulane (2018)

concluded that fear, in light of the apparent risk that inoculation will prompt Autism, among

Somali moms in Tensta and Rinkeby is clear and impacted by the sentiments of companions and

relatives. Child Healthcare Center nurses are essential in the decision-making process with

respect to acknowledgment of MMR immunization. There is a need to address moms' worries

with respect to antibody safety while at the same time improving the methodology of medical

nurses as they address these worries (Jama, 2018).

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Among the debates on being vaccinated for the MMR vaccine, there is a religious component,

which is a barrier for some religions. Wombwell, Fangman, Yoder, and Spero (2015) wrote an

article on a discussion with respect to religious and philosophical convictions identified with the

acceptability of the measles antibody. Late measles flare-ups in the US have been connected to

religious networks that have decided not to immunize. This paper looks at the confidence

conviction premise contributing explicitly to refusal of the M-MR II and ProQuad

immunizations, which contain the measles antibody. Strangely, refusals dependent on religion

frequently focus on the utilization of prematurely ended human baby tissue utilized in the rubella

part of the consolidated immunization products, and animal derived gelatins utilized in antibody

generation. Nevertheless, a few communities inside these religions have decided not to immunize

because of safety and viability concerns. The Hindu faith does not disallow the utilization of

immunizations, however devotees of the religion may object to inoculation because of its

induction from fetal cells or containing bovine components. In general, there are no laws or

compositions forbidding the utilization of antibodies in Christianity; however, complaints to the

M-M-R II and ProQuad immunizations emerge because of the rubella infection component

starting from prematurely ended human embryo tissue. Essentially, Roman Catholicism

proclaims the demonstration of fetus removal to be corrupt and in this way bolsters the

improvement of an antibody item taken from non-prematurely ended tissue. The Jehovah's

Witness religion has had various updates on the subject of antibody use overall. Initially

immunizations were viewed as blood items and were not to be regulated. Recently, Jehovah

Witness' have withdrawn this perspective and now surrenders it over to the person to immunize

or not. In Islam, the essential concern is the utilization of a porcine-based gelatin in

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 19

immunization generation. There is certainly not a uniform explanation concerning this issue

yielding shifting convictions among Islamic people (Wombwell, 2015).

Studies have shown that there is misguided information on the MMR vaccine. Bolton-Maggs,

Conrad, Keenan, Lamden, Ghebrehewet, and Vivancos (2012) found the steadiness of misguided

judgments about the MMR vaccination regarding safety, impression of risk/benefit and number

of dosages required features the requirement for awareness raising to build disease information

and vaccination learning among college students to improve immunization take-up in this

population. Educating children and young adults about vaccination is also a critical component

as they are the ones at risk based on their parents’ decision, which may or may not have been

based on an informed decision. Whelan (2016) acknowledges there are general medical problems

where views are as very captivated as those concerning immunization arrangements are. For this

reason, Whelan (2016) evaluates lowering the age of consent in order to push back against the

anti-vaccine movement that has been going on. Whelan (2016) concluded bringing down the age

of consent would not take out the negative impact of the counter immunization development on

vaccines prescribed for babies and young children. Nevertheless, in the particular setting of

antibodies against STIs focusing on pre-young people and teenagers, bringing down the age of

consent is a legislative way to deal with start pushing back against the anti-immunization

development. Because of state legislatures' ineffective endeavors to command the antibody and

the expansive exceptions given under the two existing HPV immunization mandates, this article

contends that state lawmaking officials should look to the methodologies recently utilized by

California and Missouri, which enacted laws bringing down the age of consent for vaccinations

against STIs. Numerous changes can help increase the vaccination uptake. For example, more

grounded commands with less exclusions, and bringing down the age of consent is one

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 20

authoritative change that can happen at the state level and possibly prepare for minors to agree to

different vaccines against infectious diseases. Bringing down the age of consent clears the way

for public authority officials, healthcare providers, school authorities, and other important parties

to actualize approaches that improve immunization conveyance and guarantee teenagers have the

chance to think about the antibody in classified counsel with their healthcare provider (Whelan,

2016). Correspondingly, Foster (2018) suggests vaccination against measles; mumps and rubella

ought to be made obligatory for students beginning college to avoid outbreaks, public health

specialist’s state. Healthcare providers ought to likewise be made to have the MMR poke or

demonstrate they are normally safe to the illnesses to guarantee the NHS is set up to manage any

future cases. Numerous young adults over the UK are in danger of measles since they did not get

the full MMR immunization when they were more youthful (Foster, 2018). Furthermore, Foster

(2018) examines how mandatory immunization for kids have been introduced in France and

Italy. Take-up is as of now high yet there are fears from numerous individuals from Scotland that

are presently young adults who did not get the full portion when they were younger, as around 20

years prior wellbeing alarms encompassed the security of the MMR antibody when a logical

report wrongly connected it to autism in kids (Foster, 2018). Despite the high number of

vaccinated individuals in France, an opinion paper written by Partouche, Gilberg, Renard, and

Saint-Lary (2019) argue the expansion of required vaccination of newborn children as long as

two years old from three diseases (diphtheria, lockjaw, poliomyelitis) to 11 diseases, presented in

France in January 2018, is certainly not a manageable reaction to the test of controlling antibody

preventable maladies. In France, in 2017, infant vaccination inclusion rates were adequately high

or expanding, with the exception of measles, mumps and rubella (MMR) and meningococcal C

ailment. Regardless of whether inoculation commitment makes it conceivable to accomplish the

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 21

MMR vaccination inclusion targets among newborn children, correspondence programs and

bolstered counsel from healthcare providers are fundamental for the get up to speed of

defenseless grown-ups to acquire herd immunity. The effect of obligatory vaccination on

reluctance stays questionable, and it repudiates the development of the patient's job in the

administration of his or her own wellbeing and the guideline of self-sufficiency. Various

investigations have demonstrated that mediations and guidance from healthcare providers

improve immunization acceptance. To address the poor execution of some immunization

programs by health experts, solid correspondence and assets from health specialists are required,

instead of a retreat towards a requirement. Decreasing botched chances and expanding access to

vaccination are fundamental goals. At last, an immunization arrangement dependent on essential

consideration and a patient-focused way to deal with every immunization are bound to lessen

antibody reluctance, reasonably (Partouche, 2019).

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 22

Methods

This research study assessed the perceived benefits and barriers about the MMR vaccine

among the parents of a pediatric population in South Florida. The main goal of this quantitative

study was to identify the perceived benefits and barriers on the MMR vaccine.

Research Design

This research was a descriptive study. In order to assess the perceived benefits and barriers about

the MMR vaccine among the parents of a pediatric population, the researcher surveyed parents

with young children.

Participants

The participants, parents, were asked to participate in a survey based on the fact they are a parent

of a pediatric population. Only parents, over the age of 18 years old, were inclusive in this

research study. Parents were targeted in any age range, as long as they were over 18 years old.

The inclusion criteria for research participation was being a parent of a pediatric population

whose child is between the ages 0 and 5 years old. The researcher surveyed 100 parents with

young children.

Instrumentation

The participants were asked to complete a 19-question questionnaire via Survey Planet. The

survey was divided in two sections: demographic information and MMR vaccination questions.

The survey questions were based on the questionnaire used on Mary Flynn’s prospective

questionnaire on Predicting Uptake of MMR Vaccination (2004). The questions developed in this

survey follows the health belief model. The survey uses the 5-point Likert Scale, ranging from

(1) “strongly disagree” to (5) “strongly agree,” which follows the analysis of Mary Flynn’s

(2004) research study. The total score was summated and the reliability of the scores was

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 23

assessed using Cronbach’s A. The questionnaire used in this research study can be located in

Appendix A.

Procedures

In order to begin the research, the researcher generated a survey via Survey Planet. The questions

asked of participants consisted of demographic information, knowledge on vaccinations, and the

participants view on the obtaining vaccination for their children. Some of the demographic

information collected included: how old the parents and children are, how many children do the

parents have, gender of the parent, and income information. Once the survey was generated via

Survey Planet, the researcher made flyers that contained the survey link. Furthermore, the

researcher shared the survey link via social media, which included Facebook, WhatsApp,

LinkedIn, Instagram, and Twitter. Additionally, the researcher reached out to known prospective

participants that are parents of a pediatric population. The researcher gathered results in a 2-week

time period.

Data Analysis

The results from the survey were evaluated using descriptive statistics for the variables in this

research study. The variables, parents of a pediatric population (independent), perceived benefits

(dependent), and the barriers (dependent), were measured on Survey Planet using SPSS for

Windows. In order to avoid missing data during this research, the questions on Survey Planet

were required to answer. No optional questions were allowed. In the event that there was any

missing data from the questions asked, then statistical techniques would have been used to work

around that missing data.

The percentage of the parents were determined based on the number of respondents obtained.

The perceived benefits were measured based on the survey results, which were centered on the

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 24

parents’ responses. The barriers were also measured based on what the parents’ responded on the

Survey Planet survey. The data obtained by the survey was handled by categories. There was an

analysis of any missed variables, outliers, or any normality that arise from the data.

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 25

Results

Parents of a pediatric population in South Florida were asked several questions in order to

assess their perceived benefits and barriers. The following section goes in depth on the results by

assessing the demographic characteristics, perceived benefits, and perceived barriers.

Demographic Characteristics

Descriptive statistics for demographic information among parents of a pediatric population in

South Florida are given in Table 1. Out of the 100 participants, 71 were women and 29 were

men. Among those participants, six were in between the 18 to 24 age group, 63 were in between

the 25 to 34 age group, 23 were in between the 35 to 44 age group, seven were in between the 45

to 54 age group, and one was older than 65 years old. The majority of participants have a degree

as only two out of the 100 participants currently have no degrees. Sixteen participants have their

middle or high school degree, 48 participants have their college degree, and 34 participants have

a graduate degree. The gross income among the participants varied with eight having less than

$20,000, 15 with a gross income between $20,000 to $34,999, 23 participants between $35,000

to $49,999, 32 participants between $50,000 to $74,999, 9 participants between $75,000 to

$99,999, and 9 participants over $100,000. Almost half of the participants, 51, have one child,

while 29 participants have two children, eight have three children, one has four children, and one

has more than five children. More than half of the participants’ children, 61, are between the ages

2 to 5 and 39 participants’ children are under 2 years old.

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 26

Table 1.

Demographic Characteristics of Parents of a Pediatric Population in South Florida

(n = 100)

Demographic Characteristics

Gender

Men

Women

Age

18 to 24

25 to 34

35 to 44

45 to 54

65+

Education Level

None

Middle/High School Degree

College Degree

Graduate Degree

Gross Income

Less than $20,000

$20,000 to $34,999

$35,000 to $49,999

$50,000 to $74,999

$75,000 to $99,999

Over $100,000

Number of Children

1

2

3

4

5+

Children’s Age Range

Under 2

2 to 5

29

71

6

63

23

7

1

2

16

48

34

8

15

23

32

9

13

51

39

8

1

1

39

61

Perceived Benefits

Analysis of the survey results using descriptive statistics on the SPSS software is shown in Table

2. To assess the benefits of the MMR vaccine, the following questions were asked: I have strong

knowledge on the MMR vaccine, I have researched the benefits of the MMR vaccine, my

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 27

research has led me to make an informed decision on vaccination, measles, mumps, and rubella

is a serious illness for a child to acquire, and I believe vaccinations are beneficial to prevent a

child from being diagnosed with a life-threatening condition. The minimum value is 5.00 and the

maximum is 25.00. The mean of the five benefit questions is 19.1300 with a standard deviation

of 5.42842. Fifty-seven percent of participants have high-perceived benefits on the MMR

vaccine and 43% have low perceived benefits on the MMR, which can be seen in graph 1.

Perceived Barriers

Assessing the barriers of the MMR vaccine was analyzed. The minimum value is 8.00 and the

maximum is 66.00. The mean of the eight barrier questions is 23.1100 with a standard deviation

of 6.60562. Forty-four percent of participants have high-perceived barriers on the MMR vaccine

and 56% have low perceived benefits on the MMR, which can be seen in graph 2.

Table 2.

Descriptive Statistics on Survey Results Assessing the Perceived Benefits and Barriers

(n = 100)

Benefits

Minimum

Maximum

Mean

Standard Deviation

Perceived Benefits

Low Perceived Benefits

High Perceived Benefits

Barriers

Minimum

Maximum

Mean

Standard Deviation

Perceived Barriers

Low Perceived Barriers

High Perceived Barriers

5.00

25.00

19.1300

5.42842

43%

57%

8.00

66.00

23.1100

6.60562

56%

44%

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 28

Graph 1.

Graph 2.

43% 57%

56% 44%

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 29

Discussion

Among the 100 individuals who completed the survey, 71% of the respondents were

females, while 29% respondents were males. The higher amount of responses being from a

female’s perspective could be due to mothers usually being the one to do more research than

fathers do, which is supported by the 57% of perceived benefits among the sample. In addition,

63% of respondents were between the ages 25 to 34. Individuals that fall into the 25 to 34--age

range are parents. This age range could mean parents are more mature given their high-perceived

benefits of the MMR vaccine. The 82% of respondents have a college degree or higher, which

indicated more than half of the sample size are educated individuals. Given their education

background, parents are more likely to do their research on MMR vaccines in order to make an

informed decision. Jackson, Cheater, Peacock, Leask, and Trevena (2010) found parents who

used a decision aid on the MMR vaccine allowed them to make an informed decision because

they knew all of the benefits and barriers beforehand.

There were 57% of parents that have high-perceived benefits of the MMR vaccine, while

43% have low perceived benefits. Given the demographic information of the majority of the

respondents being more mature and having an educational background, the percentage of having

low perceived benefits is higher than anticipated. Similarly, the 56% of the parents have low

perceived barriers of the MMR vaccine, and 44% have high-perceived barriers of the MMR

vaccine. There is still a good amount of parents who are reluctant to following the CDC’s

national recommendation on being vaccinated in order to prevent getting Measles, Mumps, or

Rubella.

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 30

Conclusion

The majority of the respondents were younger female parents. These demographic

characteristics indicated that more than half of the respondents have a high-perceived benefits as

well as low perceived barriers on the MMR vaccination. The higher perceived benefits were

related to individuals who are educated and have more of an inclination of making an informed

decision when debating whether their child should be vaccinated.

Recommendations

Fifty seven percent of respondents indicated they have higher perceived benefits of the

MMR vaccine. While 43% of respondents have, a low perceived benefits of getting the MMR

vaccine. This percentage is relatively high considering the 98% of respondents are educated. The

Center for Disease Control and Prevention recommends everyone to get the MMR vaccine in

order to protect our health (MMR Vaccination, 2019). There is a gap with the national

recommendation and the findings of this survey, with 43% respondents having low perceived

benefits of the MMR vaccine. Therefore, it would be recommended to implement a decision aid

in South Florida in order to inform parents of the benefits and barriers of the MMR vaccine. The

decision aid will educate parents on all the good and bad of the vaccination. This will allow

parents to make an informed decision that does not rely on social media or family and friends.

Furthermore, this study was assessed in a small sample size. It is recommended to conduct this

study on a national level to gain a better understanding of the perceived benefits and barriers.

These results could be used in order to help decrease the current Measles outbreak in the United

States.

Furthermore, this study had a few limitations. One of the major limitations involves with

the population being only in South Florida, which is an extremely diverse population. Another

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 31

limitation of this study was the sample size. The sample size could have been larger than 100

participants to really see any gaps in the research.

APPENDIX A

Questionnaire

Demographic Information:

Gender  Female

 Male

Age  18 to 24

 25 to 34

 35 to 44

 45 to 54

 55 to 64

 65+

Number of Children  1

 2

 3

 4

 5+

Children’s Age Range  Under 2

 2 to 5

Education Level  Middle/High School Degree

 College Degree

 Graduate Degree

 None

Gross Income  Less than $20,000

 $20,000 to $34,999

 $35,000 to $49,999

 $50,000 to $74,999

 $75,000 to $99,999

 Over $100,000

Please rate the following items on a scale from 1 to 5, with 1 being “strongly disagree” and 5

being “strongly agree.”

I have strong knowledge on the MMR vaccine.

1

2

3

4

5

I have researched the benefits of the MMR vaccine.

1

2

3

4

5

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 32

I have researched the risks of the MMR vaccine.

1

2

3

4

5

My research has led me to make an informed decision

on vaccination

1

2

3

4

5

I have used social media platforms to learn more about

the MMR vaccine.

1

2

3

4

5

I have relied on family/friends to learn more

information on the MMR vaccine.

1

2

3

4

5

I rely on information about health problems from

magazines.*

1

2

3

4

5

Measles, Mumps, and Rubella is a serious illness for a

child to acquire.*

1

2

3

4

5

I would feel guilty if my child was diagnosed with

Measles, Mumps, or Rubella that could have been

prevented by vaccination.*

1

2

3

4

5

I would feel guilty if my child caught an illness that

could have been prevented by vaccination.*

1

2

3

4

5

Vaccination could possibly harm the body’s immune

system.*

I believe vaccinations are more harmful than preventing

a specific condition.

1

2

3

4

5

I believe vaccinations are beneficial to prevent a child

from being diagnosed with a life-threatening condition.

1

2

3

4

5

*Questions obtained from Mary Flynn’s questionnaire on Predicting Uptake of MMR

Vaccination (2004)

PERCEIVED BENEFITS AND BARRIES ON MMR VACCINE 33

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