Shourie S, Jackson C, Cheater FM, Bekker HL, Edlin R, Tubeuf S, Harrison W, McAleese E, Schweiger M, Bleasby B, Hammond L. A cluster randomised controlled trial of a web based decision aid to support parents' decisions about their child's Measles Mumps and Rubella (MMR) vaccination.
Vaccine 2013;
31:6003-10. [PMID:
24148574 PMCID:
PMC3898271 DOI:
10.1016/j.vaccine.2013.10.025]
[Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 08/22/2013] [Accepted: 10/08/2013] [Indexed: 11/30/2022]
Abstract
The use of decision aids for immunisation decisions is under researched and controversial.
Parents receiving a decision aid or a leaflet had reduced decisional conflict for the MMR decision.
MMR uptake in the decision aid and control arms achieved levels required for population immunity.
Leaflet arm parents were less likely to vaccinate their child.
Childhood immunisation decision aids can achieve both informed decision-making and uptake.
Objective
To evaluate the effectiveness of a web based decision aid versus a leaflet versus, usual practice in reducing parents’ decisional conflict for the first dose MMR vaccination decision. The, impact on MMR vaccine uptake was also explored.
Design
Three-arm cluster randomised controlled trial. Setting: Fifty GP practices in the north of, England. Participants: 220 first time parents making a first dose MMR decision. Interventions: Web, based MMR decision aid plus usual practice, MMR leaflet plus usual practice versus usual practice only, (control). Main outcome measures: Decisional conflict was the primary outcome and used as the, measure of parents’ levels of informed decision-making. MMR uptake was a secondary outcome.
Results
Decisional conflict decreased post-intervention for both intervention arms to a level where, parents could make an informed MMR decision (decision aid: effect estimate = 1.09, 95% CI −1.36 to −0.82; information leaflet: effect estimate = −0.67, 95% CI −0.88 to −0.46). Trial arm was significantly, associated (p < 0.001) with decisional conflict at post-intervention. Vaccination uptake was 100%, 91%, and 99% in the decision aid, leaflet and control arms, respectively (χ2 (1, N = 203) = 8.69; p = 0.017). Post-hoc tests revealed a statistically significant difference in uptake between the information leaflet, and the usual practice arms (p = 0.04), and a near statistically significant difference between the, decision aid and leaflet arms (p = 0.05).
Conclusions
Parents’ decisional conflict was reduced in both, the decision aid and leaflet arms. The decision aid also prompted parents to act upon that decision and, vaccinate their child. Achieving both outcomes is fundamental to the integration of immunisation, decision aids within routine practice. Trial registration: ISRCTN72521372.
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