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      Determinants of vaccine hesitancy in Switzerland: study protocol of a mixed-methods national research programme

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          Abstract

          Introduction

          Vaccine hesitancy is a complex public health issue referring to concerns about the safety, efficacy or need for vaccination. Relatively little is known about vaccine hesitancy in Switzerland. This ongoing study (2017–2021) focuses on biomedical and complementary and alternative medicine (CAM) providers and their patients since healthcare professionals play important roles in vaccination decision-making. This national research programme seeks to assess the sociocultural determinants of vaccine hesitancy regarding childhood and human papillomavirus vaccines in Switzerland. We aim to provide a detailed characterisation of vaccine hesitancy, including CAM and biomedical perspectives, patient–provider interactions, and sociocultural factors, to establish the mediating effects of vaccine hesitancy on underimmunisation, and to design an intervention to improve vaccination communication and counselling among physicians, parents and adolescents.

          Methods and analysis

          Our transdisciplinary team employs a sequential exploratory mixed-methods study design. We have established a network of more than 150 medical providers across Switzerland, including more than 40 CAM practitioners. For the qualitative component, we conduct interviews with parents, youth, and biomedical and CAM providers and observations of vaccination consultations and school vaccination information sessions. For the quantitative component, a sample of 1350 parents of young children and 722 young adults (15–26 years) and their medical providers respond to questionnaires. We measure vaccine hesitancy with the Parent Attitudes about Childhood Vaccines 15-item survey and review vaccination certificates to assess vaccination status. We administer additional questions based on findings from qualitative research, addressing communication with medical providers, vaccine information sources and perceptions of risk control vis-à-vis vaccine-preventable diseases. The questionnaires capture sociodemographics, political views, religion and spirituality, and moral foundations.

          Ethics and dissemination

          The study was approved by the local ethics committee. The results will be published in peer-reviewed journals and disseminated to healthcare professionals, researchers and the public via conferences and public presentations.

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          Most cited references44

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          Measuring vaccine hesitancy: The development of a survey tool.

          In March 2012, the SAGE Working Group on Vaccine Hesitancy was convened to define the term "vaccine hesitancy", as well as to map the determinants of vaccine hesitancy and develop tools to measure and address the nature and scale of hesitancy in settings where it is becoming more evident. The definition of vaccine hesitancy and a matrix of determinants guided the development of a survey tool to assess the nature and scale of hesitancy issues. Additionally, vaccine hesitancy questions were piloted in the annual WHO-UNICEF joint reporting form, completed by National Immunization Managers globally. The objective of characterizing the nature and scale of vaccine hesitancy issues is to better inform the development of appropriate strategies and policies to address the concerns expressed, and to sustain confidence in vaccination. The Working Group developed a matrix of the determinants of vaccine hesitancy informed by a systematic review of peer reviewed and grey literature, and by the expertise of the working group. The matrix mapped the key factors influencing the decision to accept, delay or reject some or all vaccines under three categories: contextual, individual and group, and vaccine-specific. These categories framed the menu of survey questions presented in this paper to help diagnose and address vaccine hesitancy.
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            Grounded Theory and Sensitizing Concepts

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              Mapping vaccine hesitancy—Country-specific characteristics of a global phenomenon

              Highlights • Vaccine hesitancy is a global problem that is complex and multilayered. Vaccine hesitancy is context, time, place and vaccine specific. • Interviews with immunization managers were conducted to determine the breadth and perceived drivers of vaccine hesitancy at the countries’ level. • Our study results, not unexpectedly, revealed a wide variation in the reported basis for vaccine hesitancy across countries.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2019
                2 November 2019
                : 9
                : 11
                : e032218
                Affiliations
                [1 ] Swiss Tropical and Public Health Institute , Basel, Switzerland
                [2 ] University of Basel , Basel, Switzerland
                [3 ] departmentDepartment of Pediatrics , HFR Fribourg Cantonal Hospital , Fribourg, Switzerland
                [4 ] departmentUniversity Department of Medicine , Kantonsspital Baselland, University of Basel , Bruderholz, Switzerland
                [5 ] Klinik Arlesheim , Arlesheim, Switzerland
                [6 ] departmentInstitute of Sociological Research , University of Geneva , Geneva, Switzerland
                Author notes
                [Correspondence to ] Dr Philip E. Tarr; philip.tarr@ 123456unibas.ch
                Author information
                http://orcid.org/0000-0003-2224-8173
                Article
                bmjopen-2019-032218
                10.1136/bmjopen-2019-032218
                6830664
                31678955
                69713095-1d01-455f-813b-77454947761d
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/.

                History
                : 11 June 2019
                : 21 August 2019
                : 17 September 2019
                Funding
                Funded by: NRP 74 Smarter Health Care;
                Award ID: 167398
                Categories
                Infectious Diseases
                Protocol
                1506
                1706
                Custom metadata
                unlocked

                Medicine
                vaccine hesitancy,under-immunisation,childhood vaccinations,hpv vaccination,complementary and alternative medicine (cam),mixed methods research,patient-provider communication,vaccination information sources

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