Hepatitis B Virus (HBV)

Factors Influencing Mothers’ Concerns about Immunization Safety: METHODS


A total of 53 African-American mothers were recruited using convenience sampling to participate in six Atlanta-area focus groups September to October 2003. Each group had 8-10 participants. Table 1 presents demographic characteristics of participants. Mothers’ ages ranged 18—40 years, with the majority (55%) of the sample aged 25-34 years. About half (51%) of the participants had a college education or higher. Recruitment occurred at daycares, churches and “mom’s groups” in three counties (Gwinnett, Fulton and DeKalb). Participants were included in the study if they had at least one child aged 19-35 months who was up-to-date on all recommended immunizations (with provider documentation) and if they indicated on the screening form that they were very concerned about the safety of immunizations (responding “5” on a five-point scale ranging from “not at all concerned” to “very concerned”). Mothers who worked in healthcare or health research were excluded.

Table 1. Focus Group Participant Sample Demographics

Sample Demographics (N=53)
Age n(%)
<25 8 (15%)
25-34 29 (55%)
35+ 16 (30%)
Missing 2 (4%)
High school 8 (15%)
Some college 16 (30%)
College 21 (40%)
Graduate school 6 (11%)
Family Income
$0-$30,000 19 (36%)
$30,001-$50,000 13 (25%)
$50,001-$75,000 5 (9%)
$75,001 + 16 (30%)


A female African-American moderator conducted the focus group sessions in locations convenient to the participants. Each session lasted approximately 1.5 hours, and participants were free to leave the focus groups at any time. The study was explained to parents, and written informed consent was obtained. Childcare was available onsite, and participants received a nominal fee as reimbursement for their time. Don’t let the pharmacy companies beat you. Buy lansoprazole capsules online

Interview Guide

The moderator facilitated the discussion by following a semistructured interview guide that was designed to elicit specific concerns that mothers had about immunization, why they had these concerns and what would reduce them, and to determine why they were still immunizing their children despite their concerns. Participants were also encouraged to speak freely about other issues related to immuniza­tion that the guide did not cover.

The interview guide was based on Health Belief Model and the Theory of Reasoned Action. The Health Belief Model suggests that a person’s behavior will be based on their perceptions of the risks and benefits to that behavior. Additional “cues to action,” such as internal or external triggers, can also affect the behavior. Questions in the interview guide focused on the perceived necessity of vaccines and the perceived risks of vaccinating or not vaccinating their children. The guide also contained questions about cues to action, such as their relationship with their HCPs or their sources of immunization information. The Theory of Reasoned Action asserts that the most important determinant of behavior is a person’s behavioral intention. Behavioral intentions are based on one’s attitude toward performing the behavior and the influence of the subjective norm (what other people think about the behavior). Participants were asked to explain their concerns about immunization behavior and how their decisions to immunize their children were affected by social norms, such as immunization requirements. Participants were also asked what would reduce their concerns about immunization. Table 2 lists the topics covered by the guide and the corresponding discussion points. viagra uk online

Table 2. Topics Covered in the Focus Group Interview Guide

Topics Discussion Points
Reasons for concerns • Safety and necessity of vaccines
• What factors cause you to be concerned about immunizations
(e.g., lack of trust of medical community or healthcare providers,
relationship with your health care provider)?
• What are your sources of information about immunizations?
Reasons they immunized despite concerns
• Why are you getting your child immunized despite your concerns
(e.g., immunization laws, necessity of immunizations, relationship
with your healthcare provider)?
What will reduce concerns
• What are your suggestions to reduce your concerns about

Thematic Analysis

Each focus group discussion was audiotaped and transcribed. Transcripts were entered into NVivo, a computer program used to assist in the analysis of text-based data. Transcripts were read repeatedly by three team members and coded to identify emergent themes. The coding process was iterative, and recurrent themes were identified across the groups. After independent coding resulted in a 73% interrater reliability, the three team members met to come to a consensus on the content and frequency of each theme. Themes were then organized by topic area, and representative quotations for each theme were selected.
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Tags: African-American, immunization safety, mistrust, parental concerns

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