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Exploring the Association between Parental Concern about Vaccine Safety and Incomplete Childhood Immunization: A Multivariate Model Open Access


Other title
population health
postal survey
public health
Type of item
Degree grantor
University of Alberta
Author or creator
MacDonald, Shannon E.
Supervisor and department
Schopflocher, Donald (Nursing & Public Health)
Examining committee member and department
Scott, Shannon (Nursing)
Reutter, Linda (Nursing)
Russell, Margaret (Medicine)
Kushner, Kaysi (Nursing)
Vaudry, Wendy (Medicine)
Faculty of Nursing

Date accepted
Graduation date
Doctor of Philosophy
Degree level
High levels of immunization coverage are required to maintain control of infectious diseases that previously caused significant illness and death in Canada. However, childhood immunizations have been so successful that many Canadians have never seen the impact of these diseases, with some parents becoming more concerned about the safety of vaccines than about the infectious diseases that they were designed to prevent. The purpose of this thesis was to determine if parental concern about vaccine safety is significantly associated with incomplete childhood immunizations, and whether other personal or systemic factors play a role in influencing uptake. The thesis consists of four related papers focusing on: (1) The value and challenges of applying the population health framework in nursing research; (2) The benefits and drawbacks of using postal surveys for public health nursing research; (3) Assessment of the accuracy of the immunization database utilized in this study in terms of immunization status classification, as compared to parent report; and, (4) The findings of the multivariate data analysis in the study. The main conclusions of this thesis are as follows: (1) The population health framework, while presenting challenges for nurse researchers, provides a valuable framework for assessing the multi-level factors influencing health behaviours, such as immunization uptake; (2) Awareness of the potential for survey error is essential when using postal surveys in research, and measures must be taken to minimize, assess, and control for non-response bias; (3) The immunization database used in this study had a low, but not inconsiderable, number of misclassification errors of immunization status, while parent report had a greater number of errors; and (4) Parental concern about vaccine safety was indeed associated with incomplete immunizations, but other personal and systemic factors were also associated with vaccine uptake and/or mediated the relationship between parental concern and uptake.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
Citation for previous publication
MacDonald, S. E., Newburn-Cook, C. V., Allen, M., & Reutter, L. (2013). Embracing the population health framework in nursing research. Nursing Inquiry, 20(1), 30-41. DOI: 10.1111/nin.12017MacDonald, S. E., Newburn-Cook, C., Schopflocher, D., & Richter, S. (2009). Addressing non-response bias in postal surveys. Public Health Nursing, 26(1), 95-105. DOI: 10.1111/j.1525-1446.2008.00758.x

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