A national survey to understand why physicians defer childhood immunizations

Arch Pediatr Adolesc Med. 1997 Jul;151(7):657-64. doi: 10.1001/archpedi.1997.02170440019004.


Objective: To determine the causes of low childhood immunization rates based on physicians' knowledge, attitudes, and self-reported practices concerning childhood immunization.

Design: A standardized telephone survey conducted by trained interviewers.

Setting: Primary care physicians across the United States.

Participants: A stratified random sample of office-based family physicians, pediatricians, and general practitioners younger than 65 years was selected from the American Medical Association master file list that includes nonmembers. Physicians seeing 5 or more patients per week younger than 6 years and having 50% or more primary care patients were eligible for study. Of 1769 eligible physicians who spoke directly with the interviewers, 70% (N = 1241) completed the questionnaire.

Interventions: The interview was designed to determine physicians' likelihood of recommending vaccination in common clinical scenarios and to probe reasons behind these decisions.

Results: Only 4% of physicians who thought the risk for side effects was increased by upper respiratory tract infection (URI) were likely to vaccinate a child with URI vs 55% of physicians who thought there would be no increased risk (P < .001). Eighty-three percent of those who thought the efficacy of measles, mumps, and rubella vaccine would not be affected by a URI recommended vaccination vs only 8% of physicians who thought efficacy would decrease (P < .001). Some respondents (11%) would not administer 3 injectable vaccines simultaneously based on beliefs about side effects, parental objections, and vaccine efficacy. Physicians' likelihood of vaccination also varied by type of visit: 47% were less likely to vaccinate a child with a URI in an acute care as opposed to a well-child setting.

Conclusion: Physicians' beliefs and practice policies materially influence their likelihood of recommending vaccinations.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Attitude of Health Personnel
  • Child
  • Family Practice
  • Health Care Surveys*
  • Humans
  • Immunization / statistics & numerical data*
  • Pediatrics
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Surveys and Questionnaires
  • Telephone
  • Time Factors
  • United States