Countering controversy: a qualitative study of information provision and service organisationa around MMR

Background: Controversy over the mumps-measles-rubella vaccine has reduced uptake, raising concerns of future disease epidemic. Aim: To explore parent’s accounts of decision-making relating to MMR controversy, identifying uptake determinants and education needs. Design of study: Qualitative interviews analysed using the “framework” approach. Setting: Five general practices in the Leeds area, 2002/3. Methods: Sixty-nine interviews conducted with parents of children aged between four and five years, and twelve interviews with primary care practitioners, managers and immunisation co-ordinators serving participating sites. Participants were interviewed one-to-one in a place of their choosing. Results: Vaccination decision is primarily a function of parental assessments of the relative acceptability and likelihood of possible outcomes. Those who decline to vaccinate have observed children with autistic disorders, believe children vaccinated are at risk of the disorders, and associate more negative outcomes with autism than the mumps-measles-rubella diseases. For most parents the evidence of science and medicine play little role in decision. While local GPs and health visitors are trusted information sources, the influence of primary care providers on vaccination decision is limited by concerns over consultation legitimacy, discussion opportunity and perceptions of financial and political partiality. Parents and practitioners identify a need for new approaches to decisions support and learning when faced with this and similar health care controversy. Conclusion: The study identifies new ways in which parents and practitioners need to be supported in order to increasing user understanding of medical science, reduce pressure on routine primary care services, and secure more informed decision in the face of health controversy.