# Presentation: 842470

## Informing the information – the UK use of communication research

- Jo Yarwood
- Head of Immunisation Information
- Department of Health

## Why bother?

## The role of the media in reporting 

-  It is 'political' since it is recommended by Governments.
-  It plays victims against the establishment, and experts against experts.
-  The science element gives it an aura of mystique.
-  Communicable diseases are no longer feared - vaccines are now.

- The role of the media in reporting
- on vaccination issues.

## Research

- pre-testing
- ‘strategic’ research
- bi-annual tracking

## What is the commitment?

- two waves of ‘parental’ tracking per year
- one wave of professional tracking per year
- pre-testing (as appropriate)
- other ad hoc work (eg MMR work)
- about £250,000 per annum (a small proportion of the total vaccines budget)

## Tracking aims

- parents knowledge of immunisation
- parents attitudes towards immunisation
- parents experience of services
- To monitor advertising over time on key indicators
- In addition, to examine all of the above in the light of continued publicity surrounding childhood immunisations (esp. MMR)

**Notes:**
A brief reminder of the research aims

## Tracking survey

- Random location sampling design in 152 areas in England (geographically representative)
- 1004 in-home personal interviews with “primary care givers” (usually parents) of 0-2s in England using Multi-Media CAPI.

## Background cont.

- Sampling can be adapted (or added to) to explore other groups in depth
- Core questions can be adapted for new concerns
- Information is used to inform the communication strategy

## Advertising and publicity 

## Spontaneous awareness of advertising, information or publicity in last 12 months

- Any advertising,
- information or
- publicity

- TV programme

- Base: All primary care givers of 0 - 2s  (W29  n = 1004)

- Newspaper article

- TV advertisement

- Oct 03

- May 05

- Feb 02

- Sep 02

- Mar 03

- May 04

- Nov 04

- Nov 05

- **

- **

**Notes:**
Looking at awareness of publicity we can see that it is still driven more by advertising than media publicity.

Awareness of TV programmes has continued to decline, most probably due to a lack of media attention in recent months (**check). 

Newspaper articles remained stable (some publicity in the Guardian criticising epidemiological studies into the link between MMR and autism, but this was 8th Nov and unlikely to have had much impact on the results)

## What remember most about advertising information or publicity (unprompted)

- Mention of MMR and Autism / bowel disease

- Get your child immunised/parents responsibility

- Debate about MMR/controversy/
- whether to have it or not

- Positive mention of MMR

- Get children immunised/don’t miss immunisations

- Base: All who recall seeing/ hearing advertising, information or publicity about immunisation (W29  n=726)

- About immunisations/vaccinations

- **

- *

**Notes:**
Instead, there has been a shift towards recall of issues about immunisations or vaccinations in general, as shown here in the blue box.

## Whether seen advertising, info or publicity that might have persuaded them not to immunise

- Oct 03

- May 04

- Nov 04

- Base: All who spontaneously recall seeing/ hearing advertising, information or publicity (W29  n = 726)

- Feb 02

- Sep 02

- Mar 03

- May 05

- Nov 05

- Sep 01

- Mar 01

- Oct 00

- Mar 00

- Sep 99

- Mar 99

- Sep 98

- 34% of these people had postponed or rejected MMR (compared with 14% of all respondents)

**Notes:**
Of those who had seen something which might persuade them not immunise, 34% had postponed or rejected MMR (compared with 14% of all respondents).

There was very little difference by age or social grade (refer to handouts for details).

## Prompted awareness of other publicity about immunisation for children

**Reference guide**

**Pre-school leaflet**

**Notes:**
These are the new leaflets (new at last wave) that we are tracking this time. The Reference guide on the left and the pre-school leaflet on the right. These are leaflets that are sent through the post to parents before their child’s immunisations.

## Prompted recall of leaflets

- Mar 03

- Oct 03

*Old *Guide to childhood immunisation

- May 04

**Base: All primary care givers of 0 - 2s  (W29  n = 1004)**

- MMR Facts (old v2)

- Feb 02

- Sep 02

- MMR Facts (V3)

- MMR Facts (old v1)

*New* guide to immunisation for babies

- Nov 04

- Sep 01

- May 05

- Reference guide

- Pre-school leaflet

- Nov 05

**Notes:**
At this wave, we asked about the current leaflets in use, shown on the right hand side of this chart: the latest Guide to Childhood Immunisations (in orange), the latest version of MMR The Facts (in purple), the Reference guide (dark blue) and the pre-school leaflet (green).

There is very little change since the last wave and recall remains fairly stable for all four leaflets.

The Immunisation for Babies and MMR The Facts leaflets remain highest with recall among half of parents.

In contrast, the pre-school leaflet is least remembered with one in five recall. 

## Immunisation Information and MMR The Facts Websites

**Notes:**
We also prompted parents with screenshots from the Immunisation Information and MMR: The Facts websites and asked if they had visited either site 

## Internet access amongst primary care givers

- Oct 03

- May 04

- Nov 04

- Base: All primary care givers of 0-2s (W29  n = 1004)

- Sep 02

- Mar 03

- Internet use

- Internet access

- May 05

- Nov 05

- Visited MMR: The Facts website

**Notes:**
... though visits to the MMR The Facts website were higher at 11% (significant result)

## MMR

**Notes:**
Moving on now to MMR.

## Perceived safety of MMR by social grade

- Completely safe

- Slight risk

- Moderate risk

- Don’t Know

**ABC1**

**C2DE**

- High risk

- Nov 04

- Nov 04

- Base: All primary care givers 0 - 2s   (W29  n = 1004)

- May 05

- May 05

- Nov 05

- Nov 05

**Notes:**
When we look at this by social grade, you can see that there has been a slight increase since May in the proportion of ABC1s thinking that MMR in completely safe, although this increase is not significant. However the increase seen since November 2004 is significant.

As in May 2005, around four in ten C2DEs believing that MMR is completely safe.

So overall, there has been some fluctuation over wave on wave, but this is not significant.

## Proportion who consider MMR a greater risk than the diseases it protects against

**Base: All primary care givers of 0 - 2s  (W29  n = 1004)**

- Spontaneous

- Total

- Oct 03

- Nov 04

- May 04

- Mar 03

- Nov 05

- Oct 00

- Sep 01

- Feb 02

- Sep 02

- Mar 01

**Notes:**
MMR is really the only immunisation seen as carrying a greater risk than the diseases it protects against, although we have seen a decrease in the proportion thinking this.  These results represent a return to the levels recorded in Sep 2001 – the wave before the last major period of negative publicity. As you can see, the past few waves have shown more stability than in 2001 and 2002 during the big scare stories.

Breaking this down, there is now no difference between ABC1s and C2DEs in terms of the proportion considering MMR to be a greater risk than the diseases it protects against – whereas prior to November 2004 ABC1s were less positive.

Older respondents aged 35 and above are also slightly more likely to think that MMR is a greater risk than the diseases it protects against (18% of 35+ compared with 13% of 15-24s).

## Spontaneous awareness of immunisations

- Polio

- Whooping Cough

- Hib

- MMR

- Oct 03

- Base: All primary care givers of 0 - 2s  (W29  n = 1004)

- May 04

- Men C

- May 05

**5 in 1 vaccine**

- Mar 03

- Nov 04

- Children’s flu

- Pneumococcal

- **

- Nov 05

**Notes:**
Comparing spontaneous awareness of immunisations, MMR still remains very much the top of mind.

There has been a decrease in those aware of polio, with awareness levels now similar to 2004. The peak seen in May 2005 was possibly due to the publicity surrounding the Polio vaccine being replaced by the 5 in 1 vaccine. As the publicity has subsided, awareness has dropped, and we may expect awareness to continue to decline with time.

Down at the bottom of the chart low spontaneous awareness for the children’s flu and pneumococcal. And not much higher for the five in one vaccine at 19%.

## Perceived safety of immunisations

- Old Polio (by mouth)

- % completely safe

- DTaP / IPV

- 5 in 1 vaccine

- Men C

- MMR

- Nov 05

- May 05

- Nov 04

- May 04

- Oct 03

- Mar 03

**Base: All primary care givers of 0 - 2s  (W29  n = 1004)**

**Notes:**
And just focusing on the proportions who say ‘completely safe’, we should note the increases over the last two waves in the proportions for DTaP / IPV, the 5 in 1 vaccine and MMR. Meningitis C has seen a slight decrease since last wave, however it is still significantly higher than in November 2004.

## Perceived severity of diseases

- Meningitis

- Polio

- Diphtheria

- Hib

- % very serious

- Oct 03

- Base: All primary care givers of 0 - 2s  (W29  n = 1004)

- May 04

- Nov 04

- Rubella

- Measles

- Mumps

- Mar 03

- Nov 05

**Notes:**
We saw earlier that the perceived severity of Measles, Mumps and Rubella had remained stable.  Here we can see that they remain among the diseases perceived as least severe, along with Hib.

As we can see, Meningitis and Polio remain the diseases perceived as most severe.

## Uptake, Refusals and Delays

**Notes:**
So we’ve seen attitudes towards MMR – these could have some impact on uptake of the immunisation.

## Attitudes to immunisation (from MMR work)

- they would not usually question the ‘received wisdom’ to immunise
- rationally...
- they know that vaccinations have been clinically tested and are safe
- they believe the Government would not deliberately harm children and risk litigation (because it wouldn’t get re-elected)
- they know that immunisation is not 100% effective, but believe that it reduces the chances of damage from diseases
- awareness and understanding of the need for 95% population coverage is low, but parents are concerned about the threat to their own children if other parents fail to immunise

- Attitudes to immunisation (from MMR work)

## Vaccinations delayed and refused

- Refused MMR

- Refused any

- Mar 03

- May 04

- Nov 04

- May 05

- Oct 03

- Base: All primary care givers of 0 - 2s  (W29  n = 1004)

- Delayed MMR

- Delayed any

- Nov 05

**Notes:**
Looking at the actual proportions delaying or refusing immunisations, and MMR in particular, around 3 in 10 primary care givers reported delaying any immunisation, with 1 in 5 delaying MMR.  These figures have been decreasing slightly since a peak in November 2004. Note that AB respondents were more likely to delay any immunisation than other groups (43% compared with 29% overall).

Looking at refusals, these were much more MMR led than delays. While just 6% refused any immunisation, 4% refused MMR. 

Note, there’s a chart in your handouts which shows that overall respondents thought that only 7 in 10 children are given the MMR.

## Delaying & refusing MMR: past and future

- Base:  All primary care givers of 0-2s (W29  n = 1004)

- Delayed indefinitely, refused
- or would refuse in the future

- Postponed for reasons other than
- safety (since done/intend to do)

- Postponed for safety reasons
- (since done/intend to do)

- Rejected - delayed indefinitely/ refused outright

- 18% postponed for safety reasons or refuse

**Notes:**
Putting all of the delaying and refusals together, we can see that the proportions delaying or refusing are fairly stable over time.
14% delayed but not for safety reasons and went on to have the MMR done – this increased this wave due to higher proportion  (71% compared with 65% in May 2005) saying they have since had MMR done.
This leaves 18% who delayed for safety reasons or refused, with 14% only postponing the MMR, and 5% refusing outright or delaying indefinitely.
If we bring in those who would reject MMR in the future, we see a hard core of 6% of rejectors. This proportion is stable over time.
Breaking the findings down, we should note that a quarter of the AB group delayed because of concerns over safety compared with 14% of all respondents.

## Which immunisations would not allow a

-  future child to have (prompted)

- Base: All primary care givers of 0 - 2s  (W29  n = 1004)

**Notes:**
Look in more details at those who would reject a future immunisation, 7% of parents would reject something. This is led by MMR (4%), and as we can see, lower levels are citing MMR than in previous waves.

## The Immunisation Process

- Information gathering

**Notes:**
One thing parents with any doubts can do is to gather the available information. So if we look at the sources that they consulted before any immunisations were due...

## Sources of information consulted before immunisations were due (prompted)

- Base: All primary care givers of 0 - 2s  (W29  n = 1004)

- Leaflets

- Healthcare/childcare magazine articles

- Immunisation appointment card

- Books

- Television adverts

- Women’s magazines

- Television programmes

- Internet

- Newspaper articles

- NHS Direct

**Notes:**
...we can see that leaflets continue to be the most used source. Except for television programmes, it really is the written sources that continue to dominate, such as the immunisation appointment card, healthcare, childcare magazine articles and books.

The internet continued to be used by two in ten parents.

## Whether discussed immunisations with a 

- health professional before the immunisations were due

- Base: All primary care givers of 0 - 2s  (W29  n = 1004)

- Mar 03

- Any

- Health
- Visitor

- GP

- Midwife

- May 04

- Nov 04

- May 05

- Sep 02

- Practice Nurse

- Oct 03

- Nov 05

**Notes:**
Moving on from written sources to the discussions that parents had with health professionals. Three in four had spoken to a health professional. Again this was most likely to be the health visitor. There’s been very little change over time.

## Information gaps

-  Information on side effects (7%) (8% at W28)
- More information in general on all aspects (6%) (6% at W28)

- The most frequently mentioned requests were for more general information

- 70% felt they had all the info about immunisation that they wanted before their child’s immunisations were due.

- No MMR related issue was mentioned by more than 2% of all respondents.

**Notes:**
So there seemed to be mismatch between sources consulted and sources parents would have preferred to consult, but did this mean that there were any gaps in parents information. Seven in ten had all the information they needed before an immunisation was due. This hasn’t changed over time.

The most frequently mentioned requests were for information on side effects and more information in general on all aspects. No MMR related issue was mentioned by more that 2% of all respondents.

## The Immunisation Process

- The decision process

**Notes:**
They’ve got the information, how do they come to their decision.

## Consent

- Base: All who accompanied their child for most recent immunisation  (W29  n = 826)

- In writing

- Any consent

- May 04

- Verbally

- Oct 03

- May 05

- Mar 03

- Nov 04

- Nov 05

- *

**Notes:**
Most recent wave has seen an increase in the number who remember giving consent to 68%, but as you can see this is more of a recovery since the last wave rather than an increase over time.

43% remembered giving consent in writing, and 28% verbally. This has remained stable over time.

Of those who didn’t recall giving their consent, the majority felt that it didn’t matter (70%).

## The process of deciding to have child immunised – by age and social grade

- AGE

- SOCIAL GRADE

- Base: All primary care givers of 0 - 2s

**Notes:**
Its still the younger and C2DE parents who are more likely to automatically have their children immunised.

These haven’t changed over time, but details are in your handout.

## The Immunisation Process

- Satisfaction

**Notes:**
We’ve seen fewer people weighing up the pros and cons before immunisations, so are they generally more satisfied with the immunisation process.

## Satisfaction with most recent visit

- Somedissatisfaction
- (net)

- Not enoughtime todiscuss issues

- Not givensufficientexplanation

- Not ableto askquestions

- Dissatisfiedoverall

**Notes:**
HIDDEN

## Trust advice about immunisation given by 

- HPs and government

- Nov 04

- % Strongly Agree

- Mar 03

- Health visitors

- GPs

- Practice nurses

- Oct 03

- May 04

- May 05

- Nov 05

- NHS

- Government

- Base: All primary care givers of 0 - 2s – Four-fifths sample

**Notes:**
If we look at those who strongly agree over time – you can see that the increase in those strongly agreeing that they trust the NHS and health professionals is more than just a recovery after lower levels in 2005. Trust in the government is slowly increasing over time.

## Slide 38

## Slide 39

## Media tracking

## Activities of DH Immunisation Information Unit (January 2005 – January 2006)

- Conferences 					11 (delegates 5,115)
- Health professional seminars 		74
- Parents seminars 				8
- Parents research 				2,000 interviews
- Health professionals research 		1600 interviews
- Leaflets, posters, videos and factsheets 	8,378,050
- _[www.immunisation.nhs.uk](http://www.immunisation.nhs.uk/)_   (highest month)       35,741 visits
- _[www.mmrthefacts.nhs.uk](http://www.mmrthefacts.nhs.uk/)_ 			19,535 visits
- MMR ‘your questions answered’ 	1,460

## Immunisation communication - public perspectives.

-  Public acceptability will be of increasing importance, irrespective of scientific virtues.
-  The media provide the interface between immunisation programmes and the public.
-  We cannot assume that the media share our views and we must recognise their independence.
-  The public increasingly seek information on an active basis.
-  The internet, where information is unregulated, contains much that is potentially wrong and harmful.
-  We must compete effectively and dedicate as much effort to communicating on vaccines as we do on providing them.

## Child protection

## Slide 44