Post on 13-Aug-2020
Report of Findings
Pennine Lancashire -
Immunisation Programmes
for Under 5s
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 2
Introduction
• MLCSU undertook activities in order to gain insight on behalf of NHS England to
the opinions and feedback from parent/carers of children aged under 5 on childhood
immunisation programmes in the East Lancashire and Blackburn with Darwen areas.
• An online survey was developed and promoted to capture the views of
those parents/carers. The survey was live between Monday 12 February 2018 and
Wednesday 14 March 2018.
• Two face-to-face focus groups were run on 19 March and 21 March.
• Overall, 79 individuals completed the survey and 12 people attended the focus groups.
This Report of Findings summarises their responses and outlines MLCSU’s conclusions
and recommendations.
Please note that where percentages do not total 100%, this is due to rounding or participants being able to select more than
one answer.
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 3
Aims and objectives
• Understand current views of parents/carers of children aged under 5 around:
• the uptake for childhood vaccinations for under 5s
• motivating factors for having/not having the vaccinations
• information provided and communication channels
• accessibility of the services
• any potential barriers
• Explore methods to increase uptake and raise awareness of the immunisation
programmes.
Online survey
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 5
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 6
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 7
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 8
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 9
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 10
Survey findings
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 12
Area participants liveOver two thirds of participants live with the East Lancashire area.
67%(53)
33%(26)
East LancashireBlackburn with
Darwen
Within which area of Lancashire or South Cumbria do you live? Base: 79
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 13
Parent/carer of a child under the age of 5 years old
Are you a parent/carer of a child under the age of 5 years old? Base: 79
Yes
No
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 14
Informed about child(ren) due for vaccinations
Other comments verbatim:
Method of informing Number Percentage
GP surgery letter 56 80.00%
Friends/family 1 1.43%
Read information in red book 19 27.14%
Healthcare professional advises 7 10.00%
Appointment card/letter in post 19 27.14%
Other (please specify) 2 2.86%
"School also" and "To advert"
How are you informed your child(ren) are due for vaccinations? Base: 70
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 17
Main reasons for getting your child vaccinated
What are the main reasons for getting your child(ren) vaccinated? Base: 70
Main reasons Number Percentage
To protect my child(ren) from illness/disease 66 98.5%
Healthcare professional recommendation 21 31.3%
Had other child(ren) vaccinated 18 26.9%
Recommendation from family/friends 6 9.0%
Other 2 3.0%
Other comments verbatim:
“I'm a scientist who understands
the public health implications”
“To protect those in the greater
population that are unable to be
vaccinated”
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 18
Information provided to aid decision making
What information did your school/nursery or a healthcare professional provide to assist you in deciding whether to have
your child(ren) vaccinated? Base: 70
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 19
Other comments
What information did your school/nursery or a healthcare professional provide to assist you in
deciding whether to have your child(ren) vaccinated?
“None whatsoever”
“Information leaflet within appointment letter”
“Not enough information has ever been given. I
sought information from research available. Along
with peer reviewed research.”
“Not of school age yet”
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 20
Research to aid decision-making
What research did you do before deciding on whether to allow your child(ren) to be vaccinated? Base: 70
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 21
Other comments
“Peer reviewed published research available
online. Plus non peer reviewed. No research has
been done on true placebos.”
“I am a nurse, vaccination is something I do as
part of my job & passionate about”
“My profession is healthcare”
What research did you do before deciding on whether to allow you child(ren) to be vaccinated?
“I'm a health professional and have a working
knowledge of immunisations and vaccinations”
Demographic profiling
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 23
Demographic profilingPostcodes
What is your postcode? Base: 70
Additional postcodes
1.4% - BB8, BBB, B10, BL1, B12, B18,
B19, L32, M25, M26, M29, M62, OL1,
PR2, WN6, WN7
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 24
Demographic profilingEthnicity, religion or belief
What is your ethnicity? Base: 69. What is your religion or belief? Base: 69.
Christianity
Atheist, no
religion
English, Welsh,
Scottish, Northern
Irish, British
Other ethnicities include Irish and White &
Black Caribbean
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 25
Demographic profilingAge
What is your age? Base: 70
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 26
Demographic profilingGender
What is your gender? Base: 70
100%Female
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 27
Demographic profilingSexual orientation
What is your sexual orientation? Base: 69
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 28
Demographic profilingRelationship status
What is your relationship status? Base: 70
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 29
Demographic profilingDisability
Do you consider yourself to have a disability? Base: 69
Focus groups
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 31
Area participants liveTwo thirds of participants live in the Blackburn with Darwen area.
67%(8)
33%(4)
Blackburn with Darwen East Lancashire
Base: 12
Group Date Participants
1. 19 March 2018 4
2. 21 March 2018 8
Breakdown of focus groups
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 32
Participants in support of having their child/children vaccinated
100%(12)
Yes
Do you intend to have your child/children vaccinated? Base: 12
33MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT
What words/thoughts do you associate with childhood immunisations?
Blackburn with Darwen:
• Meningitis
• General illness
• Prevention
• Children’s screams
• Protection
East Lancashire:
• Side effects
• Disease
• Protection
• Immunity
• Pain/screams of child
• Statistics – those who are
vaccinated versus those who are
not
• Nervousness, but know they have
to have them
• Reactions to vaccine
34MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT
Blackburn with Darwen:
• Peace of mind that children are
protected against disease.
• Protection for children against other
children that haven’t had the vaccination.
• Trust that the medical advice is right,
(sometimes hard to understand the
information that is shared).
East Lancashire:
• Just go with it.
• NHS recommendation.
• Trust in the vaccinations.
• Knowing what the risks/effects of
diseases are.
• If you’ve had them yourself as a child.
• Exhausted with a new born child so
easier to go with the flow.
• Something to have planned and done.
• Experience of family or others around
you is very influential.
What are your motivating factors for having your child/children immunised?
“In Asian heritage it’s very important that
we have certain types of vaccinations as
we don’t have the same chromosomes as
other ethnic groups”
“A recommendation
from a trusted
authority goes a
long way”
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 35
What, if any, research did you undertake when making a decision about
having your child/children vaccinated?Blackburn with Darwen
• source.
“I researched the
flu injection”
“Research is key but knowing the
correct place to get easy to read
and understandable information is
hard”
“I stay away from
Google as every child is
different and the
responses aren’t always
right”
Google - to see
comments
which people
have left on
groups; these
can be helpful
Facebook to
see the
community
questions
NHS
website
GP
advised to
use NHS
Choices
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 36
What, if any, research did you undertake when making a decision about
having your child/children vaccinated?East Lancashire
• Combination of online research and Health Visitor advice.
• Social media is a big driver but caution needed over the qualifications of the person
writing the post as ‘people make things up’.
• Use Google to look for NHS or NICE guidance/recommendations.
• Advice from friends.
• Use the book provided by healthcare.
“If the doctors say I should
vaccinate then I will follow
their instructions”
“A kick-boxer on YouTube claims to
tell the truth about vaccinations but
you must subscribe to find out more”
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 37
Trusted sources of information
Blackburn with Darwen:
• Patient.co.uk
• Babycentre.co.uk
• NHS Choices
• Facebook communities
East Lancashire:
• NHS Choices website
• NICE guidance
• GP
• Health visitor
• Friends
• Red book
• Facebook/Twitter/YouTube
• Mumsnet
• Netmums
• NHS Immunisations webpage
• BBC articles on health
“Rarely do I follow ‘official’ groups on
social media e.g. NHS England or Clinical
Commissioning Groups”
“NHS is a trusted source of information
but not a popular channel for messages”
38MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT
• People are worried and scared about the side effects of the injections.
• Low uptake could be a result of language and the person not understanding English.
• A lot of media coverage about autism being caused by the vaccinations which can put
some people off.
• Social media: one parent could post something and others see this, share it and the
information might not be correct but it puts people off having vaccinations.
• People are much more aware about what they are taking these days but it’s really hard to
understand what the ingredients are within the vaccinations.
Opinions about childhood vaccinations(self/family/friends/wider community)
Blackburn with Darwen
“Eggs are in the flu vaccination which makes
you wonder what’s in all vaccinations”
“We went private two years ago and
haven’t had any problems”
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 39
Opinions about childhood vaccinations(self/family/friends/wider community)
East Lancashire
• People complain after the flu jab that children will
fall ill.
• A rule imposed by a breastfeeding group forum
admin that vaccinations will not be talked about as
they are so controversial.
• The NHS is trying to make people poorly.
• Speculation that there’s a link between MMR and
autism.
• Campaigners who have had a bad experience
can make a lot of noise online, despite the risks
being small.
• It is difficult to tell who is right and who is wrong.
“I read in the paper that smallpox is
coming back”
“A mum I know would not let her
daughter be immunised (at school)
without her being there – as this
couldn’t happen, the immunisation
didn’t take place”
“My sister is dead against her children
having these”
40MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT
Personal experience of having child/children vaccinatedBlackburn with Darwen
“My son is 15 years old and has just had
a booster but after he had this I learnt
the booster contained animal fat. They
need to be clearer about ingredients and
if they have alternatives they should
offer them well in advance.”
“I was sent for injections when my son didn’t need
them, as he had already had them at the hospital
(Manchester Royal) as he has a kidney disorder. I knew
he didn’t need them so I was able to speak with the GP
and resolve it but it still took time and shouldn’t have
happened. The GP should have been aware my son
had already received the vaccinations.”
(GP: Barbara Castle Way)
“When my son was 2 weeks old he had to go for
his TB vaccination. This was carried out at the
birthing centre (Burnley). They were really
welcoming and said I could arrive at any point
from 10am-12pm and not to worry if I was feeding
him; they could wait.”
“The only thing I don’t like is the reaction from the
children when they are having the injections, as
the screaming is upsetting”
“Little Harwood GP surgery is very good”
41MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT
Personal experience of having child/children vaccinatedEast Lancashire
“We were reassured that all we needed to deal with
side effects was Calpol but they (side effects) were
much worse than I was led to believe by doctors”
“It was not made
clear what to
expect”
“I made one decision for one of my children and
another for the other”
“I still have the scar
from TB”
“I had a devastating experience of vaccinations – my young sibling collapsed at 13 months old and
was left with brain damage”
“My experience was worse than
expected due to too many
injections in one day”
42MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT
Information received about immunisation programmes/when vaccinations
are dueBlackburn with Darwen
“A lot of jargon is
used and you feel
silly asking what
this word and that
word means”
“My GP gives me the
time to ask questions,
and leaflet for
information on side
effects was provided”
(GP surgery: Little
Harwood)
“When you make your
appointment for the
vaccinations you don’t
receive a letter
confirming it”
“I received letters from
the school each time
each of my children
have a vaccination but
I pay for private
healthcare”
One participant
received a white slip
but never a yellow
one
One
participant
never received
a yellow slip
Two participants
received a yellow
slip but didn’t know
what to do with
it/couldn’t
understand what it
was for.
Two participants
received a lot of letters
and said it was hard to
keep track, especially
when you have more
than one child.
43MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT
Information received about immunisation programmes/when vaccinations
are dueBlackburn with Darwen (continued)
“My health visitor gave me her
personal number which I can call
whenever I have a question, which
is really great”
“I called my health visitor, but
no-one ever came back to me. I
know they are so busy.”
“Health visitors are so busy, as
are midwifes”
“I received information from my
health visitor who I have a great
relationship with so I feel I could
ring her if I had any vaccination
questions, but they are so busy I
don’t like to trouble them”
East Lancashire
“We are bombarded with letters –
I need time to consider the
implications”
“Invitations for the flu jab come at
the wrong time of the year (in
summer) and I am more likely to
have my jab in winter”
44MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT
• Hard to keep track when receive lots of letters.
• More difficult to keep on top of all appointments when
have more than one child.
• Easy to forget appointment as don’t receive a letter confirming it.
Availability/access to appointmentsBlackburn with Darwen
“I had to rearrange my son’s vaccination
appointment two days before the appointment. I
was told to call the GP to do this who then had to
contact the company that provided the
vaccinations. I had to wait for a letter in the post
with my new appointment. It would have been
much easier if I could have rearranged it straight
away.” (Shifa surgery)
“In my experience the GP
practice is very flexible around
appointments which is a positive
thing” (Surgery: Little Harwood)
Multiple letters
Appointment
letter
45MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT
Have you experienced any barriers?Blackburn with Darwen
“Even if I did seek out
reports on the vaccinations,
I’m not sure I would
understand what they said
because of the terminology
used in them.”
“Communication between NHS providers is
sometimes muddled and you get told different
things by different people. This is confusing
especially when you’ve just had a baby.”
“Language could be barrier not just
for Muslim people but Eastern
European. I know people that can’t
read English who receive letters and
if no-one reads them for her she
throws the letters in the bin.”
“It seems all surgeries are
so different. Some like
mine (Little Harwood) try
their very best to rearrange
appointments for
vaccinations whereas
others don’t seem to want
to help – this could mean
people don’t attend.”
“I wanted to take my son swimming once he’d had
his injections but as we had a delay with the
injections it meant that I had to delay starting his
lessons. It’s only a small thing but when your baby
is so small you look forward to those things.”
46MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT
Availability/access to appointments/other barriersEast Lancashire
“I always rely on health visitors – I rarely go
anywhere as I can’t drive – I don’t have money
for a taxi or bus.”
“Nowhere was made available for
breastfeeding at appointments and if you miss
your slot by even a few minutes, you have to
rearrange and that can be hard with a child.
Some people might not bother.”
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 47
What types of communication do you prefer?Blackburn with Darwen
• Leaflets on the wall in the
room during focus group at
Little Harwood Children’s
Centre were voluntarily
pointed out and rated by the
group as examples of
good/bad use of imagery
when it comes to getting a
message across to people
when English isn’t their first
language.
“Image is good as you
can understand it’s
about feeding your baby
even if you don’t speak
English”
“Image is poor as I
wouldn’t understand
what it’s about unless I
could read”
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 48
What types of communication do you prefer?
Blackburn with Darwen:
• Clear, concise, image-led, plain English leaflets.
• Not everyone has smartphones, so posted letters needed as well.
• Letters can be wordy, so a simple text will be easier to understand
and help with the language barrier.
• Face to face information seen as really important.
East Lancashire:
• Leaflet.
• Appointment confirmation letter.
• Face to face discussion with Health Visitor.
“Text or email would work for
me, as it’s handy to have the
details on my phone”
“I prefer face to face but if I got
the information I could read and
then discuss it face to face, I
would like that”
“Little Harwood Children’s
Centre promote their website
a lot and I use it”
Face to face
Letters - simple
text
Leaflets - clear,
concise,
image-led
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 49
What could improve the uptake of vaccinations in your area?Blackburn with Darwen
“Make sure that the language used to
communicate with the patient’s parent is the
language that they speak and understand”
“Leaflets should be left in popular spots, such
as, supermarkets, children’s centres,
community halls, public notice boards, boots,
childcare places etc”
“A lot more information needs to be shared
during pregnancy so that you are prepared for
what you need to do once the baby arrives”
Word of mouth
Leaflets that are sent
out with vaccination
reminder letters
Campaigns with
leafletsSocial media
PostersFace to face
information
Workshops
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 50
What could improve the uptake of vaccinations in your area?Blackburn with Darwen (continued)
• Vaccination drop in sessions each week (similar to health visitor sessions).
• Vaccinations given at the weigh-in clinics by health visitors.
• Workshops on childhood vaccinations to educate during pregnancy and then reminder
workshops afterwards.
• More information as child gets older – plenty of information when leaving hospital with
a new born, but not much as child gets older.
• Accompany the appointment letter with a detailed information leaflet about side effects
and full ingredients list.
“The NHS puts an
importance for weigh in
clinics (drop in) so why
don’t they do it for
vaccinations?”
“Drop in clinics for vaccinations work best. With a new baby
you can try your very best to be on time to your appointment,
but it only takes a dirty nappy as you’re leaving the house to
make you late and then you have missed your appointment
and need to start all over again.”
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 51
What could improve the uptake of vaccinations in your area?East Lancashire
• Clearer information. Lack of transparent information leads to
surprises when having an immunisation, which puts people off for
subsequent occasions e.g. more injections than expected or
harsher side effects.
• Clear labelling and branding of messages (NHS or NICE) is very
important.
• Use social media for getting the correct information out there.
• Use celebrities to promote vaccinations.
• Leaflet should be provided listing the ingredients in each vaccine
and their possible side effects.
• Handy timetable of childhood immunisation programme
should be provided – something durable that can be kept in case
invite letter gets lost.
“Branding and labelling of
the source is more
important than what I read
in blogs and on forums”
“The NHS should myth
bust – monitor online and
social media channels for
incorrect information and
dispute it”
“Branding and labelling of
the source is more
important than what I read
in blogs and on forums”
“Branding and labelling of
the source is more
important than what I read
in blogs and on forums”
Conclusions
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 53
Conclusions
• Healthcare professionals, other parents and friends/family are most trusted for advice.
• Healthcare visitors are heavily relied upon by new parents for any
information/reminders.
• Face to face conversations are very popular – especially when followed up with
information to take away, digest and keep.
• Parents/carers worry about the health implications/side effects that have been linked
to vaccinations and due to the variety of places to go for advice/research, find it confusing
to know what and who is correct, especially on online channels.
• An inconsistent amount of information is provided to parents living in different
areas/different GP practices.
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 54
Conclusions
• Not enough is done by healthcare professionals to explain the side effects (short-term
and long-term) of vaccinations or exactly what ingredients the vaccinations contain –
driving parents/carers to do their own research and finding inaccurate information (at
times).
• Not enough is done proactively to engage with those whose first language is not
English.
• NHS Choices website is a popular source for finding information but NHS social media
channels are not well known or used.
• Flexibility and access to appointments (days/times/ability to change appointment)
varies across different GP practices.
• Parents/carers (especially those with more than one child) struggle with the amount of
communications/information they are given – not just healthcare related.
Recommendations
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 56
Recommendations
• Hold workshops during pregnancy to educate parents about childhood vaccinations.
• Provide all parents/carers with a durable, high quality leaflet (more likely to be kept) for
childhood immunisations - use clear imagery and include dates and full ingredients list.
• Display leaflets in popular public spots e.g. supermarkets (nappy aisle), children’s
centres, community halls, chemists, shopping centres – places that parents/carers visit.
• Provide merchandise that is more likely to be kept – provide after birth of a child e.g. a
fridge magnet of vaccinations and ages they’re due at.
• Offer vaccination drop-in sessions as an alternate to a set time appointment.
• Offer vaccinations at the weigh-in clinics.
• Allow parents the option to be present during vaccinations that take place at school.
• Use celebrities in campaigns – telling their own personal stories/experiences.
MIDLANDS AND LANCASHIRE COMMISSIONING SUPPORT UNIT 57
Recommendations
• Engage with parents/carers online – go to where they are rather than expecting them to
find your channels e.g. monitor online forums and Facebook community groups to
provide advice and correct information. Ensure that it is clear the person is speaking on
behalf of the NHS e.g. use appropriate username on forums, ‘blue tick’ verification on
Twitter, and verified badges on Facebook and Instagram pages/profiles, which allow
users to know they’re authentic.
• Use plain English in communications – be clear, concise and avoid jargon/too many
acronyms.
• Post a reminder letter when vaccinations due and follow up with a reminder SMS.
• Post a confirmation of appointment letter and follow up with a confirmation SMS.
• Proactively provide the leaflet/letter/SMS in first language of the parent/carer.
• Send SMS reminder the day before an appointment.