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Parents' preferences for outcomes associated with childhood vaccinations
M Kuppermann1, R F Nease, L M Ackerson
1Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA.
Insights
Parents value avoiding severe vaccine outcomes more than minor ones, trading more time and money for better protection. Individual preferences vary significantly, impacting vaccination decisions.
Area of Science:
- Pediatric Health
- Vaccinology
- Health Economics
Background:
- Childhood immunization schedules are expanding, increasing the importance of understanding parental concerns.
- Psychological costs, adverse events, and vaccine-preventable diseases are key considerations in vaccination decisions.
Purpose of the Study:
- To assess parental preferences for vaccination outcomes using time tradeoff and willingness-to-pay metrics.
- To explore how parental preferences for vaccination outcomes correlate with demographic characteristics.
Main Methods:
- 206 parents of infants receiving care in Northern California were surveyed.
- Time tradeoff and willingness-to-pay were used to quantify preferences for six vaccination outcomes.
- Statistical analyses, including Tukey's multiple comparisons and rank correlation, were employed.
Main Results:
- Parental willingness to trade time or money increased with the severity of the vaccination outcome.
- All six main outcomes showed statistically significant differences in parental preferences (P < 0.0001).
- Parental education, income, race/ethnicity, and birth order did not significantly explain preference variations.
Conclusions:
- Parents are willing to sacrifice more resources (time, money, life expectancy) to avoid severe, permanent outcomes compared to minor, temporary ones.
- Significant variation exists in parental preferences for avoiding vaccination outcomes.
- Healthcare guideline developers should consider individual parental preferences in vaccination decision-making.
Background:
The number of shots in the childhood immunization schedule has been increasing and is likely to continue to increase in the coming years. Consideration of the psychologic costs of multiple injections, adverse events and vaccine-preventable disease is therefore growing in importance.
Methods:
We assessed parent preferences, using both the time tradeoff (i.e. amount of parent time willing to trade) and willingness-to-pay (i.e. dollars willing to pay) metrics, for possible outcomes of vaccination among 206 parents of infants receiving care at Kaiser, Northern California Region. We also explored the relationship between preferences and subject characteristics.
Results:
In general the amount of time subjects were willing to give up and the quantity of money they were willing to spend to avoid an outcome increased with the severity of the outcome. Preferences for our six main outcomes of interest all differed from one another (P < 0.0001, Tukey's multiple comparisons procedure). Rank correlation coefficients between time tradeoff and willingness-to-pay values for the six main outcomes ranged from 0.42 to 0.52 (all P < 0.004). Subject characteristics, including education, income, race/ethnicity and the child's birth order, did not explain the variation in parent preferences.
Conclusions:
In general subjects were willing to give up more money or time to avoid less desired outcomes. They were willing to give up only very small amounts of their own life expectancy or money to avoid minor, temporary outcomes (e.g. moderate fussiness, fever and pain) whereas they were willing to forego substantial lengths of their life or amounts of money to avoid a major, permanent outcome (i.e. permanent disability). Nonetheless much variation surfaced in the amount of time (or money) subjects were willing to trade to avoid outcomes. If this variation represents true differences in preferences, guideline developers must consider the role of individual parent preferences in decisions concerning vaccination.