Washington State Licensed Child Care Facility Directors' Perspectives on Childhood Immunization

The study objective was to determine Washington State childcare facility directors' compliance with state immunization education and monitoring requirements and the role of directors' immunization attitudes and beliefs on compliance.

We mailed a self-administered survey to 2000 randomly selected childcare facility directors in Washington State. The primary outcome measures were reported compliance with state requirements to educate parents about the importance of immunizations and monitor the immunization status of enrolled children.

Our response rate was 28%. The majority of respondents worked at facilities with a licensed capacity of <25 children, had ≥11 years of experience, and were parents themselves. Overall, 68% agreed that they educated enrolled parents about the importance of immunizations and 90% agreed that they monitored the immunization status of enrolled children. However, 60% were concerned that children might have a serious side effect from an immunization, 51% were concerned that any one of the childhood immunizations might not be safe, and 11% were distrustful of the immunization information they received. These beliefs were associated with a statistically significant decreased likelihood of educating parents about immunization (adjusted odds ratios [aORs]: 0.57, 0.46, 0.19, respectively) and monitoring immunization status of children (aORs: 0.32, 0.32, 0.19, respectively).

Most Washington State child care facility directors who responded to our survey are compliant with state requirements for immunization education and monitoring. A substantial number of directors are concerned about vaccine safety, however, and these concerns may decrease the likelihood of these requirements being followed.