Informing the information – the UK use of communication research

1. Informing the information – the UK use of communication research Jo Yarwood Head of Immunisation Information Department of Health

2. Why bother?

3. The role of the media in reporting on vaccination issues. • Vaccination affects huge numbers of 'readers' or 'viewers'. • 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.

4. Research • pre-testing • ‘strategic’ research • bi-annual tracking

5. 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)

6. Tracking aims • To provide information on the following for strategic planning: • 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)

7. Tracking survey 29 waves of research dating back to October 1991. Wave 29 fieldwork: 17th October – 14th November 2005. 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.

8. 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

9. Advertising and publicity

10. Spontaneous awareness of advertising, information or publicity in last 12 months Any advertising, information or publicity ** ** TV advertisement TV programme Newspaper article Feb 02 Sep 02 Mar 03 Oct 03 May 04 Nov 04 May 05 Nov 05 Base: All primary care givers of 0 - 2s (W29 n = 1004)

11. What remember most about advertising information or publicity (unprompted) Get children immunised/don’t miss immunisations * About immunisations/vaccinations ** Get your child immunised/parents responsibility Debate about MMR/controversy/ whether to have it or not Mention of MMR and Autism / bowel disease Positive mention of MMR Base: All who recall seeing/ hearing advertising, information or publicity about immunisation (W29 n=726)

12. Whether seen advertising, info or publicity that might have persuaded them not to immunise 34% of these people had postponed or rejected MMR (compared with 14% of all respondents) May 05 May 04 Nov 04 Feb 02 Sep 02 Mar 03 Oct 03 Nov 05 Sep 98 Mar 99 Sep 99 Mar 00 Oct 00 Mar 01 Sep 01 Base: All who spontaneously recall seeing/ hearing advertising, information or publicity (W29 n = 726)

13. Prompted awareness of other publicity about immunisation for children Reference guide Pre-school leaflet

14. Prompted recall of leaflets Old Guide to childhood immunisation New guide to immunisation for babies MMR Facts (V3) Reference guide MMR Facts (old v2) MMR Facts (old v1) Pre-school leaflet Sep 01 May 05 Nov 05 Feb 02 Sep 02 Mar 03 Oct 03 May 04 Nov 04 Base: All primary care givers of 0 - 2s (W29 n = 1004)

15. Immunisation Information and MMR The Facts Websites

16. Internet access amongst primary care givers Internet access Internet use Visited MMR: The Facts website Sep 02 Mar 03 Oct 03 May 04 Nov 04 May 05 Nov 05 Base: All primary care givers of 0-2s (W29 n = 1004)

17. MMR

18. Perceived safety of MMR by social grade Completely safe Slight risk Moderate risk High risk Don’t Know Nov 04 May 05 Nov 05 Nov 05 Nov 04 May 05 ABC1 C2DE Base: All primary care givers 0 - 2s (W29 n = 1004)

19. Proportion who consider MMR a greater risk than the diseases it protects against Total Spontaneous Nov 05 Feb 02 Mar 03 Oct 03 May 04 Nov 04 Oct 00 Mar 01 Sep 01 Sep 02 Base: All primary care givers of 0 - 2s (W29 n = 1004)

20. Spontaneous awareness of immunisations MMR ** Polio Men C Hib Whooping Cough 5 in 1 vaccine Children’s flu Pneumococcal Nov 04 Mar 03 Oct 03 May 04 May 05 Nov 05 Base: All primary care givers of 0 - 2s (W29 n = 1004)

21. Perceived safety of immunisations DTaP / IPV Old Polio (by mouth) Men C 5 in 1 vaccine MMR % completely safe Mar 03 Oct 03 May 04 Nov 04 May 05 Nov 05 Base: All primary care givers of 0 - 2s (W29 n = 1004)

22. Perceived severity of diseases Meningitis Polio % very serious Diphtheria Rubella Measles Hib Mumps Nov 05 Mar 03 Oct 03 May 04 Nov 04 Base: All primary care givers of 0 - 2s (W29 n = 1004)

23. Uptake, Refusals and Delays

24. Attitudes to immunisation (from MMR work) • Parents generally get their children immunised on trust… • 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 itwouldn’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 concernedabout the threat to their own children if other parents fail to immunise

25. Vaccinations delayed and refused Delayed any Delayed MMR Refused any Refused MMR Nov 05 Mar 03 Oct 03 May 04 Nov 04 May 05 Base: All primary care givers of 0 - 2s (W29 n = 1004)

26. Delaying & refusing MMR: past and future Postponed for reasons other than safety (since done/intend to do) Postponed for safety reasons (since done/intend to do) 18% postponed for safety reasons or refuse Rejected - delayed indefinitely/ refused outright Delayed indefinitely, refused or would refuse in the future Base: All primary care givers of 0-2s (W29 n = 1004)

27. Which immunisations would not allow a future child to have (prompted) Base: All primary care givers of 0 - 2s (W29 n = 1004)

28. The Immunisation Process Information gathering

29. Sources of information consulted before immunisations were due (prompted) Leaflets Immunisation appointment card Healthcare/childcare magazine articles Television programmes Internet Books Newspaper articles Television adverts Women’s magazines NHS Direct Base: All primary care givers of 0 - 2s (W29 n = 1004)

30. Whether discussed immunisations with a health professional before the immunisations were due Any Health Visitor GP Practice Nurse Midwife Sep 02 Mar 03 Oct 03 May 04 Nov 04 May 05 Nov 05 Base: All primary care givers of 0 - 2s (W29 n = 1004)

31. Information gaps 70% felt they had all the info about immunisation that they wanted before their child’s immunisations were due. The most frequently mentioned requests were for more general information • Information on side effects (7%) (8% at W28) • More information in general on all aspects (6%) (6% at W28) No MMR related issue was mentioned by more than 2% of all respondents.

32. The Immunisation Process The decision process

33. Consent * Any consent In writing Verbally Mar 03 Oct 03 May 04 Nov 04 May 05 Nov 05 Base: All who accompanied their child for most recent immunisation (W29 n = 826)

34. The process of deciding to have child immunised – by age and social grade SOCIAL GRADE AGE Base: All primary care givers of 0 - 2s

35. The Immunisation Process Satisfaction

36. Satisfaction with most recent visit Somedissatisfaction (net) Not enoughtime todiscuss issues Not givensufficientexplanation Not ableto askquestions Dissatisfiedoverall Base: All who accompanied their child on most recent visit (W29 n = 826)

37. Trust advice about immunisation given by HPs and government GPs Health visitors Practice nurses NHS % Strongly Agree Government Nov 05 May 05 Mar 03 Oct 03 May 04 Nov 04 Base: All primary care givers of 0 - 2s – Four-fifths sample

40. Media tracking

41. 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(highest month) 35,741 visits • www.mmrthefacts.nhs.uk 19,535 visits • MMR ‘your questions answered’ 1,460

42. 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.

43. Child protection