Condition-specific quality of life questionnaires for caregivers of children with pediatric conditions: a systematic review.

PURPOSE: Childhood illness or disability can affect the quality of life (QoL) of the child's primary caregiver. Our aim was to identify, describe the content and systematically review the psychometric properties of condition-specific QoL questionnaires for caregivers of children. METHODS: Medline, PsycInfo, Embase, CINAHL, and the Cochrane library databases were searched from 1 January 1990 to 30 June 2011. Articles related to the development and measurement of caregiver QoL were screened to identify condition-specific questionnaires. The characteristics of the questionnaires were extracted, and their psychometric properties were evaluated using the consensus-based standards for the selection of health measurement instruments checklist with 4-point scale. RESULTS: We identified 25 condition-specific caregiver QoL questionnaires covering 16 conditions. Conditions included atopic dermatitis, asthma, diabetes, oro-facial disorders, and two acute illnesses. Questionnaires were developed predominantly in high-income countries. Questionnaires had the highest quality rating for content validity, followed by hypothesis testing. Methodological quality was satisfactory for criterion validity; fair in reliability and responsiveness; and poor in internal consistency and structural validity. CONCLUSIONS: The increasing number of questionnaires developed over time shows improved recognition of the importance of caregiver QoL. There is a paucity of QoL questionnaires for caregivers of otherwise healthy children suffering from physical injuries and acute conditions associated with significant caregiver burden. Cultural validation of existing and new questionnaires in lower-income countries is necessary. Data collected by condition-specific questionnaires can assist clinicians and health economists in estimating caregiver burden and the types of healthcare services caregivers require and may be useful for healthcare administrators to evaluate interventions.

School-based vaccination: a systematic review of process evaluations.

OBJECTIVE: School-based vaccination is becoming a more widely used method of vaccine delivery. However, evaluations of school-based vaccination program implementation have not been systematically reviewed. This paper describes the results of a systematic review of the literature on process (or implementation) evaluations of school-based vaccination delivery. METHODS: Search terms: "school based vaccination" OR (("schools" OR "school") AND ("immunisation" OR "immunization" OR "vaccination")). LIMITS: Humans; English language; Age: 6-18 (school-age children and adolescents); No editorials; No letters. Databases: PUBMED; Embase.com; Cochrane Database of Systematic Reviews; Cinahl; Web of Science; PsycINFO. Inclusions: Articles must have originated from an advanced economic 'developed' country, be peer-reviewed, available in English, randomised or non-randomised controlled design, published from 1970 to August 2010 and focused on vaccinations provided in the school setting and during school time which reported one or more outcomes. EXCLUSIONS: qualitative or descriptive papers without any evaluation component; papers that only reported on impact evaluation (i.e. number of students vaccinated); and those published before 1970. RESULTS: A total of 14 articles were identified as including some element of a process evaluation of a school-based vaccination program. Nurses, parents, teachers, and adolescents were involved in measures of procedural factors related to school-based vaccination implementation. Outcomes included return rates of consent forms; knowledge about the specific vaccine offered; attitudes toward vaccination and school-based vaccination; reasons for non-vaccination; resources, support, and procedures related to implementation; and environmental factors within the school that may impact vaccination success. Vaccination coverage was also reported in the majority of papers. CONCLUSIONS: Many studies reported on the importance of ensuring all stakeholders (school nurses, parents, teachers, and adolescents) receive appropriate information and are involved in the vaccination program and implementation processes. Specific consent form dissemination procedures have demonstrated higher return rates. Further controlled studies are needed to determine the best practice approach to implementing these programs is a variety of contexts.

Parents' attitudes towards the influenza vaccine and influencing factors.

AIM: To determine what factors are associated with parents' attitudes towards accepting the influenza vaccine for their child. METHODS: Parents' attitudes were measured as part of a pilot randomised controlled trial of influenza vaccination in children attending day care in 2007. Parents and their children were recruited to the study upon a doctor's visit to the day care. A questionnaire elicited beliefs and attitudes towards influenza and vaccination. Descriptive analyses and χ(2) were calculated to determine factors associated with parental attitudes towards the influenza vaccine and with vaccination status. RESULTS: One hundred sixty-nine care givers were interviewed. The following factors were identified as preventive by parents: washing hands (81%); eating a healthy diet (75%); immunisation (74%); keeping their child out of child care when flu is around (54%); disinfecting household surfaces (53%); and breastfeeding for 6 months (48%). Only 5.9% of parents generally or strongly opposed influenza vaccination for their children, and only 1.8% thought that there was a high risk associated with their child having the vaccination. Parents with stronger support for the vaccine tended to view it as safer than other parents and also tended to know more about preventing influenza than other parents. Level of support for the vaccine and perceived safety of the vaccine were both significantly correlated with parents' acceptance of the offer for child influenza vaccination. CONCLUSIONS: There were small numbers of our sample that did not support influenza vaccination; thought that it was unsafe; and/or had low levels of knowledge about prevention of influenza but still vaccinated their child against influenza. There is a need for strong and well-justified recommendations for parents to accept seasonal influenza vaccination for their children.

"Is cancer contagious?": Australian adolescent girls and their parents: making the most of limited information about HPV and HPV vaccination.

INTRODUCTION: Australia has implemented a nation-wide program providing HPV vaccination to girls at school. To date, there are no published studies that explore knowledge about HPV and HPV vaccine post-implementation of the national school-based HPV vaccination program. METHODS: A purposive sample of schools was selected to reflect a range of vaccination coverage (high versus lower uptake), and different school types (Catholic, Independent or Government). Semi-structured focus groups and interviews were conducted with girls and their parents respectively, until saturation was reached. Transcripts were analysed, letting themes emerge from the data. RESULTS: A core theme from both girls and parents was lack of knowledge. Supporting themes were lack of knowledge of HPV, lack of knowledge of vaccine, and realisation of their lack of knowledge. Their lack of knowledge was common in three areas: what HPV is, how HPV is transmitted, and the HPV and cervical cancer connection. The lack of knowledge about HPV vaccination was reflected in what the vaccine protects against, how the vaccine works, HPV vaccination recommendations, the vaccine and Pap smear connection, and myths about HPV vaccination. Both girls and parents wanted more information, had a tendency to defer responsibility, and parents expressed judgment of themselves as parents. DISCUSSION: Low levels of knowledge and understanding about HPV vaccination among adolescents and parents have implications for adolescents' future health practices, including sexual risk behaviour, condom usage, and cervical screening. Reasons for the low levels of knowledge are explored, as are implications for school-based educational interventions.

"All manner of ills": The features of serious diseases attributed to vaccination.

Anti-vaccination writings have linked vaccines with a wide range of negative outcomes. The majority of evidence negates such connections raising the question of what makes these attributions attractive. This research identified diseases and conditions which are claimed to have been caused by vaccines and identified their shared societal features. They shared an idiopathic origin; apparent rise in incidence; face-value biological plausibility of a link to vaccines; dreaded outcomes; and their onset having close proximity to immunisation. Any attempt to re-frame erroneous claims about vaccination first requires an identification of the deeper anxieties in which they are located.