Increasing parental involvement in an immunization program helped to increase the number of young children who received the influenza vaccine, according to study results published in the Journal of the American Association of Nurse Practitioners.

The influenza vaccine is associated with one of the lowest compliance rates of all recommended pediatric immunizations in the United States, especially in the youngest age group. The Centers for Disease Control and Prevention recommends 2 doses of the influenza vaccine during the first year of receipt. To increase the influenza immunization rate in children aged 6 to 24 months, the researchers developed a quality improvement program at a family health center.  

To identify underlying causes of, and barriers to, influenza immunization, an open-ended telephone survey was created and administered to 30% of parents whose children were eligible for the influenza immunization. Interview questions included whether parents were planning to vaccinate their child against influenza this year. Based on a literature review and the parents’ survey responses, the program included reminder calls, parent education, proactive appointment scheduling, and social media reminders. Each aspect was implemented simultaneously over a 6-month period during the 2017 to 2018 influenza season.

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A total of 85 parents were surveyed through randomized sampling in English and Spanish; based on the survey, 71% of parents reported that they were planning on immunizing their child against influenza the subsequent fall, 18% stated they would consider immunization, and 11% stated they were not intending to have their child receive the influenza vaccine.

According to parents, the primary barriers to influenza immunization included forgetfulness, unawareness that the vaccine can be given at the age of 6 months, and beliefs that the vaccine is unnecessary and causes a flu-like reaction. Successful measures to overcome these barriers would include text message reminders, call reminders, and additional information or education on the influenza vaccine. Parents of patients who had well-child care or acute visits were offered the vaccine.

Of the 165 children, 56 had received the vaccine before the start of the study. All patients who had not yet received the influenza vaccine by October 2017 (n=109) received a reminder call. A total of 78% of parents responded to the phone conversation and scheduled an appointment; of these, 90% attended the appointment and 88% agreed to the vaccine after receiving the handout and discussing it with their provider. Parents who did not return the phone call received a reminder in the mail; this mailing only resulted in a 5% response rate.

An educational handout was distributed to each parent whose child did not receive the influenza vaccine; a convenience sample of 15 parents reported understanding the handout and requested that their child to receive immunization. By the end of March 2018, the influenza immunization rate had increased from 44% the year prior to 57%, representing an absolute increase of 13% and a relative increase of 31%.

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“Increasing parent engagement in discussions on increasing immunization rates not only promotes awareness surrounding vaccines but also allows primary care providers to learn from parents to create a patient-centered, patient-partnered immunization program,” concluded the investigators. “Programs that specifically target immunization efforts toward parental concerns have the potential for increased vaccine acceptance and improved health outcomes.”


Bauer KE, Agruss JC, Mayefsky JH. Partnering with parents to remove barriers and improve influenza immunization rates for young children [published online February 4, 2020]. J Am Assoc Nurse Pract. doi:10.1097/JXX.0000000000000381.

This article originally appeared on Clinical Advisor