Knowledge, Attitudes, and Beliefs of School Nurses and Personnel and Associations With Nonmedical Immunization Exemptions

• Published in: Pediatrics (Evanston) 2004-06, Vol.113 (6), p.e552-e559
• Main Authors: Salmon, Daniel A, Moulton, Lawrence H, Omer, Saad B, Chace, Lesley M, Klassen, Ann, Talebian, Pejman, Halsey, Neal A
• Format: Article
• Language: English
• Subjects: Allied Health Personnel - psychology; Attitude to Health; Child; Colorado; Complementary Therapies - statistics & numerical data; Disease Susceptibility; Health Care Surveys; Health Knowledge, Attitudes, Practice; Humans; Logistic Models; Massachusetts; Missouri; Nurses - psychology; School Health Services; Selection Bias; Vaccination; Vaccines - adverse effects; Washington; Workforce
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.113.6.e552

We studied school personnel involved in the review of student's immunization status to determine whether personnel training, immunization-related knowledge, attitudes, and beliefs, use of alternative medicine, and sources of vaccine information were associated with the vaccination status of school children. Surveys were mailed to a stratified and random sample of 1000 schools in Colorado, Massachusetts, Missouri, and Washington. School personnel reported their training and perceptions of disease susceptibility/severity, vaccine efficacy/safety, key immunization beliefs, use of alternative medicine, confidence in organizations, sources, and credibility of vaccine information, and the rates of vaccine exemptors in their schools. Logistic regression analysis was used to explore associations between personnel factors and beliefs (independent variables) with the likelihood of a child having an exemption (dependent variable). Regression models were adjusted for clustering of children in schools, type of school (public versus private), and state. Surveys were returned by 69.6% of eligible participants. A child attending a school with a respondent who was a nurse was significantly less likely to be have an exemption than a child attending a school with a respondent who was not a nurse (odds ratio [OR]: 0.39; 95% confidence interval [CI]: 0.28-0.56). The majority of respondents believed that children (95.6%) and the community (96.1%) benefit when children are vaccinated. Nurses were more likely than nonnurses to hold beliefs supporting the utility and safety of vaccination. Greater perceived disease susceptibility and severity and vaccine efficacy and safety were associated with a decreased likelihood of a child in the school having an exemption. Vaccine misconceptions were relatively common. For example, 19.0% of respondents were concerned that children's immune systems could be weakened by too many immunizations, and this belief was associated with an increased likelihood of a child in the school having an exemption (OR: 1.51; 95% CI: 1.00-2.28). Most respondents had a moderate amount or great deal of confidence in state health departments (91.4%), the Centers for Disease Control and Prevention (CDC) (93.9%), local health departments (88.8%), health care providers (88.5%), the Food and Drug Administration (73.6%), and the health care system (65.2%). Fewer respondents had a moderate amount or great deal of confidence in the media (17.4%). A child attending a schoo