Informations betydning for forældres beslutningstagning i det danske børnevaccinationsprogram

Abstract

Resumé Baggrund: Børnevaccinationer er aktuelt et omdiskuteret emne i den danske folkesundhedsdebat, hvor specielt HPV-vaccinen, som en del af det danske børnevaccinationsprogram, debatteres. Forældres beslutningstagning om vaccination knytter sig til et valg, hvor der indgår overvejelser om barnets sundhed. De seneste år er der registreret en faldende tilslutning til sundhedstilbuddet, hvor forældres tvivl og bekymring om børnevacciner ses som et voksende fænomen. I takt med dette, kan det nuværende informationsgrundlag ses som værende udfordret. Af sundhedslovens ret til informeret samtykke, ses en brugerorienteret tilgang. Forældres oplevelse af det nuværende informationsgrundlag er ikke undersøgt i en dansk kontekst, hvorved der ses et aktuelt videnshul. Formål: Specialets formål er, ud fra en brugerorienteret tilgang at undersøge forældres oplevelser og erfaringer relateret til nuværende informationsgrundlag i det danske børnevaccinationsprogram. Ydermere undersøges forældres ønsker og behov for information og inddragelse, for derved at udlede forandringsforslag tilpasset disse. Metode: I specialet anvendes en fortolkende interviewundersøgelse med semi-strukturerede interview med førstegangsforældre, herunder fem individuelle med mødre og et dyadisk med et forældrepar. Den empiriske analyse er foretaget ud fra en hermeneutisk analysestrategi med anvendelse af en abduktiv tilgang i analysens fjerde trin. Hertil er udvalgte begreber af Niklas Luhmann, Thomas Breck og Sherry R. Arnstein inddraget. Desuden er en systematisk litteratursøgning udført, til udarbejdelse af litteraturanalyse, som baggrund for interviewguide og til brug i diskussion af den empiriske analyses resultater. Resultater: Det fremgår, at det aktuelle inddragelsesniveau er lavere end svarende til forældres ønsker og behov. Dertil findes en gennemgående oplevet uforudsigelighed i forhold til hvor, hvornår og af hvem der kunne forventes information. Endvidere fremgår tidlig information inden barnets første vaccination ved tre måneders alderen, samt balanceret og kombineret skriftlig og mundtlig information som værende betydningsfuld. Sundhedsstyrelsens pjece ”Børnevaccinationsprogrammet i Danmark – 2015” opleves anvendelig, men hvor længde og sprogbrug heri opleves som en barriere og derved ikke findes tilpasset den brede befolkning. Ydermere viser resultaterne at forældreuddannelser anses som et oplagt sted for italesættelse og informationsformidling af børnevaccination, i kraft af at tillid og erfaringsudveksling er væsentlige elementer på disse uddannelser. Konklusion: Der fremgår flere forandringsperspektiver relateret til praksissektoren og de kommunale sundhedsordninger. Overordnet anbefales tidlig informationsgivning, balanceret information og italesættelse af vaccinationsvalget medtænkt i det videre sundhedsfaglige arbejde. Ydermere fremgår et behov for yderligere fokus på procedurer for udlevering af skriftligt informationsmateriale, samt behov for mundtlig information som et supplement til skriftlig information. Mere konkret kan det anbefales at Sundhedsstyrelsens pjece ændres så den tilpasses niveauet for den brede befolkning og at der på forældreuddannelser, indføres et emne om vaccination. Det kan dog konkluderes, at der på flere områder er behov for mere forskning, som inddrager de relevante aktører fra sundhedsvæsenet for at opnå et helhedsorienteret perspektiv på praksisorienterede forandringsmuligheder.

Abstract Background: Childhood vaccinations are currently a hot topic in the Danish public health debate, particularly the HPV-vaccine as part of the Danish childhood vaccination programme. Parents' decisions about vaccination is linked to a choice related to the individual child's health. In recent years, a declining commitment to this health offer is recorded, where parents doubt and concern about childhood vaccines is seen as a growing phenomenon. Concurrently, the current information base is being challenged. A user-oriented approach is verified through the right to informed consent, as stated in the health legislation. Parents' experience of the current information base has not been studied in a Danish context, which indicates a lack of knowledge. Objective: The aim of the thesis is to examine parents' experiences related to the current information base in the Danish childhood vaccination program, based on a user-oriented approach. Furthermore, parents' wishes and needs for information and involvement is examined, in order to derive change proposals adapted to these. Method: This thesis uses an interpretive interviewstudy with semi-structured interviews of first-time parents, including five individual interviews with mothers and one dyadic interview with parents. The empirical analysis is based on a hermeneutical analysis including the use of an abductive approach in the fourth step of the analysis. In addition, selected theoretical concepts of Niklas Luhmann, Thomas Breck and Sherry R. Arnstein are included. Furthermore, a systematic literature search is conducted for the production of a literary analysis as a basis for themes in the interview guide and for use in the discussion of the results from the empirical analysis. Results: It appears that the current level of participation is lower than the level corresponding to the parents' wishes and needs, just as they had only received limited information about vaccination. A general experience of unpredictability related to how, when and by whom the parents could expect to receive information, occurs. Furthermore, early information prior to the child's first vaccination at three months of age, as well as balanced and combined written and verbal information, emerged as being important. The pamphlet "The Danish childhood vaccination programme 2015" by Sundhedsstyrelsen is experienced usable, but the length and language herein perceived as being at too high a level for the general public. Furthermore, the results show that the parent training programme is considered as an ideal place for articulation and dissemination of childhood vaccination, by virtue of trust and exchange of experience as essential components in these fields. Conclusion: More perspectives of change, related to the practice and the municipal health plans, occurs Overall early information communication, balanced information and articulation of the choice related to the childhood vaccination program, is identified as recommendations for future health care work. Moreover, a need for more focus on procedures for the extradition of written information appears, as well as a need for verbal information as a supplement to written information. More specifically, it is recommended that the pamphlet from Sundhedsstyrelsen is changed to adapt the level of the general population and that the parent training programme introduces a topic on vaccination. It can be concluded that in several areas the need for further research involving relevant stakeholders from the health care system, to achieve a holistic perspective on practice-oriented options of change.

A master thesis from Aalborg University

Informations betydning for forældres beslutningstagning i det danske børnevaccinationsprogram - Forandring ud fra et brugerperspektiv