Vaccines & Autism: A Parental Perspective

Background: Highly publicized controversy has arisen regarding the possible links between childhood vaccines and autism in the. As fear of links between vaccination and autism begin to take root, the decision to vaccinate may become increasingly difficult for many parents. In preparation for parents' pending concern, healthcare providers need to thoroughly understand the range of attitudinal and ecological factors influencing parents' intention to vaccinate.

Objectives: The purpose of this study is to explore the perspectives of parents of children with autism regarding childhood vaccination. Attitudinal and ecological influences on vaccine acceptance are assessed. Attitudinal associations include parental perceptions of vaccine safety/efficacy, parental perception of disease risk, and parental distrust of health providers. Ecological associations include family demographics (income, race, community size, and education), parental exposure to anti-vaccine media, and parental experience with child's medical care.

Methods: A convenience sample of parents of children with autism (n=20) were recruited through their participation in another autism-related study. Two self-administered cross-sectional surveys representing (a) attitudes toward childhood vaccines and (b) perception of medical care were developed. Both surveys were comprised of 4-point Likert scale items ranging from strongly agree to strongly disagree. The first survey contained 43 items and 4 main subscales (perception of vaccine safety/efficacy, perception of disease risk, communication with provider regarding vaccination, and vaccine acceptance). Vaccine acceptance represented the dependent variable and was measured by responses on a 3-item subscale that asked about parents' general intent to vaccinate and to recommend others to vaccinate. The perception of medical care survey consisted of 23 items and 5 subscale ratings of physicians' informativeness, interpersonal sensitivity, partnership building, communication, and competence, as well as 2 subscale ratings of general accessibility and affordability of medical care. Simple linear regression was used to assess bivariate associations between constructs and vaccine acceptance. Multivariate linear regression with forward selection was used to identify the construct most strongly predictive of vaccine acceptance.

Results: The internal reliability of the two measures was strong, and the Cronbach's alpha exceeded 0.7 for 6 of the 7 subscales entered into all linear regression models as potential predictors. No statistical significance (p<.05) was reached in the bivariate associations between vaccine acceptance and media exposure or parental demographics. Similarly, none of the attitudinal variables reached statistical significance in their bivariate associations with vaccine acceptance. The only construct to reach statistical significance in its bivariate association was affordability of care (p=.028). The multiple linear regression revealed affordability of care to be the strongest predictor of vaccine acceptance (R²=0.401, p=.027).

Conclusions: Attitudes toward childhood vaccination among parents of children with autism can be influenced by a complex array of factors. To effectively communicate with parents regarding vaccination, healthcare providers must recognize the existence of attitudinal and ecological influences, such as affordability of care.