Informing the information – the UK use of communication research

Informing the information – the UK use of

communication research

Jo Yarwood

Head of Immunisation Information

Department of Health

Why bother?

• Vaccination affects huge numbers of 'readers' or 'viewers'.• It is 'political' since it is recommended by Governments.• It plays victims against the establishment, and experts against experts.• The science element gives it an aura of mystique.• Communicable diseases are no longer feared - vaccines are now.

The role of the media in reporting on vaccination issues.

Research

• pre-testing

• ‘strategic’ research

• bi-annual tracking

What is the commitment?

• two waves of ‘parental’ tracking per year

• one wave of professional tracking per year

• pre-testing (as appropriate)

• other ad hoc work (eg MMR work)

• about £250,000 per annum (a small proportion of the total vaccines budget)

To provide information on the following for strategic planning:

parents knowledge of immunisation

parents attitudes towards immunisation

parents experience of services

To monitor advertising over time on key indicators

In addition, to examine all of the above in the light of continued publicity surrounding childhood immunisations (esp. MMR)

Tracking aims

29 waves of research dating back to October 1991. Wave 29 fieldwork: 17th October – 14th November 2005.

Random location sampling design in 152 areas in England (geographically representative)

1004 in-home personal interviews with “primary care givers” (usually parents) of 0-2s in England using Multi-Media CAPI.

Tracking survey

Background cont.

• Sampling can be adapted (or added to) to explore other groups in depth

• Core questions can be adapted for new concerns

• Information is used to inform the communication strategy

Advertising and publicity

Spontaneous awareness of advertising, information or publicity in last 12 months

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Any advertising,information orpublicity

TV programme

Base: All primary care givers of 0 - 2s (W29 n = 1004)

Newspaper article

TV advertisement

Oct 03 May 05Feb 02 Sep 02 Mar 03 May 04 Nov 04 Nov 05

**

**

What remember most about advertising information or publicity (unprompted)

13%

9%

9%

6%

6%

6%

12%

6%

5%

7%

7%

7%

1%

6%

13%

7%

12%

11%

7%

5%

3%

5%

24%

10%

Nov-05

May-05

Nov-04

Oct-03

Mention of MMR and Autism / bowel disease

Get your child immunised/parents

responsibility

Debate about MMR/controversy/whether to have it or not

Positive mention of MMR

Get children immunised/don’t miss immunisations

Base: All who recall seeing/ hearing advertising, information or publicity about immunisation (W29 n=726)

About immunisations/vaccinations

**

*

27%

33% 32%28% 28%

23% 23% 24%

20%

32%

22% 24%

17%

26%26%

0%

10%

20%

30%

40%

50%

60%

70%

Oct 03

May 04

Nov 04

Whether seen advertising, info or publicity that might have persuaded them not to

immunise

Base: All who spontaneously recall seeing/ hearing advertising, information or publicity (W29 n = 726)

Feb 02

Sep 02

Mar 03

May 05

Nov 05

Sep 01

Mar 01

Oct 00

Mar 00

Sep 99

Mar 99

Sep 98

34% of these people had postponed or rejected MMR (compared with 14% of all respondents)

Prompted awareness of other publicity about immunisation for childrenReference guide Pre-school leaflet

Prompted recall of leaflets

46%

55%

68%

52%

66%62%

52%

73%

42%

44%50%

32%

58%47% 52%

52%47%

38%

56%

53%

21%

42%42%

22%

19%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Mar 03 Oct 03

Old Guide to childhood immunisation

May 04


MMR Facts (old v2)

Feb 02 Sep 02

MMR Facts (V3)

MMR Facts (old v1)

New guide to immunisation for babies

Nov 04Sep 01 May 05

Reference guide

Pre-school leaflet

Nov 05

Immunisation Information and MMR The Facts Websites

72%71%

56% 60% 59%65%

69%70%69%

57% 57%61%

67%

53%

11%9%9%8%7%7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Oct 03 May 04 Nov 04

Internet access amongst primary care givers

Base: All primary care givers of 0-2s (W29 n = 1004)

Sep 02 Mar 03

Internet use

Internet access

May 05

Nov 05

Visited MMR: The Facts website

MMR

8% 9% 6%12% 10% 8%

20% 17% 17%

17% 14% 14%

48%47%

40%36%

31% 34%

22% 27%34% 32%

40% 38%

7%5%

Perceived safety of MMR by social grade

Completely safe

Slight risk

Moderate risk

Don’t Know

ABC1 C2DE

High risk

Nov 04Nov 04

Base: All primary care givers 0 - 2s (W29 n = 1004)

May 05 May 05Nov 05 Nov 05

Proportion who consider MMR a greater risk than the diseases it protects against

15%

12%

19% 18% 17%18%

13% 14% 12%

9%

16%

24%22%

20% 21%

17% 18%15%

12%

19%

0%

10%

20%

30%

40%


Spontaneous

Total

Oct 03

Nov 04

May 04

Mar 03

Nov 05Oct 00

Sep 01

Feb 02

Sep 02

Mar 01

Spontaneous awareness of immunisations

62% 62% 62% 63%68%

60%

31%

42%

55%

45%

41%33%

22%

23%

22% 24%20% 20%

84%83%81% 82%

84% 82%

43%43%

42%40% 39%

40%

19% 18% 19%

6% 7% 7%

1% 3%3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Polio

Whooping Cough

Hib

MMR

Oct 03


May 04

Men C

May 05

5 in 1 vaccine

Mar 03 Nov 04

Children’s fluPneumococcal

**

Nov 05

Perceived safety of immunisations

54%

57%55%53%

56%53%

36%35%28%28%27%25%

47%

44%48%47% 41%

42%

50%52%52%

46%53%

55%

36%

40% 45%

0%

10%

20%

30%

40%

50%

60%

70%

Old Polio (by mouth)

% c

om

ple

tely

safe

DTaP / IPV

5 in 1 vaccineMen C

MMR

Nov 05May 05Nov 04May 04Oct 03Mar 03


Perceived severity of diseases

93%93%95%95%97%

61%61% 62% 62% 60%

41%44%

40%

45%41%

28%

31%35% 28%35%

28%24%24%22%

37%

41%38%40%

39%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Meningitis

Polio

Diphtheria

Hib

% v

ery

seri

ous

Oct 03


May 04 Nov 04

RubellaMeasles

Mumps

Mar 03 Nov 05

Uptake, Refusals and Delays

• Parents generally get their children immunised on trust…

– they would not usually question the ‘received wisdom’ to immunise

– rationally...• they know that vaccinations have been clinically tested and are safe

• they believe the Government would not deliberately harm children and risk

litigation (because it wouldn’t get re-elected)

– they know that immunisation is not 100% effective, but believe that it reduces the chances of damage from diseases

– awareness and understanding of the need for 95% population coverage is low, but parents are concerned about the threat to their own children if other parents fail to immunise

Attitudes to immunisation (from MMR work)

Vaccinations delayed and refused

6%

10% 9%6% 6% 6%

4%5%

4%5%6%

8%

29%32%

34%

30%30%

34%

25%

20% 20%21%23%

19%

0%

10%

20%

30%

40%

50%

Refused MMRRefused any

Mar 03 May 04 Nov 04 May 05Oct 03


Delayed MMR

Delayed any

Nov 05

8%

14%

5%

6%

8%

9%

5%

8%

10%

7%

6%

7%7%

6%

7%

7%

Nov-05

May-05

Nov-04

May-04

Delaying & refusing MMR: past and future

Base: All primary care givers of 0-2s (W29 n = 1004)

Delayed indefinitely, refusedor would refuse in the future

Postponed for reasons other thansafety (since done/intend to do)

Postponed for safety reasons(since done/intend to do)

Rejected - delayed indefinitely/ refused outright

18% postponed for safety reasons or refuse

Which immunisations would not allow a future child to have (prompted)

12%

1%

2%

2%

6%

9%

1%

3%

3%

7%

11%

0%

1%

2%

4%

7%

2%

7%

Meningitis C

5 in 1 vaccine

Second dose of MMR

MMR

Any

Nov-05May-05Nov-04May-04


The Immunisation Process

Information gathering

Sources of information consulted before immunisations were due (prompted)

12%

12%

12%

20%

17%

18%

25%

24%

23%

70%

11%

12%

13%

18%

19%

19%

21%

23%

25%

71%

Nov-05

May-05


Leaflets

Healthcare/childcare magazine articles

Immunisation appointment card

Books

Television adverts

Women’s magazines

Television programmes

Internet

Newspaper articles

NHS Direct

Whether discussed immunisations with a health professional before the

immunisations were due


77% 77%

57%53%

13%

80%77%

74% 76%79%

57%53% 54% 56%

60%

27%30%29%

28% 26% 28% 28%

12%8% 9%

11% 9%14%

18%17% 15%20%18%17%17%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Mar 03

Any

HealthVisitor

GP

Midwife

May 04 Nov 04 May 05Sep 02

Practice Nurse

Oct 03 Nov 05

Information gaps

• Information on side effects (7%) (8% at W28)

•More information in general on all aspects (6%) (6% at W28)

The most frequently mentioned requests were for more general information

70% felt they had all the info about immunisation that they wanted before their child’s immunisations were due.

No MMR related issue was mentioned by more than 2% of all respondents.


The decision process

68%67%64%

68% 69%62%

43%38%

43% 44%39%43%

28%23%

29% 27% 27% 27%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Consent

Base: All who accompanied their child for most recent immunisation (W29 n = 826)

In writing

Any consent

May 04

Verbally

Oct 03 May 05Mar 03 Nov 04 Nov 05

*

68%77%

59%69%

56%74%

40%44%24%30%20%30%

TOTAL(1004)

15-24(216)

25-34(498)

35+ (290) ABC1(393)

C2DE(611)

I weighed up the pros and cons ... before deciding whether to have my child immunised

I automatically had all my child's immunisations done when they were due

The process of deciding to have child immunised – by age and social grade

AGE SOCIAL GRADE

Base: All primary care givers of 0 - 2s


Satisfaction

Base: All who accompanied their child on most recent visit (W29 n = 826)

Satisfaction with most recent visit

5%

24%

18%16%

11%

6%

23%

18%16%

11%

4%

10%

16%17%

22%

May-04

Nov-04

Nov-05

Somedissatisfaction

(net)

Not enoughtime to

discuss issues

Not givensufficient

explanation

Not ableto ask

questions

Dissatisfiedoverall

Trust advice about immunisation given by

HPs and government

0%

10%

20%

30%

40%

50%

60%

Nov 04

% S

trongly

Agre

e

Mar 03

Health visitors

GPs

Practice nurses

Oct 03 May 04 May 05 Nov 05

NHS

Government

Base: All primary care givers of 0 - 2s – Four-fifths sample

Media tracking

0

20

40

60

80

100

120

140

Feb-

01

Mar Apr May J un J ul Aug Sep Oct Nov Dec J an-

02

Feb Mar Apr May J un J ul Aug Sep Oct Nov Dec J an-

03

Feb Mar Apr May J un J ul Aug Sept Oct Nov Dec J an-

04

Feb Mar Apr May J un J ul Aug Sep Oct Nov Dec J an-

05

Positive Negative Neutral

Activities of DH Immunisation Information Unit (January 2005 – January 2006)

• Conferences 11 (delegates 5,115)

• Health professional seminars 74• Parents seminars 8 • Parents research 2,000 interviews

• Health professionals research 1600 interviews

• Leaflets, posters, videos and factsheets 8,378,050• www.immunisation.nhs.uk (highest month) 35,741 visits• www.mmrthefacts.nhs.uk 19,535 visits• MMR ‘your questions answered’ 1,460

http://www.immunisation.nhs.uk/

http://www.mmrthefacts.nhs.uk/

Immunisation communication - public perspectives.

• Public acceptability will be of increasing importance, irrespective of scientific virtues.• The media provide the interface between immunisation programmes and the public.• We cannot assume that the media share our views and we must recognise their independence.• The public increasingly seek information on an active basis.• The internet, where information is unregulated, contains much that is potentially wrong and harmful.• We must compete effectively and dedicate as much effort to communicating on vaccines as we do on providing them.

Child protection

Documents

Informing the information – the UK use of communication research