Background report Research Methodologies in Nursing

Background report: Research Methodologies (NURS) Question (20 marks) (400 word equivalent) Question 1A After reading the background information, develop a researchable question from the background information that you have been given relating to immunization. This question can be suited to quantitative or qualitative methods. Type your question below: Why do some patients hesitate when it comes to getting vaccinated, and how are they dealt with by healthcare providers? Question 1B: List three sources of information that would provide you with the best (strongest) evidence that would enable you to answer your research question. For each of the three sources, give an example of the type of information that would be available to you from this source. Source of information Type of information European Centre for Disease Prevention and Control This study attempts at improving insights into safety-related concerns and vaccine hesitancy among European patients and vaccine providers, in addition to examining the potential influence and association between both populations (ECDC, 2016). World Health Organization The study aimed at minimizing obstacles and improving current vaccine coverage. The protocol delineates an instrumentation and design options-based strategy for gauging awareness, confidence, expected use and resistance in child-bearing-age females potentially targeted for vaccine administration, and their partners/spouses potentially influencing or participating in this decision (World Health Organization, 2015) Israel Journal of Health Policy Research The study recognizes the continuum between downright refusal and wholehearted acceptance of all or a few vaccines, challenging prior pro- or anti- vaccine individual/group understandings. Vaccine reluctance may be influenced by confidence, complacency and convenience. Vaccine reluctance causes may be explained using the following epidemiological triad – the multifaceted interaction between external (environmental), parent (host), and vaccine (agent) -specific elements (Kumar et al., 2016). Question 1C: List five search terms that would assist you to find suitable literature to answer your question. For each of the search terms, suggest an alternate word for which the Boolean function “or” could be used. Keyword Search term for Boolean ‘or” 1 Immunisation Mistrust 2 Vaccine Controversy 3 Immunization Hesitancy 4 Immunisation Misconception 5 Anti-vaccine Attitude Question 1D: If your search failed to find a satisfactory number of quality articles, outline the actions that you could take to improve your search results. The search will commence using generic parameters taken from the research problem identified. Conditions for exclusion and inclusion will be utilized in succession for (A) abstracts and titles, and (B) the complete text, in the course of literature screening. The complete text for researches whose abstracts and titles fulfill the aforementioned conditions will be acquired, besides researches for which not enough data is available for their exclusion based on abstract/title screening. This review will adopt suitable steps for decreasing researcher bias as well as ensuring all relevant studies get incorporated into a systematic review, taking into account budget and time constraints. At the title/abstract screening phase, exclusion/inclusion criteria will be utilized for screening titles/abstracts followed by separate screening of researches earlier excluded, by another reviewer, for making sure no relevant research is omitted accidentally in the review. The next phase of full-text screening will also adopt a similar tactic. 11 | Page Question 2 (40 marks) (800 word equivalent) Complete the attached table with the relevant information from each of the four articles. Do not use dot points. Table 1. Meta-analysis (+/- systematic review) Full reference: Nursing Taylor, L.E., Swerdfeger, A.L. and Eslick, G.D., 2014. Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine, 32(29), pp.3623-3629. Access via https://ac-els-cdn-com.access.library.unisa.edu.au/S0264410X14006367/1-s2.0-S0264410X14006367-main.pdf?_tid=0faa94de-0985-11e8-a381-00000aab0f01&acdnat=1517732953_c2e06dba46682bf164edc03782248b99 Search strategy The databases were searched using the following search terms or combinations: vaccine; autistic; immunize: immunization; Asperger; autism; PDD; and pervasive developmental disorder. Search approach adopted: peer-reviewed studies by two separate scholars before implementation. Further, reference lists containing relevant papers were searched for applicable researches. Language restrictions weren’t utilized in study selection or the search process. Unpublished studies weren’t searched for. Inclusion/exclusion criteria The review included case-control and prospective and retrospective cohort researches published in all languages, which examined the link between immunization and autism spectrum disorders (ASDs). Limits weren’t placed on date of paper publication, subject characteristics, or publication status. Studies recruiting participant cohorts from only the US VAERS (Vaccine Adverse Event Reporting System) were excluded on account of limitations like high bias probability, underreporting, lack of unimmunized control cluster, unverified reports, inconsistent information quality, and several litigation-linked reports. Also excluded were researches failing to fulfil inclusion criteria. Issue (what was being studied) This meta-analytic study aims to make a quantitative assessment of available information from researches from different nations pertaining to childhood immunization and autism rates to adequately substantiate the link between them, no matter how significant (or insignificant). Context (study setting) In the last many years, the issue of the potential relationship between ASD development and childhood immunization has been frequently raised, with the following vaccinations receiving maximum focus: MMR (measles, mumps, and rubella), DPT (diphtheria, tetanus, and pertussis) and other thimerosal-containing vaccinations. Outcome (main findings) The meta-analysis involving five cohort and case-control researches each did not find any evidence of an association between immunization and related ASD development risks. Subgroup analyses that specifically studied MMR vaccines, thimerosal exposure and cumulative mercury dose, separately, also failed to yield evidence, as did subgroup analyses that specifically studied autistic disorder development versus other ASDs. Table 2. Systematic review Full reference Nursing Jefferson, T., Price, D., Demicheli, V., Bianco, E. and European Research Program for Improved Vaccine Safety Surveillance (EUSAFEVAC) Project, 2003. Unintended events following immunization with MMR: a systematic review. Vaccine, 21(25-26), pp.3954-3960. Access via ScienceDirect Journals (Available from 1995 volume: 13) Search strategy Study authors came up with a specialized approach for conducting search, guided by an information expert, for identifying every relevant research published or conducted from 1969 to January 2003. Their detailed search approach included searches of the Cochrane Database of Systematic Review, Cochrane Control Register of Controlled Trials, MEDLINE, Biological Abstracts, and NHS Database of Abstracts of Reviews of Effects (1985), and Science Citation Index and EMBASE (1974). Additional published and unpublished references were requested from research scholars, public health officers, and vaccine manufacturers. Related published reviews and article bibliographies were evaluated, with the latter tracked for more studies. Inclusion/exclusion criteria Authors included comparative retrospective or prospective researches on healthy persons up to fifteen years of age, published or conducted from 1969 to 2003. Researches had to evaluate prevalence and potential unintentional or undesirable events transpiring in relation to all combined MMR vaccines administered separately, irrespective of dosage, time schedule or preparation, compared with a placebo, do-nothing, or any one or two vaccine elements in any given combination Issue (what was being studied) A systematic analysis was performed, for evaluating and amassing evidence on incidence and kind of unintentional events linked to MMR vaccine, as compared to placebo or no immunization or attenuated MMR vaccine combination. Context (study setting) Of late, the MMR’s vaccine’s safety has been a subject of great controversy, with the vaccine supposedly contributing to the development of various rare conditions like thrombocytopenic purpura, joint pain, encephalopathy, aseptic meningitis, Crohn’s disease, sensorineural deafness, regressive developmental disorder (RDD) with chronic enterocolitis, and convulsion. Outcome (main findings) Authors discovered scant evidences of MMR vaccine safety in comparison to separate measles, rubella, mumps vaccinations from low bias risk researches. The small number of researches depicting least likelihood of being impacted by systematic errors indicate a potential link with fewer infections of the upper respiratory tract, and no increase in aseptic meningitis rates (in case of Jeryl–Lynn strain-encompassing mumps vaccination). Low bias risk evidence fails to support causal linkages with ulcerative colitis or Crohn’s disease. However, this finding is founded on a fairly small case-control research. Authors experienced internal validity issues in a few included researches, with selection, attrition, reporting, performance, and detection related biases negatively impacting their con?dence in research ?ndings. Table 3. Experimental quantitative studies Full reference: Nursing Prymula, R., Bergsaker, M.R., Esposito, S., Gothefors, L., Man, S., Snegova, N., Štefkovi?ova, M., Usonis, V., Wysocki, J., Douha, M. and Vassilev, V., 2014. Protection against varicella with two doses of combined measles-mumps-rubella-varicella vaccine versus one dose of monovalent varicella vaccine: a multicentre, observer-blind, randomised, controlled trial. The Lancet, 383(9925), pp.1313-1324. Full text available via Elsevier ScienceDirect (Available from 07/01/1995 volume: 345 issue: 8941) Study Design (e.g.: cohort, RCT,) This is a randomized, observer-blind, controlled trial. Population (how many participants, age, gender, disease, etc) This research was performed in a total of 111 European study centers situated in the following countries: Czech Republic (22), Italy (9), Greece (11), Lithuania (9), Romania (9), Slovakia (17), Norway (5), Poland (10), Sweden (5), Romania (9), and Russia (14). Eligible subjects were healthy infants aged between 12 and 22 months during ?rst immunization, with a negative measles, mumps, rubella and varicella disease and immunization history; in addition to either (1) being at home in the company of one or more siblings (with negative varicella immunization and disease history), or (2) going to a childminder (in which one or more children are without known positive varicella immunization and disease history; or (3) playing every week for over five minutes with other children without known positive varicella immunization and disease history, or (4) registered with a daycare facility from the age of two years. 5803 subjects were inoculated. Intervention (what was being implemented) Healthy infants between the ages of 12 and 22 months were administered (1) 2 MMRV doses (MMRV group), or (2) MMR (dose I) and monovalent varicella (dose II) (MMR+V group), or (3) 2 MMR dozes (control group, MMR group) forty-two days apart. Comparison (was the intervention being compared to another strategy, e.g. placebo?) Effectiveness of 2 MMRV dozes in fighting all varicella; effectiveness of 1 varicella vaccine doze in fighting all varicella. Outcome (main findings) This research of over 5000 subjects found effectiveness of 2 MMRV dozes in fighting all varicella to be nearly 95 percent, and in fighting acute or moderate varicella to be over 99 percent. This protection proved to be greater as compared to 1 varicella vaccine dose, whose effectiveness in protecting from all varicella was roughly 65 percent, and in fighting acute or moderate varicella was approximately 91 percent. More MMRV group subjects (roughly 57 percent) reported a minimum 38°C fever within a fortnight of immunization (dose I) as compared to other groups (between 38 and 45 percent). Acute immunization-linked adverse-event incidence was 3 for the MMRV cluster, 4 for the MMR+V cluster, and 1 for the MMR cluster. Table 4. Qualitative study Full reference Nursing Guillaume, L.R. and Bath, P.A., 2004. The impact of health scares on parents’ information needs and preferred information sources: a case study of the MMR vaccine scare. Health Informatics Journal, 10(1), pp.5-22. Full text available via SAGE (Available from 1999 volume: 5 issue: 1) Study Design (ie: cohort) Semi-structured interview technique was adopted Population (how many participants, age, gender, disease, etc) Of the 17 research subjects, all but one were female (i.e., 94.1%). Every subject was either living with a partner or married. All but one (i.e., 94.1%) subjects were white. Two subjects (11.8%) were full-time workers, 3 subjects (17.6%) worked part-time, 10 subjects (58.8%) were unemployed, and 2 subjects (11.8%) were employed but on maternity leave. Issue (what was being studied) The research aimed at identifying MMR vaccine-linked information requirements of parents having children aged below 5 years. Context (study setting) The MMR vaccination garnered extensive negative publicity in January of 2002, after suspected outbreaks of measles in Newcastle and London, ascribed to MMR immunization rate decreases. These reports renewed discussions on MMR vaccine safety. This research was conducted in this period. Outcome (main findings) The MMR outbreak and relevant information were interlinked concerns for parents. Authors revealed vaccine-related knowledge’s potential contribution to encouraging immunization. But parents must trust and believe their source of information. Further information providers ought to take into consideration parental information needs instead of developing information for altering behavior. Question 3 – 800 words · Discuss the reasons that the studies above would or would not be helpful in enabling you to have an informed discussion with parents about immunisation for their children. Comment on the relative value of the studies to your argument. Use supporting evidence where appropriate. Vaccine reluctance has now become a universal problem. Parents are showing increasing concern regarding the need for vaccines, their safety, and effectiveness, with the drop in vaccine-preventable illness exposure in industrialized nations like Australia. Further, parental concerns are influenced by immunization schedules’ increasing complexity and greater information access via social media and the World Wide Web. Several parents refusing immunization believe their child will be safeguarded by herd immunity. Though the unimmunized child rate is <95 percent, the circle of protection faces a threat. It is crucial to maintain confidence in immunization and high vaccination coverage for preventing vaccine-preventable disease outbreaks. The provider-parent relationship represents a key factor influencing parents’ immunization-connected attitudes. A sound relationship may help address pro-vaccine parents’ concerns, in addition to encouraging reluctant parents to accept immunization for their children. Poor parent-provider communication may result in their dissatisfaction with the care process or immunization rejection (Danchin, 2016). Researchers suggest that provider-parent interactions prove crucial to influencing their behaviors, attitudes, and beliefs pertaining to immunization; in fact, they are the most important factors driving immunization acceptance. It is established that sound provider-parent relationships may encourage reluctant or refusing parents to accept vaccines. Similarly, poor communication between providers and parents may result in rejection of all or some vaccines, besides causing parents to mistrust and be dissatisfied by the services provided. The matter ought to be briefly discussed with refusing parents, though left free for further discussion if they so desire. Their concerns shouldn’t be dismissed; instead, providers ought to acknowledge them whilst taking care not to overstate vaccine efficacy and safety. After all, no vaccine can be 100% effective or safe. Challenging entrenched scientific, philosophical, or religious beliefs is discouraged. Further, providers need to avoid scientific debates and obvious confrontation. Parents must be guided to resources useful in addressing their concerns; further discussion must be encouraged. Such parents might prove more amenable to vaccines in the near future or might even forever be anti-vaccines. Regardless, the foremost step on parents’ part should be to try to work out immunization-related concerns, look into resources capable of addressing them, and discuss concerns and solutions with providers for informed immunization-related decision-making. But information alone doesn’t suffice to alter behaviors. Efforts focused at persuasion or providing more details regarding vaccines or disease risks usually backfire or prove ineffective. Clearly, it is vital to give more emphasis to communication in vaccine encounters, aimed at fostering open discussion and developing trust and rapport (Danchin, 2016). Healthcare providers can contribute significantly to the maintenance of the public’s trust in immunization, including dealing with parental concerns pertaining to immunization. Such concerns will tend to increase with the inevitable increased complexity of vaccination schedules, and greater parental access to a variety of information available on social media and the World Wide Web. Recommendations have been made in acknowledgement of the necessity of supporting healthcare providers in the aforementioned challenging task of communicating in generally-short consultations. Earlier, most recommendations concentrated on information to be provided to parents, with only some dealing with the ideal way of engagement with parents. As parents clearly desire more detailed discussions regarding immunization, paying attention to communication processes developing trust and rapport between parents and vaccine providers is highly important (Leask et al., 2012). By paying attention to the information provided as well as the way in which it is presented, a generic, integrated approach may be developed that goes beyond mere one-way information provision. The entire framework has been informed through evidence from communication and decision making related studies. It applies to every healthcare provider within the context of immunization-linked discussions, especially where parents tend to be hesitant when it comes to inoculating their child. It concentrates on children, besides applying to dialogue with other age groups that are recommended for immunization. I propose positions or categories reflecting diverse parental behaviors and attitudes in relation to immunization, and suggest position-specific, customized communication approaches. The encounter’s overarching aim is: promoting quality decision-making and, in the end, immunization (Leask et al., 2012). Sound interactions may address pro-vaccine parents’ concerns, in addition to encouraging reluctant parents to accept immunization (Gust et al., 2008). On the other hand, poor communication may result in parental dissatisfaction with the care process, or vaccine rejection (Brown et al., 2010). This poor communication usually stems from provider beliefs that parents refuse vaccines due to ignorance and that the issue may be easily resolved through persuasion or provision of more information. This approach proves counter-productive as it fails at accounting for the complex causes underlying vaccine refusal. It can even end in backfiring. As provider-parent interactions offer a focus for expression of parental concerns, effective communication in the course of such interactions is imperative (Leask et al., 2012). But the aforementioned researches have failed to consider these communication aspects and only offer information without describing a means of effectively communicating it to parents. References Gust, D.A., Darling, N., Kennedy, A. and Schwartz, B., 2008. Parents with doubts about vaccines: which vaccines and reasons why. Pediatrics, 122(4), pp.718-725. Brown, K.F., Kroll, J.S., Hudson, M.J., Ramsay, M., Green, J., Long, S.J., Vincent, C.A., Fraser, G. and Sevdalis, N., 2010. Factors underlying parental decisions about combination childhood vaccinations including MMR: a systematic review. Vaccine, 28(26), pp.4235-4248. World Health Organization (2015). Report on the Immunization and Vaccines Related Implementation research (IVIR). Available at: [Accessed 18 May 2018]. Kumar, D., Chandra, R., Mathur, M., Samdariya, S., & Kapoor, N., 2016. Vaccine hesitancy: understanding better to address better. Israel journal of health policy research, 5(1), 2. European Centre for Disease Prevention and Control (ECDC), 2016. Rapid literature review on motivating hesitant population groups in Europe to vaccinate. Available at: [Accessed 18 May 2018]. Leask, J., Kinnersley, P., Jackson, C., Cheater, F., Bedford, H. and Rowles, G., 2012. Communicating with parents about vaccination: a framework for health professionals. BMC pediatrics, 12(1), p.154. Danchin, M., 2016. How can healthcare providers help parents with vaccine concerns to make a positive decision to vaccinate?[online] Participating from the comfort of your living room: Feasibility of a group videoconferencing intervention to reduce distress in parents of children with a serious illness or injury | Murdoch Children's Research Institute. Available at: [Accessed 18 May 2018].