Social networks influence parents’ vaccine decisions

We live in a profoundly different time today when it comes to caregiving, parenting, and gaining health care/advice than we did even 5 or 10 years ago. The Internet has changed things dramatically.

During an interview recently a reporter asked, “You were raised on digital media, yes?”  Well, no. I didn’t started using email until late 1995 just prior to leaving college, didn’t get a cell phone until I was teaching, didn’t have a working computer in my apartment until I started my master’s degree (after med school), and didn’t join social media until 2008. It was bedrest with my second pregnancy that urged the establishment of a profile on Facebook. That online community changed everything.

I’m no digital native but I may act like one.

My husband, my friends, and the doctors I’ve chosen to help me raise my boys certainly do color my belief about the world. So do the things I read and watch online.

There has been 3 measles cases in Seattle this July and 58 cases of measles in Brooklyn, NY since March. Measles is preventable with a very effective vaccine. The vaccine is so good that after 2 doses of the MMR shot, over 99% of people are protected against measles for life. However, often our community shapes our decisions to vaccinate.

An insightful Pediatrics study and accompanying editorial published earlier this year illuminate the reality that social networks carry big weight for parents making decisions about immunizations. We do make decisions in the context of our lives and the social network we choose to use as a sounding board really does help us determine what to do in moments of confusion.

In the study, the “social network” referenced are not just our online “friends,” rather it’s our family and those we look to in moments of indecision. We learn from them in real life and in online social networks.

It’s no surprise then that the study found the social network surrounding parents are a powerful determinate of how parents immunize their children. Emily Brunson, MPH, PhD, a public health researcher, sought to understand who made up parents’ networks and who was the most powerful influencer for parents when making decisions about vaccines.

When you read the data, please tell me if any of this surprises you.

Social networks influence parents’ vaccine decisions:

  • Dr. Brunson surveyed just shy of 200 parents about their social networks, along with their decisions for children on a routine or delayed vaccine schedule as the dependent variable. Of note, the sample was not a random one (they enrolled in the study after solicitation) and may not reflect parents across the US well. The participants in the study consisted mainly of white (>80%) mothers (>90%) living in and around Seattle.
  • Of the 196 parents completing the survey, 126 parents indicated they followed the CDC vaccine schedule (called “conformers”) while 70 “nonconformers” completed the survey (28 parents who were completely vaccinating but on a delayed schedule, 8 parents who were partially vaccinating on time, 29 parents who were partially vaccinating on a delayed schedule, and 5 parents who were not vaccinating at all).
  • In both the conformers and non-conformer group, parents listed their spouse or partner as the #1 influencer in their social network (55% of conformers, 48% of nonconformers). However, 34% of conformer-moms listed the health care provider as the number one influencer and 36% of nonconformers said this. The remainder of social networks for these moms typically consisted of friends, family, and professors as the top 5 influencers.
  • Of note, 90% of conformers and 88% of non-conformers listed their health care provider in their top 5 influencers.
  • Dr. Brunson evaluated sources outside of the people in a social network which she called source networks. Source networks were other places parents sought information about vaccinations. One hundred percent of the non-conformers listed a source network (books, Internet, journals or magazines) as did 80% of conformers in addition to the people network they maintained. Books surpassed all other — Internet, journal articles, or magazine — information for parents when it came to vaccine decisions. In fact, 41% of nonconformers and 28% of conformers listed books as an important source of vaccine information. Particular books were not identified.
  • For those moms and dads who delayed or declined vaccines for children, Dr. Brunson found that sentiments expressed by a parent’s social network were the strongest influencer if they immunized their children on the recommended schedule. More than anything, the voices cautioning against vaccinations deterred non-comforming parents when deciding to delay or hold off on immunizations for their children.

Out of all of the variables considered in this study, the percent of parents’ network members recommending nonconformity was more predictive of parents’ vaccination decisions than any other variable including parents’ own perceptions of vaccination.

Otherwise stated, it turns out that in the group studied, it mattered more what negative things parents heard from their social network than their own held beliefs on vaccines when they decided to delay or decline an immunization for their child. Many of us really do what our friends recommend. I love the perspective provided in the (short) editorial by Drs. Marcuse and Opel which details the power of social conformity.

Clearly this data only compels me more to get pediatricians online, in your network, sharing their wisdom and expertise about vaccinations to help you understand even more the stakes at play.

I’ll often have a parent in the office decline a vaccine because of a spouse’s belief. Now I understand a bit more about why. Please share your reactions to this data. Sound about right? If you delayed a vaccine in the past, do you think it was in part (or mainly) due to what you’d heard from your network?

Wendy Sue Swanson is a pediatrician who blogs at Seattle Mama Doc.

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