| High levels of immunization coverage are required to maintain control of infectious diseases that previously caused significant illness and death in Canada. However, childhood immunizations have been so successful that many Canadians have never seen the impact of these diseases, with some parents becoming more concerned about the safety of vaccines than about the infectious diseases that they were designed to prevent. The purpose of this thesis was to determine if parental concern about vaccine safety is significantly associated with incomplete childhood immunizations, and whether other personal or systemic factors play a role in influencing uptake. The thesis consists of four related papers focusing on: (1) The value and challenges of applying the population health framework in nursing research; (2) The benefits and drawbacks of using postal surveys for public health nursing research; (3) Assessment of the accuracy of the immunization database utilized in this study in terms of immunization status classification, as compared to parent report; and, (4) The findings of the multivariate data analysis in the study. The main conclusions of this thesis are as follows: (1) The population health framework, while presenting challenges for nurse researchers, provides a valuable framework for assessing the multi-level factors influencing health behaviours, such as immunization uptake; (2) Awareness of the potential for survey error is essential when using postal surveys in research, and measures must be taken to minimize, assess, and control for nonresponse bias; (3) The immunization database used in this study had a low, but not inconsiderable, number of misclassification errors of immunization status, while parent report had a greater number of errors; and (4) Parental concern about vaccine safety was indeed associated with incomplete immunizations, but other personal and systemic factors were also associated with vaccine uptake and/or mediated the relationship between parental concern and uptake. |
