Acceptability of financial incentives or quasi-mandatory schemes to increase uptake of immunisations in preschool children in the United Kingdom: Qualitative study with parents and service delivery staff. Issue 19 (27th April 2016)

• Record Type: Journal Article
• Authors: McNaughton, Rebekah Jayne; Adams, Jean; Shucksmith, Janet
• Is Part Of: Vaccine. Volume 34:Issue 19(2016)
• Page Start: 2259
• Page End: 2266
• Publication Date: 2016-04-27
• Subjects: Childhood immunisation -- Financial incentives -- Quasi-mandatory schemes; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2016.03.009
• Languages: English
• ISSNs: 0264-410X

Abstract

Highlights: Financial incentives were deemed inappropriate and wasteful of resources in the context of immunisation. Financial incentives were interpreted as bribery that could lead to unintended consequences. Quasi-mandatory schemes were more acceptable but would remove democratic rights. The workability of quasi-mandatory schemes would be difficult with schools reluctant to police them. Abstract: Introduction: Since the 1990s strenuous attempts have been made to rebuild trust in childhood immunisations. This study aimed to understand if financial incentives (FI) or quasi-mandatory schemes (QMS), e.g. mandating immunisations for entry to universal services such as day care or school, might be acceptable interventions to increase immunisations uptake for preschool children. Material and methods: Parents and carers of preschool children ( n = 91); health and other professionals ( n = 18); and those responsible for developing and commissioning immunisation services ( n = 6) took part in the study. Qualitative methods were employed to explore the acceptability of FI/QMS with stakeholders. Framework analysis was used to develop a coding framework that was applied to the whole dataset. Interpretations of the emergent themes were verified between researchers and presented to the project's Parent Reference Group to ensure coherence and relevance. Results: (1) FI: parents and professionals felt introducing FI was inappropriate. It was acknowledged FI may encourage families living in disadvantage to prioritise immunisation, but unintended consequences could outweigh any advantage. FI essentially changes behaviour into a cash transaction which many equated to bribery that could inadvertently create inequalities. (2) QMS: parents and professionals highlighted the positives of introducing QMS, stating it felt natural, fair and less likely to create inequality. Despite QMS' potential to positively impact on uptake there were concerns about the implementation and workability of such schemes. Discussion and conclusion: FI for preschool immunisation may not be acceptable, within a UK context. Introducing FI could have detrimental effects on uptake if it were associated with bribery and coercion. Quasi-mandatory schemes, mandating immunisation for universal service entry, was the most acceptable option and could contribute to the normalising of immunisation. Future work would be needed to assess how this could be successfully implemented and if it did indeed increase uptake.