Identifying knowledge–attitude–practice gaps in parental acceptance of adolescent vaccinations in Appalachian Kentucky: Implications for communication interventions

Abstract

Rural Appalachian Kentucky adolescents are less likely to receive age-appropriate vaccinations compared with other populations and these low vaccination rates represent a major public health risk. This study investigates parental acceptance of adolescent vaccinations by examining their knowledge, attitudes, and behaviors related to vaccinating their adolescents with both state required and recommended vaccines. Using the integrated behavioral model as a guiding framework, the researchers conducted 21 in-depth interviews with parents of 11–18-year-old children in Appalachian Kentucky. Three salient findings emerged. First, knowledge was not strongly related to a parent's behavior, as both vaccinating parents and non-vaccinating parents expressed varying degrees of accurate knowledge. Second, attitudes emerged as an important predictor of behavior, such that parents with positive preventive health attitudes had the desire to protect their children's future through vaccination, indicating risk protection behavior could precede knowledge acquisition. Third, opinion leaders in the community served as important motivators for parents vaccinating their children, contributing to the knowledge–attitude–practice gap in that their influence seemed to be enough to drive behavior. The paper concludes with a discussion of the findings and appropriate communication strategies to use with parents of adolescents and local healthcare providers in order to improve both state required and recommended vaccination rates. The implications from this study could provide insights for designing similar interventions in other underserved, rural areas.

Keywords:

• Appalachian region
• Communication strategies for health behavior change
• Health campaigns
• Opinion leaders
• Parents
• Public health
• Vaccination

Acknowledgments

This work was supported in part by a research grant from the Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp.

Additional information

Notes on contributors

Elisia L. Cohen

Elisia L. Cohen, PhD is Associate Professor and Department Chair of Communication at the University of Kentucky, where she is a member of the Markey Cancer Center. For more than a decade her research has identified effective communication strategies to reduce health disparities, including community and media-based strategies to improve vaccination outcomes.

Katharine J. Head

Katharine J. Head, PhD is Assistant Professor in the Department of Communication Studies at Indiana University-Purdue University Indianapolis. Her work addresses health communication strategies in the cancer prevention context, including health message design, community intervention design and evaluation, mHealth and eHealth technologies, and interpersonal influences in health decision making.