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Vaccine Beliefs of Complementary and Alternative Medical (CAM) Providers in Oregon

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Vaccine Beliefs of Complementary and Alternative Medical (CAM) Providers in Oregon AN ABSTRACT OF THE DISSERTATION OF Sandra J. Bean for the degree of Doctor of Philosophy in Public Health presented on May 21, 2014. Title: Vaccine Beliefs of Complementary and Alternative Medical (CAM) Providers in Oregon Abstract approved: ______________________________________________________ Joseph A. Catania Health care providers, including complementary and alternative medical (CAM) practitioners, exert a significant influence on parental pediatric vaccination decisions. Use of CAM therapies is increasing in Oregon. Concomitantly, there has been a decade-long increase in parental vaccine refusal in Oregon, rising from 1 to 5 percent from 2000–2009. For example, in some Oregon schools, 70% of children are unvaccinated. I conducted hour-long interviews with 36 practitioners from five CAM modalities (i.e., acupuncture, chiropractic, homeopathy, midwifery, and naturopathy) to explore a range of associations between vaccination perceptions and vaccine recommendations to others. Data collected from the semi-structured interviews were sorted and analyzed by themes. Perceived susceptibility to and severity of either an illness or a vaccine as well as perceptions of vaccine efficacy, benefits, and risks influenced CAM provider vaccine recommendations to parents about vaccinating their children. The contextual factors of immunology beliefs, personal experience, reference group norms, and beliefs about industry and government were found to a lesser extent to influence whether a CAM provider promoted or opposed pediatric vaccination. The results of this research suggest possible interventions aimed at improving scientific knowledge of vaccine science as well as addressing hesitancy to vaccinate. These interventions could include communicating the relative risk of vaccinations; providing training for mainstream medical providers in empathic communication with patients and avoiding a directive, fact-laden model; and developing a layered approach to vaccine education, with specific content aimed at separate populations, including health care providers, journalists, policy makers, parents, educators, and children. ©Copyright by Sandra J. Bean May 21, 2014 All Rights Reserved Vaccine Beliefs of Complementary and Alternative (CAM) Providers in Oregon by Sandra J. Bean A DISSERTATION submitted to Oregon State University in partial fulfillment of the requirements for the degree of Doctor of Philosophy Presented May 21, 2014 Commencement June 2014 Doctor of Philosophy dissertation of Sandra J. Bean presented on May 21, 2014 APPROVED: Major Professor, representing Public Health Co-Director of the School of Social and Behavioral Health Sciences Dean of the Graduate School I understand that my dissertation will become part of the permanent collection of Oregon State University libraries. My signature below authorizes release of my dissertation to any reader upon request. Sandra J. Bean, Author ACKNOWLEDGEMENTS Completion of this dissertation would have been impossible without the support of several mentors. I am sincerely grateful to Dr. Joseph A. Catania, whose guidance and mentoring has been fundamental to my development as an independent researcher. His patience and humor throughout my years of study and writing have kept me focused. I also thank my other committee members—Drs. Dolcini, Donatelle, Faridani, and Tilt. Dr. Tilt, in particular, has guided me as a qualitative researcher, and my Graduate Council Representative, Dr. Faridani, whose outsider’s perspective greatly strengthened this work, led me to examine my own assumptions and to delve deeper into the literature. Thanks also go to Dr. Jorge Cham, author/creator of “PhD Comics,” for boosting my immune system through laughter and showing me that I was not alone. I thank my warm and embracing Bahá’í faith community, whose friendship and encouragement have sustained me since I moved to Corvallis to pursue this degree, and whose continuing friendship has persuaded me to stay right here in Benton County to continue my work to help improve pediatric vaccination rates in Oregon. And finally, none of this would have been remotely possible without the loving support and encouragement of my husband, “hard science guy” Dr. Roger L. Blaine, OSU alumnus in chemistry (1969), who persuaded me to apply to the public health program at Oregon State University, one of the best decisions of my life. TABLE OF CONTENTS Page Chapter 1: Introduction .................................................................................................. 1 Overview ................................................................................................................... 1 Outbreaks of Vaccine-Preventable Diseases (VPDs) ................................................ 2 The Role of Health Care Providers (HCPs) .............................................................. 3 Chapter 2: Literature Review .......................................................................................... 5 The Role of Vaccines ................................................................................................. 5 History and importance ........................................................................................ 5 Vaccine development ............................................................................................ 6 Vaccine-Preventable Diseases (VPDs) ...................................................................... 9 Importance of Herd Immunity ................................................................................ 10 Erosion of Herd Immunity ....................................................................................... 12 The Rise of Vaccine Opposition ............................................................................. 13 Vaccine resistance in Oregon .............................................................................. 15 Factors in vaccine opposition .............................................................................. 16 Complementary and Alternative Medicine (CAM) Providers ................................. 19 Summary of Findings from Previous Research ...................................................... 24 Research Approaches Compared ............................................................................ 25 Quantitative research ........................................................................................... 25 Qualitative research ............................................................................................ 26 Why study narratives? ......................................................................................... 28 Research Significance ............................................................................................. 29 Study Innovation ..................................................................................................... 30 CAM providers ................................................................................................... 31 Summary ............................................................................................................. 33 Research Aims ......................................................................................................... 34 Chapter 3: Methods ....................................................................................................... 37 Institutional Review Board ...................................................................................... 37 Sociodemographics .................................................................................................. 37 Recruitment .............................................................................................................. 37 TABLE OF CONTENTS (Continued) Page Interview Procedures ............................................................................................... 42 Data Collection and Analysis ................................................................................... 43 Data collection procedure .................................................................................... 43 Data preparation ................................................................................................. 43 Data analysis ....................................................................................................... 44 Transferability, Reliability, Validity, Confirmability .............................................. 47 Transferability ..................................................................................................... 47 Reliability ............................................................................................................ 47 Validity and confirmability ................................................................................ 47 Dissemination Plan ................................................................................................. 48 Future Research ........................................................................................................ 48 Chapter 4: Results ......................................................................................................... 51 Overview ................................................................................................................. 51 Complementary and Alternative Medicine (CAM) Defined ................................... 52 Population Demographics ........................................................................................ 52 Naturopathy .............................................................................................................
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