1
Commissioning Support for London
Increasing MMR uptake Proposed Approach to Stakeholder Workshop
Including Output from Primary Care Giver
Workshops
19th August 2010
A partnership between The Information Centre for health and social care and Dr Foster Holdings LLP
FESC approved supplier
2
Purpose
To share output from the 4 Primary Care Giver
Workshops in the context of a proposed structure
for the HCP Workshop on 23rd August, 2010.
To discuss and agree the structure and content.
3
Context
Kensington & Chelsea
Newham
Higher SEG Workshop
Higher SEG Workshop
Lower SEG Workshop
Lower SEG Workshop
Quantity of Ideas
Target 3 Workshop
Refined Intervention Ideas
4
HCP Workshop Structure
2 ½ hours
Immediate task
•
Think of the last time you visited the dentist. What was good about it and what
was not so good?
Self Introduction
•
•
Name, role in relation to child immunisation
Response to Task
Set Context
•
About enhancing the child immunisation ‘journey’, specifically in relation to
MMR. Work conducted to date.
5
HCP Workshop Structure
Set Objective
•
To assess a range of ideas generated by primary care givers, to build on those
ideas and generate additional ones which can then be taken into further
research.
Rules of Engagement
•
•
•
Every voice is equal
One voice at a time
No criticism by word, deed or facial expression
6
HCP Workshop Structure
What issues do our primary care givers have with the child
immunisation journey?
How they find out about it
How they get answers to their questions
The experience of ‘the jab’
7
Key General Findings
1. The only substantive differences between the higher and lower
socio-economic groups were:
•
•
The extent of their knowledge
The propensity to search out information, particularly online
2. Immunisation is a ‘distress purchase’
8
Key General Findings
3. It is emotionally charged
Fear and Anxiety in advance
They’re having to take important decisions, balancing risks with imperfect
knowledge
“I didn’t know what to do to the point that I felt ill I was so worried”
Upset and Anger during the experience
9
Key General Findings
4. The experience feels brutal
It is as if their child is ambushed, then ‘pinned down’, ‘pinched’,
‘jabbed’ or ‘stabbed’
5. Their knowledge is imperfect
They generally struggled to list all the jabs, what diseases they were
for and what were the potential consequences of those diseases.
10
Key General Findings
6. The barriers to MMR are many and varied
•
•
•
•
•
It is not solely about Wakefield
• the youngest are unaware of it
• others are aware of it, appreciate it has either been discredited or
is media hype but it remains a lingering concern
“the seed is planted and you’re afraid”
It is a cocktail – 3 illnesses in one injection
There is imperfect understanding of what the three diseases are and
the health risks they carry
There is little experience of the three diseases but when there is it acts
as a positive spur
There is some experience of failure
“2 of my boys had their MMR – they had all their jabs – and they still got
mumps – so I didn’t give it to my girl”
11
Key General Findings
6. The barriers to MMR are many and varied
•
•
•
There are the odd myths – a belief breastfeeding will confer a
mother’s immunity to the child.
There is specific doubt about the follow up jab – is it really necessary?
Bad first time reactions
“my daughter wasn’t well when she had her first jab and now I’m afraid to
give her the second”
12
Key General Findings
7. The barriers will only be overcome if….
•
They are treated as emotional human beings, not ‘econ heads’. They
need their feelings to be understood and validated.
•
They can access clear, impartial, balanced information ideally
independently of GP’s or the NHS who they believe have a vested
interest in securing compliance.
13
Issues
How do they find out about it?
With the first child it feels like an ambush
It takes them by surprise
“the first thing they (HCPs) do when the baby is born is stick ‘em with a
needle...they stab ‘em...”
“literally straight away – they don’t even explain anything”
It is not a coherent programme about which they have been forewarned
and for which they are prepared.
(But the degree to which they would be receptive to and engage with
information in advance needs to be ascertained.)
14
Issues
How do they get answers to their questions?
They have a myriad of potential sources but their primary needs
are for validation of their concerns or anxieties and for impartiality.
Hence, online (particularly Higher SEG) and people close to them tend to
be preferred
“You get more answers online than from the GP”
“My mum supported me in not getting the jab – they didn’t really need it”
“I would go to the NHS but I always like to get a second opinion so I
Google it or go on NetDoctor.”
15
Issues
How do they get answers to their questions?
But both are problematic: those close have imperfect knowledge; online
searches can intensify anxiety.
“I go online but have to stop myself because I’ll end up thinking I’ve got a
blood clot travelling to my brain”
16
Issues
How do they get answers to their questions?
Conversations with HCP’s are either avoided
“They’re just going to tell you you have to have it”
or of variable quality
“The nurse was dismissive, branded me as a nuisance mum”
17
Issues
The experience of ‘the jab’
•
•
•
•
Inflexible timing: appointment or drop in at restricted times
Child unfriendly surroundings
A rush
It can feel brutal – the child is ‘pinned down’ by the parent, their skin is
‘pinched’ and then they’re jabbed.
“Have to hold the child still and hold their head and then they stab
them and the child is screaming”
•
Mothers will cry, fathers feel angry, children are startled
“She looked at me as if to say ‘why are you doing this to me”
18
Issues
The experience of ‘the jab’
•
Variable quality of nurses, in terms of expertise and child friendliness
“The nurse weren’t friendly and now my little one’s got two scars where
the jabs went – that put me off altogether”
•
No influence over the ‘preparation’
“He sees ‘em preparing it and starts screaming”
•
They feel very rushed afterwards– they don’t have time to get the baby
dressed
“it’s a plaster on and GO!”
19
Issues
The experience of ‘the jab’
•
Aftermath is generally unpleasant
“she wasn’t really a crying baby but she really cried after that – it was
traumatic”
“and then for the rest of the day you can tell he’s in pain”
20
HCP Workshop Structure
What issues do you have with the child immunisation journey?
21
HCP Workshop Structure
What ideas did primary care givers have?
22
Ideas
What would be the best way to find out about jabs?
Before the birth
1. Face to Face
•
•
•
•
•
At hospital appointments
Ante-natal class on subject (compulsory for 2nd time parents)
Pre-appointment with GP or at check-up
Meeting with other new parents in a facilitated group
In school curriculum – part of PHSE
23
Ideas
What would be the best way to find out about jabs?
Before the birth
2.
•
•
•
•
•
•
•
Communications
DVD – given during pregnancy
TV screens in ante-natal departments
TV channel (not subscription)
Written
• In Pregnancy book, but easy to read with more visuals
• Emma’s Diary
• NHS leaflet sent to home or in Bounty Pack
Text
i-phone app
Website tutorial - e.g. on Bupa site
24
Ideas
What would be the best way to have your questions answered?
•
•
•
•
•
Moderated Group discussion
• Interactive NOT a lecture
• Led by health visitor/Midwife/nurse and GP
On-line forum
Specialised jabs web-site - “injections made easy”
Fuller information in Red Book
An unbiased source:
• Miriam Stoppard
• NSPCC
25
Ideas
What would be the best way to have your questions answered?
•
•
•
•
•
•
Pharmacist
Top supermarkets / Boots – stand for consultations
At Mothercare – meet an expert
Library
Imms helpline
Drugs approval authority
26
Ideas
What would be a good conversation?
Show video extracts
What would be a bad conversation?
Show video extracts
27
Ideas
Where would be best?
•
•
•
•
•
•
•
At home
Mobile unit – trailer/van/ambulance/blood bank/health van for kids
Specialised centre for immunisation (6 stars)
Children’s environments: playgroups, children’s centres, nursery,
school
Vaccination Party at someone’s house
An event: Teddy Bear’s Picnic, ‘Jab in the Park’ or ‘Jab Fest’
Pharmacy
28
Ideas
Where would be best?
•
•
•
•
•
•
•
Supermarket / shopping mall
Libraries
Village halls
At an event – Newham ‘Under the Stars’
Health centre
Sports centre
Church / mosque / synagogue
29
Ideas
Who could administer the jabs?
Familiar, friendly, reassuring
• Midwives
• Those who are likely to be most child friendly
• Screened nurses
• Nursery nurse
• Health visitor
• Community immunisation specialist
• Parents, specifically Dads
• Phlebotomist
• Beautician with medical experience (1)
• Health advisor
• Pharmacist
• Paramedics
• Health care assistants
30
Ideas
When would be best?
•
•
•
Greater flexibility to better suit working mothers and to allow for
partners to attend: evenings; early morning; weekends
Enable the making of appointments
When the child is older
31
Ideas
How could the experience be better?
•
•
•
•
•
A less ‘clinical’ environment – with toys, mobiles, colours, fish tank, TV
showing children’s films to distract the child or calming music
Show children’s idol having the jab – e.g. Dora the explorer / Ben Ten
or Rory the Car
Have a play worker to play with the child to help them relax before
going in for the jab
Have a more calming position for the child – not pinned down – to be
shown (poster) or talked about in advance
Options of:
• A nurse to hold the baby
• Take baby away so the parent is not there while being injected
32
Ideas
How could the experience be better?
•
•
•
•
•
•
Less painful ways of administering: liquid with milk; epi-pen; numb the
area
A freebie or sample on leaving (e.g. from the drug company)
Character transfer on plaster
Reward for the child e.g. lollipop
Telephone call to the parent 24 hours later to follow-up
Enable anonymous feedback
33
HCP Workshop Structure
Assessment of ideas against 3 suggested criteria:
• Cost on a scale of 1-5 where 1 is inexpensive and 5 is extremely
expensive
• Practicality on a scale of 1-5 where 1 is not difficult to implement and 5
is extremely difficult to implement
• Likely effectiveness on a scale of 1-5 where 1 is not very likely to be
effective and 5 is extremely likely to be effective
Sheets, with ideas pre-listed in rows with blank columns for agreed
criteria, are handed out and completed
34
HCP Workshop Structure
Do you have additional ideas?
Based on all you have heard what is the best possible journey we could
create which we can then realistically test out with our primary care
givers?
Summarise
What we shall be doing next
Thanks
35
Appendices
36
HCP Workshop Structure
2 ½ hours
Immediate task
•
(Think of the last time you visited the dentist. What was good about it and what was not so good?)
Self Introduction
•
(name, role in relation to child immunisation) & Response to Task
Set Context
•
About enhancing the child immunisation ‘journey’, specifically in relation to MMR. Work conducted to date.
Set Objective
•
To assess a range of ideas generated by primary care givers, to build on those ideas and generate additional ones
which can then be taken into further research.
Rules of Engagement
•
Every voice is equal
•
One voice at a time
•
No criticism by word, deed or facial expression
What issues do our primary care givers have with the child immunisation journey?
•
How they find out about it
•
How they get answers to their questions
•
The experience of ‘the jab’
Findings from the workshops we conducted with primary care givers
•
Key general findings
•
Issues
What issues do you have with the child immunisation journey?
What ideas did primary care givers have?
•
Ideas
Assessment of ideas against 3 suggested criteria:
•
Cost on a scale of 1-5 where 1 is inexpensive and 5 is extremely expensive
•
Practicality on a scale of 1-5 where 1 is not difficult to implement and 5 is extremely difficult to implement
•
Likely effectiveness on a scale of 1-5 where 1 is not very likely to be effective and 5 is extremely likely to be effective
•
Sheets, with ideas pre-listed in rows with blank columns for agreed criteria, are handed out and completed
Do you have additional ideas?
•
Based on all you have heard what is the best possible journey we could create which we can then realistically test out
with our primary care givers?
•
Summarise
•
What we shall be doing next
•
Thanks
37