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1. D’(Mis)Communication et Contexte pour les vaccinations d’enfance: un role pour psychologie de sante critique? Gray, C., Kennedy, C. & Hogg, R. *School of Nursing, Midwifery & Social Care, Edinburgh Napier University Background The promotion of childhood vaccinations is complex in the literature. Vaccination is important to ensure protection from infectious diseases but in developed countries rates for vaccinations have fallen in recent years. The Measles, Mumps and Rubella (MMR) controversy in the UK (Wakefield et al, 1998) undermined public confidence in the vaccine despite further evidence to the contrary. Within health psychology literature, the communication of risk once public confidence is eroded is recognised as a complex area (Berry, 2004). There is also limited understanding about local barriers to vaccination and much traditional research focused on quantitative survey designs. Aims To conduct a profiling exercise which considered the literature on immunisations as well as to explore local potential barriers and facilitators for childhood vaccinations amongst parents and health professionals in Edinburgh, where health services for vaccination were varied. Methods The literature on childhood immunisations was examined from developed countries. This was supplemented by an initial profile exercise which was conducted locally using qualitative semi-structured interviews and focus groups with parents and health staff in Edinburgh. Thematic analysis was used to identify key themes within and across the data (Boyzatis, 1998; Marks & Yardley, 2004). Findings Three emergent themes which implicated miscommunication about vaccinations were relevant locally and which reinforced findings from the broader literature: And the relevance of wider organisational issues in the health services for effective delivery and safety (e.g. time; vaccine shortages and complicated schedules): …and I’ve only got a 10 minute appointment so you can’t give them enough time as you feel they might want I feel as if I’m rushing them through… (Practice Nurse, Interview 2) Lay health beliefs which conflicted with health advice: ...I’m not saying I’ll put it off [MMR] but I mean I have said to a mother in the past when the child was quite small just to wait maybe another month or so – not put it off drastically – just give it another month and I don’t have any scientific basis for that apart from talking to another medical person who’s child had autism um after the MMR ... (Practice Nurse, Interview 1) 0.5 0.7 1 1.5 2.0 Negative past experiences with the health services emerged as an additional finding which was key in influencing future vaccination decisions for parents in terms of trust: [Parent describing an early experience with health services during her pregnancy] …that just left me thinking well maybe they’re not always that truthful, maybe they just tell you what they think you need to hear… I think if the information that we got from that information leaflet [NHS information sheet] had felt more honest, ... when you really look at it the lack of any real safety test available other than by the people who sell the vaccine um you know they’re doing it- they’re purely in it for the money so why would you put your children’s health in their hands really… (Parent, Interview 2) Communication and rapport between lay-professional and across professionals: you felt that you were on a conveyor belt sometimes they didnae take the time to really know your children whereas here [at present health centre] they do… (Parent, Interview 1) Conclusions: The scoping exercise indicated that a contextual consideration of vaccination experiences is relevant for health services research and is a gap within the wider literature which has tended to focus on such decisions in isolation. This finding supports Poltorak et al (2005) ethnographic study which examined mothers talk about MMR in Brighton and showed that these decisions did not occur in a vacuum but were interspersed with wider experiences with the health services and social interactions. Hence, the initial findings here have relevance for promoting other national vaccination campaigns in Scotland (e.g. Human Papillomavirus vaccines) and also for critical health psychological understandings in risk (mis)communication and the complexities associated with vaccine promotion once trust has been affected in developed countries. References: Berry, D. (2004). Risk, Communication and Health Psychology. Maidenhead, Berkshire: Open University Press. Boyzatis, R.E. (1998). Transforming qualitative information: Thematic analysis and code development. Thousand Oaks, CA: Sage. Poltorak, M., Leah, M., Fairhead, J. & Cassell, J. (2005). ‘MMR talk’ and vaccination choices: an ethnographic study in Brighton. Social Science and Medicine, 61, 709-719. Marks, D. & Yardley, L. (2004). Research methods for clinical and health psychology. London: Sage. Wakefield, A.J., Murch, S.H., Anthony, A., Linnell, J., Casson, D.M., Malik, M., Berelowitz, M., Dhillon, A.P., Thomson, M.A., Harvey, P., Valentine, A., Davies, S.E. & Walker-Smith, J.A. (1998). Ileal-lymphoid-nudular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet, 351, 637-41.