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CHILDHOOD VACCINATION

Health Behavior Models and Theories:

Childhood Vaccination

California State University of Long Beach

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Health Behavior Models and Theories:

Childhood Vaccination

Vaccinating a child is a very important part of their health as they continue to grow. When a child is young they

tend to get sick easier due to their immune system not being strong enough to fight the disease that is attacking

them. Throughout the years many parents have thought about whether they should or shouldn’t vaccinate their child.

Several parents have been against vaccines due to their belief or it causing them to get sick and not helping their

child. Children can develop immunity through vaccines without them experiencing the actual disease that vaccines

prevent (CDC, 2017). The immunity that is provided through the vaccines will help children avoid spreading or

catching any type of disease.

Significance to Public health

Vaccines play an important role in public health. They help stop the spreading of diseases and help prevent

anyone from catching the disease once they are vaccinated and immune to the disease. Thanks to vaccines,

smallpox, one of the worst disease in history, no longer exist (CDC, 2017). Smallpox has had a great impact in

history which resulted in the death of many people. Without vaccines smallpox and many other diseases would

continue to be spread and effect many people causing serval deaths. Childhood vaccination is a good behavior that

should continue to happen. Educating parents and the community about the importance of vaccinating their child is a

good way for them to continue this behavior and convincing those parents who aren’t sure if they should vaccinate

their child. Incorporating health behavior models and theories to educate the community can have a positive effect

on this behavior and would make it easier for them to understand the importance of vaccinating their child.

Relevance to HSC 421

Childhood is a relevant health behavior in this class because it’s a health behavior you choose to do which

most people do. But there is a small amount of people who decide not to take part of this behavior. Health behavior

models and theories can be shown in this behavior in both positive and negative ways. Positive being people

vaccinating their children and negative would be people not vaccinating their children which will result in the child

becoming sick and spreading their illness to the people around them.

Focus and original thoughts

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This paper will focus on the practice of health behavior models and theories in regard to childhood

vaccination. By researching professional literature based on childhood vaccination, and identifying behavior

models/theories it will show methods that have influenced this health behavior.

Main points

Vaccinating children is the first step to aid a child from becoming ill of any type of disease. The background

will focus on the reasons why vaccinating children is crucial and cases where vaccines have had a great impact in

the health of many individuals. The theories that will be provided throughout the research are the Health Belief

Model and the Theory of Reasoned Action. Both the model and theory will help demonstrate parent’s beliefs and

thoughts in regard to childhood vaccination.

Background

Throughout history there have been many diseases that have impacted the health of many individuals

including children. Vaccines has placed a big role in health by providing immunization to disease and help stop the

spreading of diseases in communities. Some have opposed on vaccinating their child due to the beliefs and thoughts

they have on vaccines. However, vaccines have been able to help reduce the amount of children deaths caused by

the spread of diseases. According to the National Center for Complementary and Integrative Health website, “before

vaccines, many children died from diseases such as whooping cough and polio- diseases that vaccines can now

prevent”. By vaccinating children, they will be protected from deadly diseases and will help the community stop the

spreading of diseases. As stated by the director emeritus of the NCCIH, Josephine P. Briggs, “It is essential that we

recognize the extraordinary success of childhood vaccination, and that we look to the abundant scientific evidence

that documents the safety and vital role of vaccines in the health of our nation” (NCCIH, 2017).

The creation of vaccines has affected the health in a positive way for several individuals. Being immunized to

all diseases that have been circulating and affecting communities has helped avoid people from visiting the hospital

caused by an illness of a disease. “Polio is one example of the great impact that vaccines have had in the United

States. Polio was once America’s most feared disease, causing death and paralysis across the country, but thanks to

vaccination the United States has been polio-free since 1979” (CDC, 2017). This is just one of many cases where

vaccines have had a positive impact of the lives of many people. Without vaccines polio and many other diseases
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that no longer exist would still be going around and effecting the community’s health. Approximately 11,000 people

were taken to the hospital every year and about 50 children died from chicken pox before the vaccine was created in

1995 (CDC, 2017). This would be something that could still be happening today if the vaccine wasn’t established.

Thankfully this isn’t the case anymore, large number of people effected by chicken pox isn’t heard of like it was

before. The vaccines have helped our bodies become immune to deadly disease that have cause the death of many

people.

Determinants of Health

A determinant of health for childhood vaccination would consist parents being influenced by social media.

Their decision on whether to vaccinate their child can be affected based on what others tell them or what they see in

social media such as Facebook. Not knowing enough information about vaccines can also cause them to be unsure.

The Policies can also affect children from getting the vaccines they need. Not funding medical can affect children

because this may be the only way they can receive vaccines because their parents may not have enough funding’s to

pay for all the vaccines they may need. Especially for families in a low-income community who have more than one

child.

Health Belief Model (HBM)

The Health Belief Model is composed of eight key components that influence health behaviors. These

components are perceived susceptibility, perceived severity, perceived threat, perceived benefit, perceived barriers,

cues to action and self-efficacy. The HBM focuses on the decisions of the individuals, whether an individual should

adapt to a certain behavior. It can also be used as part of an intervention or suggestion. This model aims at an

individual’s decisions based on their approach on any threat they may have.

Theory of Reasoned Action (TRA)

The Theory of Reasoned Action is the most current formulation of the Theory of Planned Behavior which is “a

well-rounded theory and often used in health behavior research and in information seeking behavior studies”

(Harmsen et al., 2013). This theory shows the intentions of an individual is determined by the attitude they have

towards the behavior (Harmsen et al., 2013). The TRA consist of components that include behavioral beliefs,

outcome evaluations, Subjective norms, normative belief, motivation to comply, perceived behavioral control, and
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control beliefs. This theory will help find ways to help an individual change their behavior and understand the result

of the changed behavior.

Compare and Contrast: HBM and TRA

The Health Belief model and the Theory of Reason Action both share the same idea of helping an individual

find suggestions or strategies that will support their behavior change. The applied method used in HBM is to focus

more on the individual’s ideas of a threat and the decision to act rather than their attitudes and intention towards the

behavior and their thought of how hard the change will be such as TRA. The HBM assist in their decision to change

their behavior and find ways to alter their behavior for their well-being. TRA aims more towards the attitude of an

individual and their belief on whether to allow the alteration of their behavior. This is a different approach to helping

an individual change their behavior. Although the Health Behavior Model focuses more on the individual’s decision

and the Theory of Reasoned action focuses on attitudes and intentions of an individual, both the theory and model

assist on finding strategies to help individuals with a behavior change.

HBM and TRA relevance

The Health Belief Model (HBM) is relevant to this health behavior because threats can be identified if parents

don’t vaccinate their children. This can result in parents taking action to prevent their child from catching any

diseases by vaccinating their children. Some of the concepts of the HBM can be seen such as perceived

susceptibility: the likelihood of getting a disease, perceived severity: the understanding of how serious the result or

consequence is from the disease, perceived benefits: efficacy of preventive action undertaken, and perceived

barriers: the time, money, effort, inconvenience, side effects of preventive action and pain (Bond & Nolan, 2011).

Once parents understand how serious diseases are and how it has affected many people and children they would

make the decision to vaccinate their child to protect them. Realizing that there are vaccinations that can prevent

some diseases not only will it help parents protect their children it will also save them money from visiting a

hospital, save their kids from the pain and suffering that comes from catching a disease. The Health Belief Model

can be incorporated to help parents understand the importance of vaccinating their children.

The Theory of Reasoned Action is relevant to this health behavior because parents decided if they should

vaccinate their children based on their outlook on vaccines. Educating parents in regard to vaccines will assure them
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that vaccinating their children is the best way they can help protect the health of their children. An example of one

of the TRA construct is control beliefs. Control beliefs refers to specific factors that could ease or interfere with the

performance of the behavior (Harmsen et al., 2013). Some factors that could cause ease to the parent’s decision

would be their child not catching a deadly disease or their child not spreading any disease to the public, not going to

the hospital, or not suffering because of a disease. Factors that can intervene would be their belief on vaccines

whether its religious or personal or false information they have read about vaccines. Normative belief is another

construct of the TRA that can be seen in this behavior. Normative beliefs refer to an individual’s belief that a certain

referent will or will not accomplish the behavior (Harmsen et al., 2013). The Theory of Reasoned Action can be

applied to this health behavior by education parents about the benefits and seriousness of vaccines which can change

their belief about vaccinating their children.

Health Behavior Model (HBM) Research Application

After researching peer review articles, I can across a study that incorporated the Health Belief Model. In this

study they conducted an interview with parents asking them about their experiences and their perceptions of the

severity and susceptibility of diseases. Some of the information that was collected was information about their

child’s health, the experience of illness in the family, their understanding and understanding of the risk and how this

depict their decision to immunize (Bond & Nolan, 2011). Three categories were created, the first being complete

immunizer where they received all the recommended vaccines, the second is incomplete immunizer meaning they

just received some vaccines and didn’t continue and the last category is non-immunizer, not receiving any vaccines.

Severity, susceptibility, benefits, barriers and cues to action are components of the HBM that were incorporated

in the three categories that was created in this study. For complete immunizer the severity consists of the seriousness

of the disease and preventing the disease, susceptibility is the likelihood of getting the disease, benefits is the

vaccines being effective and safe, the barriers are the lack of information about vaccines, diseases and the side

effects, and the cues to action is having a health provider you can trust (Bond & Nolan, 2011). The severity for

incomplete immunizer includes the idea that is best to get either the vaccine or the disease (some diseases) when

they are young, susceptibility: children exposure to diseases or sickness in general, benefits: vaccines not being safe

but not effective, barriers: minor illnesses, forgetting, advice from heath professionals, and cues to action: school

immunization certificate (but not for age-appropriate immunizations) (Bond & Nolan, 2011). Lastly non-immunizer,
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the susceptibility consists of the exposure to vaccine side effects, benefits: vaccines cannot prevent diseases and are

actively dangerous, and barriers: perceived serious consequences of vaccines (Bond & Nolan, 2011). The concepts

of the HBM can be seen in all three categories that were created in the study.

After conducting the study, they found that health messages concerning risk of diseases may be ineffective

since they are perceived as unbelievable or irrelevant (Bond & Nolan, 2011). Parents are influenced based on their

belief when deciding if they should vaccinate their children. As stated in the study, using a more complex theoretical

approach to public health issues will increase the chance of understanding the barriers to action and the develop

effective ways of communicating risk and carry acceptable health interventions (Bond & Nolan, 2011).

Theory of Reasoned Action (TRA) research application

In this study they created an online questionnaire that was given to 400 parents who had at least one child

between the ages of 0-4 years. The questionnaire measured four items, the first was their experience with National

Immunization Program (NIP), the second is whether child immunization is self-evident and the amount of though

given on the decision of vaccination and the third was their attitude measured in three ways, very bad/good, very

important/unimportant, and very reliable/unreliable, about the NIP (Harmsen et al., 2013). They were given multiple

choice questions and were asked if they researched information about NIP in the past.

They were able to measure the difference between the belief of high and low intenders belief based on a median

split of intention and incorporated some concepts of the Theory of Reasoned Action. Table 1 shows the application

of Behavioral belief, outcome evaluation, normative belief, and control belief. The number of low intenders is 338

and for high intenders is 254. The items under behavior belief are findings about NIP increasing their knowledge

had a resulted in a mean of 4.84 for low intenders and a mean of 4.97 for high intenders and by searching for

information on NIP will be easier for them to decide whether or not they should vaccinate their children had a mean

of 3.99 for low intenders and a 4.49 for high intenders (Harmsen et al., 2013). Under Outcome evaluations is making

a choice on whether or not they should vaccinate their child, if they think its…very bad or good had a mean of 4.55

for low intenders and 5.27 for high intenders and if they think increasing their knowledge about NIP is very good or

bad had a mean of 4.87 for low intenders and a 5.13 for high intenders (Harmsen et al., 2013). In the Normative

belief category, they had their nurse/doctor at the child welfare center think they should search for information about

NIP had a mean of 2.05 for low intenders and a 3.14 for high intenders and other parents with young children ages
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0-4 years think they should search for information about the NIP had a mean of 1.90 for low intenders and a 3.01 for

high intenders (Harmsen et al., 2013). Lastly, for control beliefs they had after reading all the pros and cons about

vaccines if they can decide where or not they will vaccinate their child had a mean of 4.95 for low intenders and

4.96 for high intenders and if they can find the information they are searching for had a mean of 5.35 for low

intenders and 5.26 for high intenders (Harmsen et al., 2013).

After conducting this research, they concluded that the information that the National Immunization program

(NIP) might not have been enough for most parents and some parents mention that they didn’t receive enough

information about the side effects of vaccines which was a topic that was the most searched by parents (Harmsen et

al., 2013). Therefore, public health institutes and child healthcare workers should be aware of the importance of

communicating this aspect to parents since child healthcare workers were seen as the most reliable source of

information and should be familiar with their role of educating parents about the NIP (Harmsen et al., 2013). When

parents are more educated about vaccines they would become more comfortable with their decision. Its important

for healthcare workers to always educate their patients about anything whether its about vaccines or their health.

Conclusion and Further Study

Vaccinating a child is a health behavior which has had a lot of parents think if they should vaccinate their child.

There have been many things that have influenced parents on their decision both from information they received

from their doctor or a reliable website or from their belief and things they heard from others. Health behavior

models and theories such as the Health Belief Model and the Theory of Reasoned Action can be seen in many health

behaviors which can help break down the stages of an individual’s behavior and find solutions to them. These

models and theory helped find information about their thoughts on vaccinating their child and about researching

information about vaccines to be able to decide if they should vaccinate their children. Further research can be done

on the influences, both negative and positive, that help parents decide if they should or should not vaccinate their

child. This can help us understand what information is being given to parents and the things that effect their decision

about vaccination. It can help us find ways for parents and others in the community be more educated and informed

about vaccines. Educating the community can have a positive effect in the lives of many families especially those in

communities who don’t have any help.

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References

Bond, L. & Nolan, T. (2011). Making sense of perceptions of risk of diseases and vaccines: a qualitative study

combining models of health beliefs, decision-making and risk perception. BMC Public Health, 11, 943.

https://doi.org/10.1186/1471-2458-11-943

Centers for Disease Control and Prevention. (2017). Five Important Reasons to Vaccinate Your Child. Retrieved

from https://www.cdc.gov/vaccines/partners/childhood/matte-articles-5-reasons.html

Center for Disease Control and Prevention. (2017). Why Are Childhood Vaccines So Important?. Retrieved from

https://www.cdc.gov/vaccines/vac-gen/howvpd.htm

Centers for Disease Control and Prevention. (2017). Why Your Child Needs Chickenpox Vaccine. Retrieved from

https://www.cdc.gov/vaccines/partners/childhood/matte-articles-chickenpox-vaccine.html

Harmsen, I. A., Doorman, G. G., Mollema, L., Ruiter, R. A., Kok, G., & de Melker, H. E. (2013). Parental

information-seeking behaviour in childhood vaccinations. BMC Public Health, 13, 1219.

http://doi.org/10.1186/1471-2458-13-1219

National Center for Complementary and Integrative Health. (2017). Childhood Vaccinations-Vital to Our Children’s

Health. Retrieved from https://nccih.nih.gov/about/offices/od/Childhood-Vaccinations-2017

National Center for Complementary and Integrative Health. (2017). Vaccinations/Immunizations for Children.

Retrieved fromhttps://nccih.nih.gov/health/vaccinations