HNN108: Understanding Research Evidence - Lee, C., and Robinson - Assessment Answer

Understanding Research & Evidence Assignment

Assignment Task

Part A:

You will be required to annotate the above articles by writing a 500 word summary of each article. Please read the specific student instructions below.

In your assignment, you are asked to review the three articles referenced above and provide three separate ‘annotations’ (structured summaries). The three annotations should be 500 words each.

The annotation should contain two main sections:

1. Description – a brief summary of the article, that includes:

? Bibliographic data

? Main focus of the journal article - aims or objectives

? Research design and methods

? Summary of key findings and conclusions

? Ethical considerations associated with the research

2. Appraisal/evaluation

? What are the strengths and limitations of the research? Comment on the usefulness or limitations of the article in relation to your question i.e. weaknesses, reliability, missing content.

? How does this article contribute to the research question? Specifically, what does the author/s say about immunisation practice in a community health setting?

Part B:

Following completion of the three annotations, you are then required to write a 500 word synthesis on how the evidence in the articles can impact on nursing practice by answering the following question:

How does each of the three (3) research articles inform immunisation practice in a community health setting?

Synthesis

Once you have annotated the three articles, write a 500 word synthesis that critically discusses how the research will impact and inform the nurse’s practice in a community health setting. Discussion about the common links between the papers as well as the limitations of the evidence should be included. You are required to reference the synthesis with the three articles using APA style referencing.

Lee, C., & Robinson, J. (2016, April 8). Systematic review of the effect of immunization mandates on uptake of routine childhood immunizations. Journal of Infection, 72(1), 659-666.

In this article Lee & Robinson assessed the extent to which immunization mandates helped in increasing the number of children being immunized. This was based on the fact that the immunization mandates are being used in the United States while many countries do not use these mandates. The study was a systematic review that looked at studies conducted to assess the efficacy of immunization mandates. The review adopted by the authors was based on Preferred Reporting Items for Systematic reviews and PRISMA statement. The search looked for research that examined rates of immunization in a population after and before implementation of the immunization mandates. The inclusion criteria also looked at studies that used similar populations where one group has the immunization mandates while the other group does not. The heterogeneity of the research design with regards to population under study, vaccines analysed and study design forced the researchers to extract and synthesize the data qualitatively. The authors analysed 21 studies eleven of which were prior to and after immunization studies and ten were analysing and contrasting uptake in comparablle populations whereby one group was immunized while the other was without immunization. Eleven of all these studies examined mandates at middle school. Among these studies, 19 showed that there was increased uptake of immunization with mandates. More precisely, longstanding mandates were associated with higher uptake of immunization among school going children. It is clear from this systematic review that immunization mandates may result in both increased long term and short term immunization uptake.

A major strength of this article is the fact that it is the only systematic review dealing with immunization madnates.as such the information provided is of great value to community based initiatives for preventing diseases among children. The information provided in this paper may also be used to guide policy development related to the uptake of routine childhood immunization for vaccine-preventable diseases. A critical limitation of the study was that the heterogeneity of the study design prevented comparing and conjoining research findings. The fact that the majority of the research was carried out in the United States introduces bias because the political, demographic and cultural climate of the US is very different from other industrialized nations. The studies used in the review relied on a national survey information which is predominantly collected using telephone surveys. This is biased towards parents who had land lines and answer to unknown callers.

The information provided in this article is very critical to a community health setting. It is clearly shown that mandates enhance immunization uptake in a community. This brings into question the fact that it would be still essential for the US to continue enforcing the immunization mandates. If the mandates result in increased uptake then it should be encouraged. This step is critical in the prevention of disease in societies and community. The use of immunization mandate to promote the immunization rates in a community can be a critical step in preventing diseases. For a community health nurse this is a positive outcome that should be promoted because of its benefits to the community. The information provided in this article is critical to disease prevention at the community level.

Glanz, J., McClure, D., Magid, D., Daley, M., France, E., & Hambidge, S. (2010). Parental Refusal of Varicella Vaccination and the Associated Risk of Varicella Infection in Children. Arch Pediatr Adolesc Med, 164(1), 66-70.

In this article, the main aim of the authors was to measure both the individual level as well as the imputable risk of varicella infection needing medical attention in cases where parents deny their children varicella immunizations. In the United States, the routine childhood immunization has resulted to meaningful decline in the morbidity and mortality rates of a large number of vaccine preventable diseases. Majority of this accomplishment can be credited to the wide-scale support and trust of the public in the national immunization program for the past 50 years. However, current trends propose that this basis of public support is slowly fading with time. This is because parental concerns regarding the safety of vaccines have been heightened as a result of the expanding childhood immunization requirements as well as intensified media coverage of apparent relations between vaccinations and chronic diseases. Moreover, parents have also shown concerns that children are at diminished risks of infections and they disregard the seriousness of many vaccine-preventable diseases. The most commonly disregarded vaccine is that against the virus varicella-zoster as both parents as well as providers the disease caused by the virus as the least severe vaccine-preventable disease. However, prior to the licensure of varicella vaccination in the year 1995, there had been reported approximately 4 million instances of varicella that resulted in approximately more than 10 000 hospitalizations and 100 deaths annually in America. Since licensure of the varicella vaccine, varicella related morbidity, mortality, and hospitalizations have decreased by 80%.

Up to date, no study had ever been conducted to establish the association between the risk of varicella infection in children and parental vaccine denial. To better examine the association between the threat of varicella infection and vaccine denial, the authors of this article studied individual level data on vaccination as well as the status of disease in a children population registered in a health care plan that is managed for a period of 10 years. The research design employed was matched case-control examination with conditional logistic regression analysis. The authors matched each pediatric physician-diagnosed case to 4 controls that were randomly selected. These cases were matched according to sex, age, as well as length of enrolment. Results exhibited that there was a greatly increased threat of varicella infection in children of parents who refused the immunization against varicella.

The strength of this article is that despite being the first study of such kind to be conducted, it was successful in achieving its objective of quantifying both the individual level as well as related risks of the infection with varicella needing medical attention in children whose parents are against the immunizations of varicella. However, the limitation of this study is that up to date, no other such research had ever been conducted and there were no results from any other study to compare their hypothesis with. Nevertheless, the findings in this article are of great significance to a community health setting as the research concludes that children whose parents are against the immunization of varicella are at an increases risk of varicella infection in contrast to children who have been vaccinated. These are very helpful results to both health care practitioners as well as parents when making decisions on the immunization of children.

Miller, N., Verhoet, M., & Cardwell, K. (2008, March 18). Rural parents' perspectives about information on child immunization. The International Electronic Journal of Rural and Remote Health Research, Education Practice Policy, 8, 1-13.

According to the authors, health care providers have historically employed information developed for parents to promote child immunization. Despite emphasis by the literature on the significance of clear, thorough and unbiased findings on child immunization, still very minimal attention has been given to the meaning of this from a parent’s point of view. With this study, the authors aimed to comprehend parents’ information requirements in regards to child immunization, in an effort to enhance and optimize the information shared by rural health professionals. In an attempt to achieve their objective, the authors examined whether any information on immunization contributed the decisions made by parents. They also explored the kind of information and content parents needed, as well as the sources of information that were considered trustworthy and helpful by the parents. In addition, the authors also explored the suggestions of parents on how information could be more effectively conveyed to them.

The authors employed a descriptive qualitative study research method, by using semi structured interviews with mothers of legal-age responsible for making decisions about immunizing their children in the past year to collect data. Public health nurses working within the area assisted with the recruitment of participants and thirty nine mothers expressed their interest of taking part in the study. The principal investigator conducted the interviews as data was collected and analysed simultaneously, and this went on until saturation was reached. Out of the eleven interviews that were conducted, five of the mothers made the decision to fully immunize their child, while the other mothers varies between waiting to immunize the child at an older age, selectively choosing vaccines, being undecided about immunizing, and not immunizing at all. The major themes that were identified from the results were factors influencing the decisions of mothers, worries of mothers in making their decisions, their views about good information, their information needs, and their recommendations to health care providers who convey immunization information to parents.

One of the strengths of this article is that its study is a descriptive qualitative study that explores on the importance of parental perspective about the information of child immunization, as this has become a significantly relative topic with the increase in cases of children with diseases that can be immunized against. However, the research also had some limitations since only mothers responded to the participation requests. In addition, the geographical area of the study was limited to the rural area where those public health nurses practiced. Nevertheless, the findings in this article are significant to a community health setting as the authors explore the significance of the perspectives of rural parents about information on child immunization, since this information is very crucial in the decisions parents make on whether or not to immunize their children.

Synthesis

The common and most important theme across all these three articles is the importance of immunization in children, as well as the factors that hinder the successful immunization of children. Parents are the parties responsible to ensure that their children are vaccinated against different forms of diseases that they can be immunized against. However, according to Glanz el al (2010), the foundation of public support is slowly eroding with time since parental concerns regarding the safety of vaccines have been heightened as a result of the expanding childhood immunization requirements as well as intensified media coverage of alleged relations between vaccinations and chronic diseases. In addition, parents seem to have become choosy on which diseases to immunize their children against and which ones not to. This is because parents have themselves have made uninformed decisions and categorised which diseases they perceive to be dangerous to their children and which ones pose less danger.

This links to the information conveyed in Miller, Verhoet and Cardwell (2008) in their article as they explore the perspective of rural parents about the information on child immunization. In order to make an informed decision of child immunization, it is important to have the significant information to supply you with the necessary knowledge to reach the informed decision. Parents from the urban regions are more informed in health matters in contrast to those living in rural areas and it is, therefore, very important for those living in rural areas to find information that is helpful and trustworthy in order to make the correct decision of immunizing their children. Findings across the articles exhibit that children whose parents refuse them to receive immunizations against diseases are increases risks of getting infections compared to children that have been vaccinated. In addition these findings are all aimed at assisting health care providers as well as parents when making decisions about the immunization of children.

According to Lee and Robison (2016), immunization against diseases is a crucial intervention for the prevention of diseases that are infectious. These authors examine the extent to which immunization mandates have assisted in increasing the number of children being immunized. This is based on the fact that the immunization mandates are being used in the United States while many countries do not use these mandates. In general, the enhanced enforcement of school entry immunization has enhanced the uptake of vaccines in the group to whom the mandate is applicable to, not only over time but in short-term as well. The overall limitation across these articles is that despite the improved enforcement of immunization mandates on school entry assisting in reducing the number of children whom their parents have refused them immunization, much research still has to be done on the impacts of mandates on the uptake of immunization in younger children to whom the mandate of school entry immunization does not yet apply.