WHAT MOTHERS SAY ABOUT WHY POOR CHILDREN FALL BEHIND ON IMMUNIZATIONS- A SUMMARY OF FOCUS GROUPS IN NORTH-CAROLINA

Objectives: To develop a more thorough understanding of the factors th at impede poor parents' utilization of health care services for their children and to refine interventions to improve immunization rates. Me thods: We conducted focus group sessions with mothers whose children r eceived care at the health departments in five North Carolina counties . Mothers were uninsured or were receiving Medicaid. A total of 50 wom en participated; group size varied from three to seven mothers. Result s: Socially disadvantaged mothers faced barriers at multiple points in the process of obtaining preventive care for their children. Organiza tional barriers, such as a lack of flexibility in scheduling and long waiting times, were exacerbated by personal barriers, such as a lack o f reliable transportation, chaotic home environments, and employment c onflicts. Lack of knowledge regarding the timing of childhood immuniza tions and misperceptions about the safety of immunizations were also i mportant obstacles. Mothers made several suggestions, such as changes in scheduling, greater assistance with transportation, improved waitin g facilities, and increased health education. Conclusions: Our study s uggests that even with improved financing of well-child care, many imp ortant barriers to adequate immunization will remain. Many of the chan ges that mothers in our focus groups advocated are not related to insu rance coverage and would be simple and inexpensive to implement. To he lp with these changes, we developed a checklist for use by health depa rtments to determine which organizational barriers exist at their faci lity and suggest strategies to overcome the problems. Organizational, personal, and attitudinal barriers pose serious problems for socioecon omically disadvantaged families. To improve vaccination rates for chil dren, new personnel and programs are probably less important than care ful strategies to maximize exisiting resources.