C. Lannon et al., WHAT MOTHERS SAY ABOUT WHY POOR CHILDREN FALL BEHIND ON IMMUNIZATIONS- A SUMMARY OF FOCUS GROUPS IN NORTH-CAROLINA, Archives of pediatrics & adolescent medicine, 149(10), 1995, pp. 1070-1075
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.