John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. Most Cochrane Reviews examine quantitative evidence on the effects of health or social care, but some review qualitative research to try to get a better understanding of and why and how interventions do or don’t work. In a new review from February 2017, Heather Ames, from the Norwegian Knowledge Centre for the Health Services at the Norwegian Institute of Public Health in Oslo, and colleagues have done this to explore how parents experience communication about vaccination for children. She tells us what they found in this podcast.

Heather: Qualitative research investigates how people perceive and experience the world around them. Our review of qualitative studies explores how parents experience communication about vaccination for children under six years of age. It supplements existing Cochrane Reviews on the effect of communication strategies on parents’ knowledge, attitudes and behaviour about childhood vaccination.
Childhood vaccination is an effective way of preventing serious childhood illnesses, but many children still do not receive all of their recommended immunisations, for a variety of reasons. Some parents do not have access to the vaccine, perhaps because of low quality health services, distance to a health facility or poverty. Others do not trust the vaccine itself or the healthcare worker who provides it, and still more parents do not see the need to vaccinate their children at all.
To address some of these issues, governments and health agencies often try to communicate with parents about childhood vaccinations, usually at healthcare facilities, at home or in the community. Communication can be two-way and interactive, for instance face-to-face discussions between parents and healthcare providers or it might be direct or one-way such as through text messaging, posters, leaflets, or radio and television programmes. Some types of communication allow parents to actively discuss the vaccine, its risks and benefits, and the disease it aims to prevent. While other types simply give information about these issues or about when and where vaccines are available.
Our review aims to help people involved in vaccine programmes to understand how parents experience different types of communication about vaccination and how this influences their decision to vaccinate their child. We included 38 studies in this qualitative review. Most of the studies were from high-income countries and explored mothers’ perceptions of vaccine communication. 
In general, parents wanted more information than they were receiving and for some parents, a lack of information led to worry and regret about their vaccination decision. Parents wanted balanced information about the potential risks and benefits of vaccination, presented in a clear and simple manner and tailored to their situation. Parents also wanted vaccination information to be available outside of the health services, and to be provided in good time before each vaccination appointment.
Parents generally found it difficult to know which vaccination information source to trust and found it difficult to find information that they felt was unbiased and balanced. Health workers were regarded as an important source of information and parents had specific expectations of their interactions with them. Poor communication and negative relationships with health workers sometimes impacted on vaccination decisions. The amount of information parents wanted and the sources they felt they could trust seem to be linked to their acceptance of vaccination, with parents who were more hesitant wanting more information.
As a take home message, we are quite confident in the evidence we found that parents want clear, timely and balanced information about vaccination for their child, but that they often find this information to be lacking. And, we can say with low to moderate confidence that the amount of information parents want and the sources they trust appear to be linked to their acceptance of vaccination.

John: If you would like to delve deeper into the findings of this qualitative evidence synthesis and the findings of the included studies, you can find the full review free to view online at Cochrane Library dot com. Just go to the website and search ‘qualitative synthesis and vaccination’.