A Service Evaluation of the Middlesbrough Primary Care Trust Hepatitis B Universal Vaccination Programme

Summary

In October 2007 Middlesbrough Primary Care Trust (PCT) commenced a pilot universal vaccination programme of secondary school children to protect against Hepatitis B (HepB). This was a local initiative in response to rising rates of HepB infection despite the current selective immunisation policy in the UK. Local surveillance of HepB infection among drug users in Middlesbrough has shown that HepB infection rates increased from 3% in 2000 to 18% in 2002. Thus, achieving high coverage rates for HepB vaccine using a selective approach has proven difficult.

Aims
This service evaluation aimed to assess the attitudes towards and experiences of the vaccination programme of young people in the year 7 (Y7) age group, parents of young people in the Y7 age group, school staff who were involved in the co-ordination of the vaccination programme, and the school immunisations team.

Methods
This service evaluation utilised both quantitative and qualitative methods of data collection to best address the aims of the project. Data was collected in three phases.

Phase one involved sending a postal questionnaire to a stratified random sample of parents of Y7 pupils across the Middlesbrough area. Phase two incorporated the use of focus groups to elicit the views and experiences of young people, parents and school staff around their involvement in the vaccination programme. Phase three involved interviewing the immunisations team about their experiences of piloting this new programme.

Findings
The ‘headline’ findings from each phase of the evaluation are listed below:
Questionnaire
• The majority of parents who responded to the questionnaire had consented for their child to be vaccinated (94%). Reasons for non-consent were usually because a child had previously been vaccinated. Only one parent did not consent as they were unhappy with their child being offered this particular vaccination.
• Most parents were happy to accept the HepB vaccination as an effective way to protect their child’s health. The majority of parents were happy with the information they had received prior to vaccination and this information also acted, in some cases, as a catalyst to find out more about HepB in general.

Young people’s views
• Young people did not, in the majority of cases, remember receiving any information about the vaccination programme and had very little knowledge about the infection and why they were receiving the vaccination.
• Young people were not concerned about knowing the reasoning behind receiving the vaccination, they were more concerned with the practicalities of receiving an injection (the pain and fear of needles),
• Young people felt quite strongly that it was their parents who should make the decision as to whether a child should be vaccinated. However some young people did note this differed across the teenage years – the older they become, the more decisions they can make for themselves.

Parent’s views
• Like the young people, parents’ knowledge about HepB was very low. This caused concern with some parents about the safety of the vaccine and raised questions about why it was given in three doses. However, despite these questions and concerns parents still felt it was important for their child to be vaccinated and trusted that if the vaccination was being offered by their health authority then it must be needed.
• Many of the parents interviewed did not remember reading the information sent prior to vaccination. Those who had read it felt that the information they were given was adequate for their needs.
• Parent’s reflected the views of the young people around consent for vaccination. They felt that at this stage of their child’s life, it was up to them to make health based decisions.

Teaching staff views
• Overall teaching staff were happy with the vaccination programme being held in school. They did however, experience disruption to their classes with children being rowdy and/ or ‘ill’ when they returned from receiving the injections.
• Teaching staff were not confident in their own knowledge about HepB and felt ill equipped to deal with any questions from either parents young people. Teachers would have liked some time dedicated to learning about HepB in tutor time so that any questions from young people could be answered.
• Teachers reiterated the difficulties in getting written parental consent for any activities in school - not just for vaccinations.

Nursing staff’s views
• Nursing staff felt they had received good training and support in order to deliver the vaccination programme. They also felt supported by the schools in terms of resources available to them.
• Most of the nursing staff interviewed would have liked the opportunity to go and deliver a session to the young people about HepB as there was doubt in their minds as to how widely used the information packs they had given out were.

Discussion
Overall the pilot HepB vaccination programme was well received by young people, parents, teachers and nursing staff. After spending time with young people, parents and teachers it was clear that knowledge of HepB was relatively low both before and after the immunisation programme. Young people in our discussion groups were not generally concerned with what the vaccination was protecting them against, they were more wrapped up in the practicalities of having the injection. However, parents in our study were more concerned with knowing ‘the basics’ about the infection and suggested that any information they received should be kept at a basic level as too much depth and too many statistics would just generate doubt in their minds.
The majority of parents interviewed were happy to put their trust in the local health authority knowing what was safe and appropriate for their child. Similarly, teachers did not receive many queries about the immunisation programme, other than at one school which was situated in an area of high deprivation. It was suggested by teachers that these queries were not due to genuine concern over the vaccine and possible safety issues, but more to do with parents’ literacy levels and difficulties reading and understand the information with which they were provided. Generally, parents were pleased that there was a vaccine to protect their child against HepB. This far outweighed any doubts they had about vaccine safety.

Teachers did not feel confident in their own knowledge when answering the questions brought to them by young people, despite schools being sent a pack of information from the PCT before the programme began and therefore felt that a session with the young people would have been beneficial if it had been delivered by someone from outside the school.