an abstract of the dissertation of

272 Pages·2014·1.76 MB·English

AN ABSTRACT OF THE DISSERTATION OF

Sandra J. Bean for the degree of Doctor of Philosophy in Public Health presented on
May 21, 2014.

Title: Vaccine Beliefs of Complementary and Alternative Medical (CAM) Providers
in Oregon

Abstract approved:
______________________________________________________
Joseph A. Catania

Health care providers, including complementary and alternative medical (CAM)
practitioners, exert a significant influence on parental pediatric vaccination decisions.
Use of CAM therapies is increasing in Oregon. Concomitantly, there has been a
decade-long increase in parental vaccine refusal in Oregon, rising from 1 to 5 percent
from 2000–2009. For example, in some Oregon schools, 70% of children are
unvaccinated. I conducted hour-long interviews with 36 practitioners from five CAM
modalities (i.e., acupuncture, chiropractic, homeopathy, midwifery, and naturopathy)
to explore a range of associations between vaccination perceptions and vaccine
recommendations to others. Data collected from the semi-structured interviews were
sorted and analyzed by themes. Perceived susceptibility to and severity of either an
illness or a vaccine as well as perceptions of vaccine efficacy, benefits, and risks
influenced CAM provider vaccine recommendations to parents about vaccinating
their children. The contextual factors of immunology beliefs, personal experience,
reference group norms, and beliefs about industry and government were found to a
lesser extent to influence whether a CAM provider promoted or opposed pediatric
vaccination. The results of this research suggest possible interventions aimed at
improving scientific knowledge of vaccine science as well as addressing hesitancy to
vaccinate. These interventions could include communicating the relative risk of
vaccinations; providing training for mainstream medical providers in empathic
communication with patients and avoiding a directive, fact-laden model; and
developing a layered approach to vaccine education, with specific content aimed at
separate populations, including health care providers, journalists, policy makers,
parents, educators, and children.
©Copyright by Sandra J. Bean
May 21, 2014
All Rights Reserved
Vaccine Beliefs of
Complementary and Alternative (CAM) Providers in Oregon

by
Sandra J. Bean

A DISSERTATION

submitted to

Oregon State University

in partial fulfillment of
the requirements for the
degree of

Doctor of Philosophy

Presented May 21, 2014
Commencement June 2014
Doctor of Philosophy dissertation of Sandra J. Bean presented on May 21, 2014

APPROVED:

Major Professor, representing Public Health

Co-Director of the School of Social and Behavioral Health Sciences

Dean of the Graduate School

I understand that my dissertation will become part of the permanent collection of
Oregon State University libraries. My signature below authorizes release of my
dissertation to any reader upon request.

Sandra J. Bean, Author
ACKNOWLEDGEMENTS

Completion of this dissertation would have been impossible without the support of
several mentors.
I am sincerely grateful to Dr. Joseph A. Catania, whose guidance and
mentoring has been fundamental to my development as an independent researcher.
His patience and humor throughout my years of study and writing have kept me
focused. I also thank my other committee members—Drs. Dolcini, Donatelle,
Faridani, and Tilt. Dr. Tilt, in particular, has guided me as a qualitative researcher,
and my Graduate Council Representative, Dr. Faridani, whose outsider’s perspective
greatly strengthened this work, led me to examine my own assumptions and to delve
deeper into the literature. Thanks also go to Dr. Jorge Cham, author/creator of “PhD
Comics,” for boosting my immune system through laughter and showing me that I
was not alone.
I thank my warm and embracing Bahá’í faith community, whose friendship
and encouragement have sustained me since I moved to Corvallis to pursue this
degree, and whose continuing friendship has persuaded me to stay right here in
Benton County to continue my work to help improve pediatric vaccination rates in
Oregon.
And finally, none of this would have been remotely possible without the
loving support and encouragement of my husband, “hard science guy” Dr. Roger L.
Blaine, OSU alumnus in chemistry (1969), who persuaded me to apply to the public
health program at Oregon State University, one of the best decisions of my life.
TABLE OF CONTENTS

Page
Chapter 1: Introduction .................................................................................................. 1
Overview ................................................................................................................... 1
Outbreaks of Vaccine-Preventable Diseases (VPDs) ................................................ 2
The Role of Health Care Providers (HCPs) .............................................................. 3
Chapter 2: Literature Review .......................................................................................... 5
The Role of Vaccines ................................................................................................. 5
History and importance ........................................................................................ 5
Vaccine development ............................................................................................ 6
Vaccine-Preventable Diseases (VPDs) ...................................................................... 9
Importance of Herd Immunity ................................................................................ 10
Erosion of Herd Immunity ....................................................................................... 12
The Rise of Vaccine Opposition ............................................................................. 13
Vaccine resistance in Oregon .............................................................................. 15
Factors in vaccine opposition .............................................................................. 16
Complementary and Alternative Medicine (CAM) Providers ................................. 19
Summary of Findings from Previous Research ...................................................... 24
Research Approaches Compared ............................................................................ 25
Quantitative research ........................................................................................... 25
Qualitative research ............................................................................................ 26
Why study narratives? ......................................................................................... 28
Research Significance ............................................................................................. 29
Study Innovation ..................................................................................................... 30
CAM providers ................................................................................................... 31
Summary ............................................................................................................. 33
Research Aims ......................................................................................................... 34
Chapter 3: Methods ....................................................................................................... 37
Institutional Review Board ...................................................................................... 37
Sociodemographics .................................................................................................. 37
Recruitment .............................................................................................................. 37
TABLE OF CONTENTS (Continued)

Page

Interview Procedures ............................................................................................... 42
Data Collection and Analysis ................................................................................... 43
Data collection procedure .................................................................................... 43
Data preparation ................................................................................................. 43
Data analysis ....................................................................................................... 44
Transferability, Reliability, Validity, Confirmability .............................................. 47
Transferability ..................................................................................................... 47
Reliability ............................................................................................................ 47
Validity and confirmability ................................................................................ 47
Dissemination Plan ................................................................................................. 48
Future Research ........................................................................................................ 48
Chapter 4: Results ......................................................................................................... 51
Overview ................................................................................................................. 51
Complementary and Alternative Medicine (CAM) Defined ................................... 52
Population Demographics ........................................................................................ 52
Naturopathy .............................................................................................................. 53
Influence on vaccine choice ................................................................................ 54
Naturopathic study participants .......................................................................... 55
Naturopathic vaccine beliefs .............................................................................. 55
Perceived vaccine risks, benefits, and efficacy ................................................... 58
Choosing naturopathy ......................................................................................... 64
Naturopathic training ........................................................................................... 67
Contextual themes ............................................................................................... 69
Acupuncture ............................................................................................................. 75
Acupuncture study participants .......................................................................... 76
Acunpuncturists’ vaccine beliefs ....................................................................... 76
Perceived vaccine risks, benefits, and efficacy ................................................... 77
Choosing acupuncture ......................................................................................... 83
Acupuncture training ........................................................................................... 84
Contextual themes .............................................................................................. 85
Chiropractic .............................................................................................................. 92
Chiropractic vaccine opposition .......................................................................... 93
Chiropractic study participants ........................................................................... 93
Chiropractic vaccine beliefs ............................................................................... 93
Perceived vaccine risks, benefits, and efficacy ................................................... 96
TABLE OF CONTENTS (Continued)

Page

Choosing chiropractic ....................................................................................... 100
Chiropractic training ......................................................................................... 101
Contextual themes ............................................................................................ 103
Homeopathy ........................................................................................................... 110
Homeopathy and vaccines ................................................................................ 111
Homeopathic study participants ....................................................................... 112
Homepathic vaccine beliefs ............................................................................. 112
Perceived vaccine risks, benefits, and efficacy ................................................. 115
Choosing homeopathy ...................................................................................... 119
Homeopathic training ........................................................................................ 122
Contextual themes ............................................................................................ 124
Midwifery ............................................................................................................... 130
Midwifery study participants ........................................................................... 132
Midwife vaccine beliefs ................................................................................... 132
Perceived vaccine risks, benefits, and efficacy ................................................. 135
Choosing midwifery ......................................................................................... 140
Midwifery training ............................................................................................ 141
Contextual themes ............................................................................................ 142

Summary ................................................................................................................ 146
Summary tables .................................................................................................. 146
Differences between vaccine positional groups ............................................... 152
Chapter 5: Discussion and Conclusion ...................................................................... 153
Significance ............................................................................................................ 153
Professional Choice ................................................................................................ 154
Vaccine beliefs followed professional education ............................................. 155
CAM continuing education reinforces vaccine hesitancy ................................. 155
Health Belief Model .............................................................................................. 156
Health Belief Model: Vaccine recommendations ............................................. 158
Vaccine benefit, efficacy and risk perceptions ................................................. 159
Vaccine risk and safety—Heuristics ................................................................. 164
Vaccine testing .................................................................................................. 166
Mercury ............................................................................................................. 167
Summary ........................................................................................................... 168
Contextual Themes................................................................................................. 168
TABLE OF CONTENTS (Continued)

Page

Immunology beliefs ........................................................................................... 168
Personal experience ............................................................................................... 171
Reference group norms ..................................................................................... 173
Perceptions of government and industry ........................................................... 173
Intervention Strategies .......................................................................................... 175
Work for policy change ..................................................................................... 175
Develop emotional narratives about VPDs ...................................................... 176
Create and publicize vaccine courses for all Oregon public health educational
programs ............................................................................................................ 177
Interventions aimed at the public ...................................................................... 177
Develop a multi-faceted approach to vaccine education ................................... 180
Implications for Further Research ......................................................................... 181
Study Limitations .................................................................................................. 182
Conclusions ............................................................................................................ 183
Evaluative frameworks ..................................................................................... 183
False equivalence .............................................................................................. 184
Personal Remarks ................................................................................................... 185
BIBLIOGRAPHY ...................................................................................................... 187
APPENDICES ............................................................................................................ 218