Date Published: July 26, 2017
Publisher: Public Library of Science
Author(s): Bing Wang, Gang Chen, Julie Ratcliffe, Hossein Haji Ali Afzali, Lynne Giles, Helen Marshall, Caroline L Trotter.
The importance of adolescent engagement in health decisions and public health programs such as immunisation is becoming increasingly recognised. Understanding adolescent preferences and further identifying barriers and facilitators for immunisation acceptance is critical to the success of adolescent immunisation programs. This study applied a discrete choice experiment (DCE) to assess vaccination preferences in adolescents.
This study was conducted as a cross-sectional, national online survey in Australian adolescents. The DCE survey evaluated adolescent vaccination preferences. Six attributes were assessed including disease severity, target for protection, price, location of vaccination provision, potential side effects and vaccine delivery method. A mixed logit model was used to analyse DCE data.
This survey was conducted between December 2014 and January 2015. Of 800 adolescents aged 15 to 19 years, stronger preferences were observed overall for: vaccination in the case of a life threatening illness (p<0.001), lower price vaccinations (p<0.001), mild but common side effects (p = 0.004), delivery via a skin patch (p<0.001) and being administered by a family practitioner (p<0.001). Participants suggested that they and their families would be willing to pay AU$394.28 (95%CI: AU$348.40 to AU$446.92) more for a vaccine targeting a life threatening illness than a mild-moderate illness, AU$37.94 (95%CI: AU$19.22 to AU$57.39) more for being vaccinated at a family practitioner clinic than a council immunisation clinic, AU$23.01 (95%CI: AU$7.12 to AU$39.24) more for common but mild and resolving side effects compared to rare but serious side effects, and AU$51.80 (95%CI: AU$30.42 to AU$73.70) more for delivery via a skin patch than injection. Consideration of adolescent preferences may result in improved acceptance of, engagement in and uptake of immunisation programs targeted for this age group.
Adolescence is a time in life that often features risk taking behaviours, however it also provides the greatest opportunity for sustained wellbeing into adulthood. Although adolescents are often treated as younger adults, their views and values are typically overlooked when public health strategies that affect them are being designed.
A total of 800 adolescents (age range 15–19 years) were enrolled and completed the survey between December 2014 and January 2015 (S1 Dataset). Females were slightly predominant (54.9%) in the study population. Of the participants, 90.0% were born in Australia, with approximately 97.8% non-indigenous (Table 2). Enrolment was initially planned to be stratified by state and gender. Due to difficulties in recruiting adolescent participants in smaller states or territories such as the Northern Territory (NT) and Australian Capital Territory (ACT), enrolment did not strictly adhere to the original regional quotas. Except for NT and ACT, participants were reasonably representative of the adolescent population of each state.
This DCE has identified preferences of Australian adolescents for immunisations providing protection against a life threatening illness, causing common but mild and resolving side effects, being administered by a medical practitioner and delivered via a skin patch at a lower price. To our knowledge this is the first study to investigate adolescent preferences for immunisation delivery using a DCE design. Because comparable data are lacking, we have reviewed literature for DCE studies associated with a specific vaccine in both parental and adolescent populations.