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Pediatrics. 2019 Nov;144(5). pii: e20190802. doi: 10.1542/peds.2019-0802. Epub 2019 Oct 9.

Previsit Screening for Parental Vaccine Hesitancy: A Cluster Randomized Trial.

Author information

Seattle Children's Research Institute, Seattle, Washington;
Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington; and.
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
Seattle Children's Research Institute, Seattle, Washington.



To evaluate the effect of vaccine hesitancy screening on childhood vaccine uptake.


We conducted a cluster randomized controlled trial in pediatric primary care clinics in Washington state. Vaccine-hesitant parents (VHPs) with a healthy newborn receiving health supervision at participating clinics were eligible. VHPs were identified by using a 4-item version of the validated Parent Attitudes About Childhood Vaccines Survey (PACV). Before their child's 2- and 6-month health supervision visits, VHPs at intervention clinics completed the 15-item PACV embedded in a survey containing placebo items. Intervention providers received a summary of parents' 15-item PACV responses and interpretation of their PACV score; discretion was given to providers regarding how they acted on this information. VHPs at control clinics completed only the placebo survey items, and their child's provider received a summary of their responses; control providers remained blinded to parent VHP status. Our outcome was child immunization status at 8 months of age expressed as percent of days underimmunized. We compared outcomes in control and intervention participants using t test and linear mixed-effects regression.


We enrolled 24 clinics (12 in each arm) and 156 parents (65 in the intervention arm). Parent characteristics were similar across arms except more intervention (versus control) parents had a first-born child (60.9% vs 44%; P = .04). No significant difference in outcome was detected between arms (25.2% [95% confidence interval: 16.0% to 34.5%] vs 19.1% [95% confidence interval: 12.0% to 26.3%] mean days underimmunized in the intervention and control arms, respectively).


Vaccine hesitancy screening was not significantly associated with days underimmunized.


Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Opel developed and validated the Parent Attitudes About Childhood Vaccines Survey (PACV), the instrument that comprised the intervention in the study. The PACV is copyrighted through the University of Washington, and Dr Opel does not receive royalties from the use of the PACV; the other authors indicated they have no potential conflicts of interest to disclose.

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