Vaccine decision-making among parents of children on Medicaid with and without autism spectrum disorder

Background: The belief that there is a link between the MMR vaccine and autism has led to a decline in childhood-immunization uptake and a resurgence of preventable infectious diseases. This study aimed to understand how the vaccine decision-making process differed between parents with a child diagnosed with autism and parents with a child that did not have autism. Methods: Interviews were conducted in September–December 2018 with 24 racially and demographically diverse parents of children on Medicaid at two Baltimore clinics serving Medicaid patients, one of which only serves families of children with autism. We conducted a semi-structured, qualitative, in-person in-depth interview study to explore parental perceptions of vaccine-decision making. Interviews with participants were transcribed from audio recordings. We then extracted and analyzed the types of barriers each participant experienced. Results: Parent descriptions of their vaccine decision-making process focused on three primary factors: concerns about vaccines, the relationship between the child's provider and the parent, and risk perception. These findings are in line with existing literature that has articulated key factors in the vaccine decision-making process generally. Parents of a child with autism were more likely to consider the idea that vaccines were linked to autism in their decision-making process, and were less likely to be influenced by personalized recommendations from the child's health care provider. Conclusion: Parental concerns about vaccines, the parent-provider relationship, and vaccine risk perception all contribute to vaccine decision-making among parents of children with and without ASD. However, providers may find it especially difficult to manage parental misconceptions about vaccines and developmental disabilities. Future studies can identify alternative communication techniques and determine what mechanisms may be more effective in encouraging vaccine acceptance among parents of children with ASD.