This article had some problems even in the title itself. The title of the article implies that it will be a review of what affects a parent’s decision making when bringing their children into a clinic to receive a vaccine. In reality, the study addressed how nurses relay information to parents and how that information is received. It does not provide an exhaustive review of other aspects that may affect a parent’s feelings toward vaccinating their child (Austvoll-Dahlgren & Helseth, 2010). While a title is meant to provide an overview of what the article will address, an abstract is a second chance to explain to the reader what will follow.
In this article the abstract was less misleading than the title, however there were still some problems in the way the abstract was completed. The wording of the aim was a little unclear. At first it seemed as though the paper was a literature review and not a study in its own right. Similarly in the findings section of the abstract, “being positive towards vaccination and being decided” was a confusing statement (Austvoll-Dahlgren & Helseth, 2010).
It was unclear whether or not this statement related to the parents, or the public health nurses. Were the nurses presenting positive information or is the term positive in reference to how the parents felt about vaccinations? In addition, the abstract boasts that nurses are the parent’s best informants in making decisions about vaccinating their child. The study did not provide an exhaustive look at other sources of information such as the internet, family and friends and even religious practices, all things that may affect their decision to vaccinate their child. As such, the conclusion that nurses are the best source of information is somewhat oversimplified.
Similarly, while the introduction did address the questions inherent to shared decision making, it was a limited review. There was little to no discussion of what factors might limit a parent in their ability to make decisions about a vaccine. There was also no in depth discussion about what knowledge base a typical parent comes to the clinic with in regards to vaccinations (Austvoll-Dahlgren & Helseth, 2010). There was also little discussion about how society impacts parental views of vaccination. This is a particularly salient point as there have been many instances where the media or other social factors has influenced how society in general views vaccinations. An example of this problem is the misunderstood fear that certain vaccinations, when received in childhood, may cause Autism. While the article says that the media is a source of information for parents, it does not give sufficient weight to just how influential the media can be in parental decisions. Similarly, while a quantitative research approach seems fitting for the question at hand, the introduction did not explicitly state why this approach was used. While this is addressed later in the design section, even this later explanation is lacking (Polit & Beck, 2014). What the introduction did well was set the scene for how the study will relate to the nursing field. It also provided appropriate background into the theme of patient empowerment and how best to avoid giving information in a parental driven manner, i.e. always assuming the clinician knows best (Austvoll-Dahlgren & Helseth, 2010).
The hypothesis was not so much explicitly stated as it was hinted at. Researchers never noted what they thought the paper’s finding would be. The implication is that patient centered informational counseling would lead to the best outcomes and the most parents leaving with a positive view of vaccinations. Authors did not state this was the study’s hypothesis, however they did utilize some research to back up their initial thought process. The citations from the World Health Organization in particular did support that patients themselves are essential to the healthcare process (Austvoll-Dahlgren & Helseth, 2010). This is in support of the hypothesis that at best existed in between the lines.
The literature review included in the methodology sections of the article was probably the highlight of the paper. It was detailed and unlike the abstract provided reasoning behind why this qualitative study approach was used. The decision to use an interview process in data collection was well supported with several research articles. It may have been to the authors’ benefit to include more current articles as the ones used in this section were more than five years old at the time of the paper’s publication (Austvoll-Dahlgren & Helseth, 2010). It is often best to consider the newest possible articles in support of a studies’ methodology. Only in including the newest information can an author be sure that they are approaching the study in the most effective way (Polit & Beck, 2014).
In the best research, the literature review should provide support for the conceptual framework of the study design. This was done to some extent in the article. Based on support from the literature review, one would likely not argue that the study should have been completed in a different paradigm. However, it seemed that the study drew some conclusions such as a relationship between parent educational status and feelings about vaccinations that were not born from the study itself (Polit & Beck, 2014). While the findings section was largely devoted to what was said in the interviews, the discussion section spoke mostly about other research. While it is common in research articles to bring other works into the discussion section to flesh out the theory behind the current study, the authors may have benefitted in their argument overall by relating the discussion more overtly to the data that was gathered at the time of the study.
Overall, the study raises an important question. The question is one that certainly involves the field of nursing. However, the methods and descriptions in the study could use some more careful review. The authors only found one limitation in their own study, i.e. that the findings may not generalize to cultures outside of Norway. Every study has strengths and limitations (Polit & Beck, 2014). Any study in which the authors cannot openly admit to limitations in their own study design should be approached with caution.
- Austvoll-Dahlgren, Astrid & Helseth, Solvi. (2010). “What informs parents’ decision-making about childhood vaccinations?” Journal of Advanced Nursing 66(11), 2421-30.
- Polit,D.F., & Beck, C.T. (2014). Essentials of nursing research: Appraising evidence for nursing practice (8th ed.). Philadelphia, PA: Wolters Kluwer. Lippincott Williams & Wilkins.