What information makes vaccine hesitant parents become vaccine acceptors?

Methods

Summary

To recruit parents to the study we plan to use the crowd-sourcing forum, mTurk, to identify parents of young children who recently changed their minds about vaccines.  We have recently completed another vaccine-related study using this method and have found it to be very convenient, efficient, and effective.  mTurk works by placing "advertisement" that go out to their pool of thousands of "workers" who sign up for "projects" based on the specified inclusion criteria.  mTurk also has mechanisms in place to ensure you are finding only high quality workers by allowing those posting project access to their rating system where other projects rate the workers abilities and timelines.  We have experimented with the various mTurk filters and how these impact the types of participants for our studies.  From this experience we have found that by limiting the invitation to workers with >1000 mTurk worker hours logged the pool of participants is more reliable and genuinely interested in completing study's truthfully.  This latter we are aware of because our participants email us to ask us clarifying  questions about our study procedures to ensure they are doing it as specified!  We will use mTurk to recruit 30 parents who will be recruited to 3 virtual focus groups.  

We have conducted numerous qualitative studies using focus groups related to parents' vaccination decisions and are very well versed in the methods needed to obtain high quality results.  For this project the study procedures will occur as follows:

1.  Potential participants identified via mTurk will be sent to an online eligibility survey.  Those who complete the usability survey will receive $0.10 applied to the mTurk account for completion (this is a high level compensation for eligibility surveys in mTurk).

2.  Those that meet eligibility criteria (i.e. parent of a child under the age of 2, were initially vaccine hesitant but now are not [based on validated screening questions], able to converse in English, and willing to participate in a virtual focus group, willing to send us their email information for further contact) will be sent an email with further study procedures including a consent form, an invitation to 1 of 3 scheduled focus groups, and instructions on how to access the focus groups. This pool of invited participants will be limited to 240 people as we anticipate that the conversion between eligibility and signing up for a study time will be ~`12%.  The first 30 people who sign the consent and sign up for one of the scheduled focus groups will be participants in the study.

3.  The focus groups will convene at the appointed times on-line using the University of Colorado's virtual meeting software.  This software allows multiple users to convene simultaneously with video and/or voice connection to facilitate discussions.   

4.  Focus groups will be moderated by a study team member, all of whom have extensive experience in conducting focus groups.

5.  Sessions will be captured with audio/videotapes for later analysis.  We anticipate that sessions will last about 60 minutes.   Users will receive a $50 Amazon gift card for their participation.

6.  Each session will be conducted using a written focus group guide that will be developed based on the study teams' expertise in immunization delivery.  The focus group guide will consist of open-ended questions and prompts to facilitate a focused discussion.  Prior to the study beginning, we will edit the focus group guide based on feedback from two immunization delivery researchers and 2 parents of young children to ensure that we have captured all relevant questions and prompts.  

Challenges

Challenges include:

1.  We cannot verify participants are being truthful as they sign up for the focus groups.  It is possible that some participants may lie to be involved in the study.  However, our expectation is that because the study consists of a conversation between multiple people, this will dissuade many people who might "fake it" from participating as they would likely be "found out" through the course of the focus group to be lying about their eligibility.  Also assuaging this concern somewhat is our experience from other studies where participants have emailed us expressing what seems to be genuine interest in completing the study according to our specifications - for example, clarifying if they are actually eligible for the study by emailing the study coordinator.

2.  Low recruitment is always a concern for research studies.  However, the pool of workers at mTurk is vast and our sample size is very small (only 30 participants), which makes it likely we will reach our goal recruitment.  Moreover, in our past experience our studies fill within 48 hours of posting. Thus we would know shortly after launch if we need to change our recruitment procedures.   If it appears the recruitment is difficult we would consider increasing the stipend for participation, changing the times of the focus groups to be at more convenient times for participants, increasing the number of participants who receive the invitation to complete the study to more than 240, or potentially switching from a focus group format to an individual interview format using the same focus group guide. 

Pre Analysis Plan

Tapes will be transcribed verbatim using a professional transcription service.  Two members of the research team will then review focus group notes and transcribed audiotapes in order to develop working themes and hypotheses to be tested and revised in subsequent interviews. In addition, interview transcripts will be entered in to Atlas Ti qualitative data analysis software (Scientific Software Development, 1999), and data will be analyzed using grounded theory and the “editing” approach suggested by Crabtree and colleague.  This particular analytic method encourages interpretation of the data using a team approach. Two investigators will independently read through the interview transcripts, highlighting particular issues or examples that appear to significantly impact the perceived desirability and feasibility of the physician communication intervention components. The investigators will then meet to discuss interpretations of the data, and transcripts will be re-reviewed to confirm or disconfirm initial and ongoing themes and codes. These themes will then be organized into an overall framework to describe the desirability, feasibility, perceived effectiveness, and potential for sustainability of various strategies to implement the provider communication intervention.