The effect of solution focused brief on overcome vaccine hesitancy: A randomized controlled study

doi:10.21203/rs.3.rs-2565619/v1

This study was carried out to determine the effect of solution-focused approach on the elimination of vaccine hesitancy. The research was applied as a quasi-experimental model with pretest-posttest control group. The population of the study included 148 couples (female-male) who did not want to vaccinate their 0-24-month-old babies in Bingöl city, Turkey. Individuals were randomly selected using a simple random sampling method and probability sampling method. The numbers of people who completed the study in the experimental and control groups were 43 and 23, respectively. Four sessions of psychological counseling with a solution-focused brief were applied to each group. The attitude of the parents in the experimental group towards the vaccine changed positively. The confidence in the vaccination of babies between 0-24 months was determine to increase. Although there was no change in the behavior sub-dimension, official records were examined in 1 month after the completion of the study. Six families in the experimental group were determined to vaccinate their children. Solution-focused brief therapy was found to change positively parents’ attitudes and behaviors towards vaccination and to increase healtly lifestyle behaviors.

nursing

Solution focused brief

vaccine

vaccine hesitancy

Infectious diseases cause permanent sequelae or death. Vaccination programs prevent the spread of infectious diseases. Vaccination is the most effective method in protecting public health and combating infectious diseases due to its low cost and reliability (Arısoy, Çiftçi, Hacımusstafaoğlu, Kara, & Somer, 2015). If the vaccination rate decreases in a society, there will be an increase in the number of disease agents and patients. Unvaccinated individuals cause an increase in the spread of the causative agent of the disease (Dubé, Vivion, & MacDonald, 2015; Fine, Eames, & Heymann, 2011). Therefore, unvaccinated individuals are accepted as threat for public health. According to the 2019 data of the Turkish Ministry of Health, polio eradication was achieved in 2002 and neonatal tetanus eradication was in 2009. The vaccination rate in Turkey has exceeded 95% in recent years. However, "vaccine indecision-vaccine hesitancy" emerging worldwide has led to decreases in vaccination rates. In addition, the insufficient vaccination of immigrants (Syria, Iraq, Afghanistan) coming to Turkey, and parents' lack of knowledge about vaccination (Yüksel, & Topuzoğlu, 2019) has led to an increase in infectious diseases. The public health nurses who provide preventive health services, is of great importance at this point. They are leaders in the society's gaining a healthy lifestyle and behavior change. Respect for the individual in the nursing philosophy, using the individual's current potential and resources, and being independent are compatible with the Solution Brief Therapy (SFBT) (Wand, 2010).

SFBT is an evidence-based psychotherapeutic and family therapy approach (de Shazer et al., 1986). SFBT focuses on the future instead of focusing on past and present problems. It enables the individual to recall past experiences and successes. It reminds and encourages how the individual has dealt with these problems before. This model enables the individual to find solutions to their problems with their own strength and to increases their self-confidence (Cooper, O'Hara, Schmid, & Bohart, 2013). SFBT is a multi-faceted counseling approach that can be applied to a wide variety of problems such as sexual abuse, school problems, marital problems, mental health, consultation and supervision. It is a method that can provide behavioral change in an individual. In addition, it can also be used in areas such as substance use, anxiety disorders, compulsive disorders, personality disorders, eating disorders, self-harming behavior, suicide, violence, abuse and sexual abuse (Karakaya & Özgür, 2019). The methods used to persuade parents who do not want their children to be vaccinated are insufficient. According to the best of our knowledge, there is no study about the use of SFBT for this purpose. It is hypothesized that SFBT may decrease the cases of vaccine refusal when is applied to parents who do not want to vaccinate their 0-24 month-old children. This study aims to reduce vaccine refusal by applying SFBT to parents who refuse to vaccinate their 0-24 month old babies in the short term, and to prevent infectious diseases and to prevent permanent sequelae and deaths caused by these diseases in the long term.

Research Hypotheses

SFBT initiatives applied to the parents in the experimental group:

H_0, It reduces the negative attitude towards vaccine hesitancy.

H₁, It reduces mistrust against vaccines.

H₂, It reduces vaccine hesitancy behavior.

H₃, It reduces vaccine hesitancy.

SFBT and Public Health Nursing in Vaccine Rejection

Vaccination provides both individual and community immunity. In order for person to become ill, they must come into contact with the disease agent. Vaccination programs minimize the spread of the disease agent in the community. If the number of unvaccinated individuals increases, the risk of contracting the disease will also increase. This situation causes the spread of infectious diseases, and the emergence of permanent sequelae and deaths (Dubé et al., 2015). The infant mortality rate increases if vaccination rates decrease. Infant mortality rate is one of the most important indicators of a country's development (Özbaş et al., 2012). Every individual has the power to acquire health behaviors that can protect and maintain his own health. Nurses should help reveal this power that exists in the individual. Nurses have responsibilities in transforming an individual's negative health behaviors into positive ones. Because of these responsibilities, nurses need effective intervention plans at primary, secondary and tertiary protection levels (Erci, 2009). Within the scope of primary protection, they provide education for individuals, families and society to acquire positive health behaviors through their independent roles. With education, it is possible to change the behavior of the individual and reshape the person. Nurses are responsible for monitoring whether the education they give to the individual, family and society is reflected in the behaviors. At this stage, the consultant role of the nurse comes into play. For the education to be effective, nurses must reveal the strengths of individuals (Erci, 2009; Walter and Peller, 1992). The individual should get to the root of their problems and find their reasons through counseling. Nurses should support the individual in solving problems (Erci, 2009).

The research was designed as a semi-experimental model with pretest-posttest control group.

The research was performed with families who do not want to vaccinate their 0-24 month old babies, which are in the official records of the Bingöl Provincial Health Directorate (Bingol city, Turkey). The sample size was calculated as 148 parents (female-male) with a power analysis of 0.05 error level, 95% confidence interval, 0.6 effect size, and 95% representation power of the universe. The parents refusing vaccination were evaluated separately as male and female. The researchers selected the sample group with simple random sampling method from probability sampling methods.

The researchers listed the parents who were refused the vaccine for a simple random sampling method and selected 148 individuals from a table of random numbers. The study was planned to include 148 experimental and 148 control groups, and the parents were randomly assigned to one experiment and one control group. However, the study was completed with a total of 66 parents (43 parents in the experimental group and 23 parents in the control) due to reasons such as the pandemic (COVID-19) at the time of the research, family reasons, and the inability to reach the parents. The research was carried out in Bingöl city between November 2020 and May 2021. The collection of research data is illustrated in the Consort flowchart (Table 1).

Table 1

Inclusion/Exclusion Criteria

The inclusion criteria were no communication problem, having a 0-24 month child, refusing to vaccinate his/her child. The exclusion criteria were determined as illiteracy and not participating more than two sessions.

Ethical Considerations

This study was approved by the scientific research and publication ethics committee, and informed consent was obtained before data collection ensued. A written document describing the aims, procedures and benefits of the study was given to participants. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Instrument

The socio-demographic characteristics-form which was prepared according to the literature (Özümit and Sarı, 2021) and the Parent's Attitudes towards Childhood Vaccines (PACV) Scale were used to collect the research data. The PACV Scale was developed by Opel et al (2011). Çevik et al. (2020) performed the Turkish validity and reliability of this scale. The scale measures parents' attitudes and behaviors towards childhood vaccinations. The scale consists of 15 questions. The scale has three sub-dimensions: behavior, attitude, and safety-effectiveness. Items 1 and 2 are behavior sub-dimension, items 3,4,5,6,11,12,13,14,15 are attitude sub-dimension, and items 7,8,9,10 are safety-effectiveness dimension. While evaluating the scale, hesitant answers are given 2 points. Answers without hesitation are given 0 points. The range of points varies between 0 and 30. If a response is missing, the total raw score ranges from 0 to 28. If two answers are missing, the total raw score takes a value between 0-26. The increase in the total score indicates that there is an increase in parents' hesitations towards childhood vaccines. Cronbach's alpha coefficient was evaluated with item-total score correlation and test-retest reliability. Çevik et al. (2020) who adapted the scale into Turkish reported that the Cronbach Alpha internal consistency coefficient was 67.The Cronbach Alpha reliability coefficient was 62 in this study.

Procedure

The researchers scanned the previous studies in the field related to SFBT. The SBFT practitioner certificate issued by the Wisdom Institute was received. The researchers collected the data in the headman's office in the province of Bingöl. The data were collected with data collection tools in approximately 20 minutes. Within the scope of the pre-test, the socio-demographic characteristics form and PACV Scale were applied to the experimental and control groups. Parents were informed about the research. Parents were invited to the trainings and a preparatory session was held. The researchers informed the individuals about the purpose and importance of the study and the content and duration of the therapy program. The researchers learned about parents' expectations from the program. The day and time of the first session was decided by the researchers and parents. A total of 4 sessions, one session per week, were applied to the SFBT experimental group. After the sessions were over, the post-test data were collected by applying the same data collection tools to the experimental and control groups.

The researchers divided the parents in the experimental group into a total of 6 groups, with 7 people in each group. The researchers counseled parents on childhood vaccinations for 4 weeks (at 1-week intervals). Each session lasted approximately 60-90 minutes. Group dynamics were created in the first week with the parents in the experimental group. The researchers have provided an interactive communication using SFBT techniques. Parents were allowed to express their feelings and thoughts. Weekly homework assignments were given to the parents to increase their awareness. The researchers set goals with parents using their own internal and external resources. Group techniques such as narration, discussion, visualization, games, small group activities and homework were used to achieve the goals. The researchers planned the session hours by considering the working hours of the parents. They terminated the counseling service when parents' negative attitudes towards vaccine hesitancy began to change. The post-test was applied with the same tools. No intervention was made in the control group.

The Dependent Variable: Attitudes of parents towards childhood vaccinations.

Independent Variable: Implementation of a solution-oriented approach to parents.

Statistical analysis

SPSS statistical program was used to evaluate the research data. The Kolmogorov-Smirnov Z test was used to determine the conformity to normal distribution. Percentage distributions, mean, number and standard deviation were used to show descriptive characteristics. Chi-square test was used for evaluation of normally distributed data, and t-test was used in dependent and independent groups. Any p value below 0.05 was accepted as statistically significant.

Due to socio-cultural factors (patriarchal society structure, husband's disapproval, unavailability, high workload etc) 100% of the experimental group was male. Demographic characteristics of the parents in the control group; 52.2% were female, 47.8% were between the ages of 31-35, 39.1% were primary school graduates, 56.5% were working, 73.9% were between the ages of 1-2, 56.5% are girls, 43.5% have 2 children in total, 69.6% of them have children aged 0-1.

In the experimental group; 69.8% of the parents did not consider it necessary to be vaccinated, 100% had past vaccination experience, 55.8% had problems with vaccines, 51.2% thought that the vaccines were harmful and caused problems such as autism, infertility, mental retardation, 95.3% thought that the vaccine had side effects and the biggest side effect (30.2%) was infertility, and 58.1% did not complete their vaccinations. In the control group, 52.2% of the parents were indecisive about vaccination, 100% of them had past vaccination experience, 52.2% had problems with vaccines, 78.3% thought that the vaccine was harmful and caused problems such as autism, infertility, mental retardation, 91.3% thought that the vaccine had side effects and the biggest side effect (42.9%) was infertility, 87% of them did not complete vaccination (Table 2).

Table 2

In the experimental group, PACV scale total pre-test mean score was 25.76±3.08 and post-test mean score was 16.69±3.81. The analyses demonstrated that there was a statistical difference between the two measurements (p=0.000). In the sub-dimensions of the PACV Scale; behavior sub-dimension pre-test mean score was 3.30±1.37 and post-test mean score was 3.72±.70. There was no statistical difference between the two groups (p=0.095). In the attitude sub-dimension, the pre-test mean score was 15.41±1.84, and the post-test mean score was 6.62±3.0. A statistical difference was found between the two groups (p=0.000). In the sub-dimension of safety effectiveness, the mean pre-test score was 7.04±1.06, the post-test mean score was 6.34±1.17 and there was a statistical difference between the two groups (p=0.001). There was a significant difference in the total score of the PACV Scale compared to the post-test mean score and the pre-test mean score. While there was no significant difference between the pre-test and post-test mean scores of the behavior sub-dimension, a significant difference was observed between the attitude and safety effectiveness sub-dimensions (p<0.001) (Table 3).

Table 3

The control group PACV scale total pre-test mean score was 27.21±2.17 and post-test mean score was 25.60±2.27. A statistical difference was found to be between the pre-test and post-test measurements (p=0.001). In the sub-dimensions of the PACV Scale; the behavior sub-dimension pre-test mean score was 3.91±.41 and post-test mean score was 3.73±.91. There was no statistical difference between the two scores (p=0.32). In the attitude sub-dimension, the values of the pre-test mean score and the post-test mean score were 15.73±1.71 and 14.39±1.87, respectively. There was a statistical difference between the two scores (p=0.001). In the sub-dimension of safety effectiveness, the mean pre-test score was 7.56±.94 and the post-test mean score was 7.47±.79. No statistically significant difference was found to be between the two scores (p=0.53). It was determined that the post-test mean score in the PACV Scale total score decreased compared to the pre-test mean score. While the difference between the pre-test and post-test mean scores in the sub-dimensions of behavior and trust was not significant, it was found to be statistically significant in the attitude sub-dimension and the total score (p<0.05) (Table 4).

Table 4

Table 5 shows the PACV Scale behavior sub-dimension pretest mean score was found in the control group (3.91±.41) and the experimental group (3.30±1.37). There was no statistical difference between the two groups according to the t-test results in independent groups (p=0.09). This finding supported that the pre-test mean scores of experimental and control group were not statistically different from each other. The mean pre-test score of the control group (15.73±1.71) and the mean pre-test score of the experimental group (15.41±1.84) were found in the attitude sub-dimension. According to the t-test results in independent groups, it was concluded that there was no statistical difference between the two measurements (p=0.49). This finding supported that the experimental and control group pre-test mean scores were not statistically different from each other. The mean pre-test score of the control group (7.56±.94) and the mean pre-test score of the experimental group (7.04±1.06) were found in the sub-dimension of safety. There was no statistical difference between the two groups according to the t-test results in independent groups (p=0.055). Namely, the experimental and control group pre-test mean scores were not statistically different from each other. PACV Scale pre-test total score averages for the control group and the experimental group were 27.21±2.17 and 25.76±3.08, respectively. A statistical difference was found between the two groups according to the t-test results in independent groups (p=0.050). In other words, the pre-test means score of the experimental and control groups were statistically different from each other (Table 5).

Table 5

Behavioral sub-dimension post-test mean scores were found in the control (3.73±.91) and experimental (3.72±.70). According to the independent group t-test results, there was no statistical difference between the two groups (p=0.09). The control group posttest means score (14.39±1.87) and the experimental group posttest mean (6.62±3.0) were found in the attitude sub-dimension. According to the t-test, a statistical difference was found between the two groups (p=0.000). The mean scores of the control group (7.47±.79) and the experimental group (6.34±1.17) were found in the sub-dimension of safety effectiveness. According to the results, there was a statistical difference between the two groups (p=0.000). PACV Scale pre-test total mean score was found in the control group (25.60±2.27) and the experimental group (16.69±3.81). These results implied that there was a statistical difference in favor of the experimental group between the two groups (p=0.000) (Table 6).

Table 6

The comparison of the intra-group pretest and posttest mean scores of the experimental and control groups is shown in Figure 1.

Figure 1

The SFBT model has been used by various disciplines to change problematic behaviors. This study provides new contributions to the literature as it includes measuring the attitude and behavior change process with a model by applying SFBT to families who do not want to have their 0–24 month old babies vaccinated. When the literature is examined, no study has been seen in which SFBT has been applied to reduce vaccine hesitancy. It was predicted that the study would contribute significantly to the behavior change process of parents who do not want to vaccinate their children in the future. This research was conducted to determine the effect of the SFBT model on parents who reject vaccination.

When the pretest-posttest mean scores of the parents in the experimental group about childhood vaccines were compared, it was determined that the post-test mean score decreased positively compared to the pre-test mean score. The difference between the two mean scores was found to be statistically significant (p < 0.05) (Table 3).

When the literature was examined, it was determined that SFBT was effective in reducing risky attitudes and behaviors but creating desired behaviors (Akgül et al., 2018; Neacsiu, Rizvi, & Linehan, 2010). In a study, it was determined that education level was effective in creating attitude and behavior change (Tuncer & Yılmaz, 2016).

It is estimated that the education level of the majority of the parents in the experimental group is high school and university, which is one of the reasons for the change in attitude and behavior. In this study, SFBT was applied to parents who exhibited risky behaviors about vaccination that affect both the child's and the community's health. The obtained data revealed that this model changed positively the attitudes of most of the parents towards the vaccine. According to official records, six parents in the experimental group vaccinated their children after the therapy. Another reason for behavioral change in the parents is that SFBT is based on alternative thinking. Instead of talking about the problem, it aims to present a solution. Therefore, methods such as SFBT increase the motivation for change in the desired direction in the individual (Bowles, Mackintosh, & Torn, 2001).

The results also displayed that in the control group, PACV Scale total score and attitude sub-dimension post-test mean score decreased positively compared to the pre-test mean score. The decrease was determined to be statistically significant (p < 0.05). Behavior and safety effectiveness sub-dimensions post-test mean scores did not show a significant change compared to the pre-test (Table 2). It is an expected result that there is no statistically significant change in the sub-dimensions of behavior and safety effectiveness, while a significant change in the total scores of the attitude sub-dimension and PACV Scale is an unexpected result. It is estimated that the death of people due to the COVID-19 epidemic has changed the attitudes of parents towards the vaccine.

According to the present data, SFBT was deduced to change the parent's attitude towards the vaccine in a positive way. This finding confirm the research hypothesis that "The intervention organized within the scope of SFBT reduces the negative attitude of parents towards vaccine hesitancy".

When alternative ways of thinking are applied with the nightmare method within the scope of SFBT, it is thought that there is a change in behavior with the effect of the bad scenario (you didn't vaccinate your child, and your child caught a vaccine-preventable infectious disease and died. How would you feel and what would you do?) inculcated in the families. The loss of a loved one causes cognitive, emotional and behavioral changes in individuals (Malkinson, Rubin, & Nadav, 2009). Another reason for parents to change their behavior towards vaccination is the inability to withstand the loss of a loved one. The researchers enabled parents to look at events from different perspectives with the mind inversion method applied within the scope of SFBT (Parents were asked to imagine a loved one alive who passed away in the past. They were told that the loved one's survival depends on vaccination. What would you do in this situation? It is thought that it paves the way for a positive behavioral change since this situation enables parents to look at vaccination from a different perspective.

When the PACV Scale pretest-posttest averages of the parents in the experimental group were compared, it was determined that the post-test mean scores of the PACV Scale total score, attitude and security sub-dimensions decreased positively compared to the pre-test mean scores. No significant change was determined in the behavior sub-dimension (p < 0.05) (Table 3). Nurses have great responsibilities to build a healthy society. In this context, it is important to use various approaches. One of the responsibilities of nurses is to provide positive health behaviors to individuals. Therefore, nurses need effective intervention plans at primary, secondary and tertiary protection levels (Erci, 2009). One of the effective intervention plans is SFBT which helps parents to deal with problems. Parents thinking about their own problems, finding the causes of these problems on their own and encouraging them to solve these problems (Erci, 2009) change the behavior of some of the parents in a positive way. However, the behavior of the vast majority does not change. It should be noted that behavior change is a process (Neacsiu et al., 2010).

According to these results, SFBT did not provide a positive change in parents' behavior towards vaccination. This finding do not confirm the research hypothesis that "SFBT reduces vaccination hesitancy behavior in parents".

The PACV Scale safety sub-dimension post-test score average of the parents in the experimental group decreased positively compared to the pre-test score average. It was determined to be statistically significant (p < 0.05). The parents in the experimental group did not trust the vaccine before SFBT. On the contrary, it was determined that the parents had confidence in the vaccine after SFBT and decided to get vaccinated. When the literature is examined, as the confidence in a product increases, usage/consumption also increases (Gürer & Akyol, 2018; Özsağır, 2007). Similar results were obtained in the present study. In the first session of SFBT, establishing the therapeutic alliance with the individual and the group is an important necessity. The main goal of the therapeutic alliance is to gain the trust of the individual. Approaches such as respecting parents, not being judged on their behavior, listening to their problems, and appreciating positive health behaviors are thought to provide positive confidence towards the researcher. In addition, it is thought that conducting the research in the environment where the parents live provides confidence towards the researcher. The results of the present study showed that SFBT positively changed the parents' confidence in the vaccine. This finding confirms the research hypothesis that “SFBT reduces parental distrust of vaccines”.

The PACV Scale attitude sub-dimension pretest-posttest total score averages of the parents in the control group were compared. It was determined that the differences were not statistically significant. When the literature is examined, it has been determined that talking about solutions instead of problems has a positive contribution to behavior change (Arslan & Akın, 2016; Ateş, 2015; Saadatzaade & Khalili, 2012). In a study, it has been reported that if nurses focus on the solution rather than the problem, both individuals and families will gain positive health behaviors. In addition, SFBT gives nurses a behavioral perspective and improves nurses' creativity (Carter, 2007). It has been reported in studies that SFBT can be used to provide healthy lifestyle behaviors to the individual, family and society in a public health perspective and to change negative behaviors in a positive way (Wakefield, 2010; Wand, 2010). Talking about the solution instead of the problem, revealing the strengths and abilities of the individual, motivating and empowering positive approaches applied to the individual, establishing a SMART (specific, measurable, attainable, realistic, time bounded) purpose for the future, concentrating on situations where there is no problem, appreciating the changes in parents with positive feedback as well as being short-term and low-cost can make positive behavioral changes in parents. The present data indicated that SFBT provided a positive change in safety effectiveness, attitude and total scores, except for the sub-dimension of parents' behavior towards vaccination. This finding confirms the research hypothesis that “SFBT reduces vaccination hesitancy in parents”.

This study demonstrated that parents' attitudes towards childhood vaccines changed positively in the experimental group after SFBT application. There was a significant decrease in total scores. In the control group which SFBT was not applied, there was a decrease between the pre-test and post-test mean scores of parents' attitudes towards vaccination. However, there was little change compared to the positive change in the experimental group. When the pre-test was applied, parents' attitudes towards childhood vaccines were found to be similar in the experimental and control groups. Compared to the control group, the attitudes of the parents in the experimental group towards childhood vaccines changed positively. The results of this study showed that SFBT was a suitable model for reducing the vaccination hesitations of parents who do not want to vaccinate their 0–24 month old babies. In addition, this approach was found to be effective in gaining healthy behaviors for the parents participating in the research.

Limitations of the research; not all parents participate in the study, women's unwillingness to participate in the experimental group for various reasons (her husband does not allow, unavailable, excessive workload etc), non-compliance with randomization limited number of women in the control group, the educational status of the parents in the experimental and control groups were different, inequality in the number of groups as it is voluntary. The research result can be generalized to the research group.

Recommendations; nurses should approach parents who do not want their 0–24 month old children to be vaccinated under the guidance of this model. While creating health policies, a SFBT should be integrated into vaccination services, which are within the scope of preventive health services. Personnel providing primary health care services should be trained in a SFBT. It is recommended to use a SFBT on individuals/groups to increase motivation and build a positive future in diseases where treatment opportunities are limited.

Ethics approval and consent to participate

Ethics committee approval of the study was obtained from the Scientific Research and Publication Ethics Committee of Inönü University (decision no: 2020/1184). Institutional permission was obtained from the Ministry of Health, Bingöl Provincial Health Directorate (decision number: 50235129-300). Researchers followed the rules stated in the Declaration of Helsinki throughout the research. Informed consent was obtained from all the individual participants before they were included in this study.

Availability of data and materials

The data that support the finding of this study are available from the corresponding author upon reasonable request.

Consent for publication: Applicable

Competing interests

The authors declare that there are no conflict of interests.

Funding

The author did not receive any financial support for the review article, authorship and/or publication of this article.

Authors' contributions

Mehmet Kaplan, Behice Erci designed the study, collected and analyzed the data and prepared the manuscript.

Acknowledgements

We would like to thank Assoc. prof. Nazlı Pınar Arslan for language editing.

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Table 1 is available in the Supplementary Files section

Table 2. Attitudes of parents in the experimental and control groups towards vaccination

Attitudes	Experimental group		Control Group
	n	%	n	%
Vaccination Necessity
Yes	1	2.3	-	-
No	30	69.8	11	47.8
Indecisive	12	27.9	12	52.2
Past Vaccination Experience
Yes	43	100	23	100
No	-	-	-	-
The Problematic Vaccine Experience
Yes	24	55.8	12	52.2
No	19	44.2	11	47.8
The Harms of Not Vaccinating
I do not know	8	18.6	5	21.7
Getting the disease faster	4	9.3	-	-
Getting sick more often	3	7	-	-
More severe disease process	6	14	-	-
Other	22	51.1	18	78.3
Vaccine Side Effect
Yes	41	95.3	21	91.3
I do not know	2	4.7	2	8.7
Vaccine Side Effect (If yes)
I do not know Erythema Pain Infection Infertility	1 3 3 5 13	2.4 7 7 11.6 30.2	- 2 2 - 9	- 9.5 9.5 - 42.9
Fever Other	5 13	11.6 30.2	3 5	14.3 23.8
Vaccination Status
Missing vaccines	25	58.1	20	87
Never vaccinated	18	41.9	3	13

Table 3. Comparison of PACV scale pre-test-post-test mean scores of the parents in the experimental group

Scale	Pre-Test	Post-Test	Test and Significance
Scale sub-dimensions and total score
	X±SD	X±SD	t	p
Behavior	3.30±1.37	3.72±.70	1.70	0.095
Attitude	15.41±1.84	6.62±3.0	16.65	0.000**
Safety effectiveness	7.04±1.06	6.34±1.17	3.42	0.001**
Scale Total score	25.76±3.08	16.69±3.81	13.35	0.000**

*p<0.05, **p<0.01

Table 4. Comparison of PACV scale pre-test-post-test mean scores of the parents in the control group

Scale	Pre-Test	Post-Test	Test and Significance
Scale sub-dimensions and total score
	X±SD	X±SD	t	p
Behavior	3.91±.41	3.73±.91	1.00	0.32
Attitude	15.73±1.71	14.39±1.87	3.87	0.001*
Safety effectiveness	7.56±.94	7.47±.79	0.62	0.53
Scale Total score	27.21±2.17	25.60±2.27	3.86	0.001*

*p<0.05, **p<0.01

Table 5. Comparison of PACV scale pre-test mean scores of parents in experimental and control groups

Scale	Control Group Pre-Test	Experimental Group Pre-Test	Test and Significance
Scale sub-dimensions and total score
	X±SD	X±SD	t	p
Behavior	3.91±.41	3.30±1.37	2.69	0.09
Attitude	15.73±1.71	15.41±1.84	0.69	0.49
Safety effectiveness	7.56±.94	7.04±1.06	1.95	0.055
Scale Total score	27.21±2.17	25.76±3.08	2.00	0.050

*p<0.05, **p<0.01

Table 6. Comparison of PACV scale post-test mean scores of parents in experimental and control groups

Scales	Control Group Post-Test	Experimental Group Post-Test	Test and Significance
Scale Sub-Dimensions and Total Score
	X±SD	X±SD	t	p
Behavior	3.73±.91	3.72±.70	0.09		0.92
Attitude	14.39±1.87	6.62±3.0	12.89		0.000**
Safety effectiveness	7.47±.79	6.34±1.17	0.25		0.000**
Scale Total score	25.60±2.27	16.69±3.81	11.88		0.000**

*p<0.05, **p<0.01

No competing interests reported.

Table1.docx

The effect of solution focused brief on overcome vaccine hesitancy: A randomized controlled study

Status:

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Abstract

Figures

Introduction

Material And Methods

Results

Discussion

Declarations

References

Tables

Additional Declarations

Supplementary Files

Status:

Version 1