INTRODUCTION: The role of healthcare providers and their use of systems is one of the most
important factors in vaccination uptake.
AIM: To identify reasons and find patterns behind why immunisation providers code the word
‘decline’ in their system for childhood immunisation events.
METHODS: A qualitative study involving face-to-face semi-structured interviews with staff
members involved in immunisation delivery. General practices were purposively selected for
having either high or low rates of registered children coded on the electronic practice management
system as having declined immunisation events. Thematic analysis was undertaken
using an inductive approach to link themes to the data.
RESULTS: A total of 35 interviews were conducted with practice nurses; 21 were from practices
with high rates of registered children recorded as having declining immunisation events,
and 14 practices with low rates of declining. Common themes were: effective use of systems,
early and ongoing engagement, adequate health care practitioner time and practitioner
experience. Practices with low rates of coded decliners had stronger approaches for early
and ongoing engagement, and were less likely to use formalised decline forms. As practice
immunisation coverage rates improved over time, there was perceived to be less expressed
vaccine hesitancy from families.
CONCLUSIONS: The reasons for coding individuals as ‘decliners’ are a complex mixture of
individual, community, practitioner and practice systems. Front-line providers need adequate
tools, time and resourcing to support effective and ongoing engagement with families. Community
factors have influence but can change over time.
KEYWORDS: Immunisation, Immunisation coverage, Primary care, Systems