Abstract
Introduction: Despite the progress made in Malaysia's vaccination programmes, measles continues to persist. Parental confidence in measles vaccines plays a pivotal role in ensuring successful immunisation. However, there is currently limited research on effective interventions to measure outcomes related to parental trust in MMR (measles, mumps, rubella) vaccination programmes in Malaysia. Hence, this study aims to determine the effectiveness of Parent's Health Education as an intervention to improve MMR vaccination confidence among parents in Malaysian urban settings. Methods: The research was conducted in three phases based on the Logical Framework Approach from June 2022 to March 2024. The phases include systematically developing and validating a Parental Health Education (PaHE-Measles) consisting of MMR brochures and framing messages for measles (MMR) vaccination. The Heuristics Framework's guiding principles were used to develop PaHE-Measles. The Emory Vaccine Confidence Index and MMR Attitude Measurement Instruments were adapted, translated, and validated to suit the Malaysian populace. Lastly, the effectiveness of Parent Health Education Intervention was delivered and assessed in a quasi-experimental study design with a control group in Government Maternal Child Health clinics in Kepong, Kuala Lumpur. Participants in the intervention group received PaHE-Measles to reinforce behavioural change. Participants in the control group received standard care from primary healthcare providers in the clinics. The pre- and post-intervention questionnaires were administered to determine parental MMR vaccination confidence. Ultimately, the uptake of the MMR vaccine at 9 and 12 months of age in children of follow-up parents was determined. The primary outcome was the proportion of parental vaccine confidence in MMR vaccination. The secondary outcome included the between-group mean difference for change in parental vaccine confidence and the uptake of MMR vaccine at 9 and 12 months of age. Participants' demographic characteristics and baseline values were compared using an independent t-test for normality-distributed variables and continuous data. Conversely, the Mann-Whitney test was used for non-normality-distributed variables, and a Chi-square test was used for the categorical data. Repeated measures of ANCOVA were used to measure the difference in MMR vaccination confidence score between the two groups. The proportion of children who received their MMR vaccinations on-time was compared at 9 and 12 months of age in children of follow-up parents. Results: The newly developed PaHE-Measles intervention exhibits strong content validity and clarity. The intervention significantly improved parental confidence in measles vaccination, as evidenced by the increase in trust (F(1, 247.8) = 53.34, p < 0.001, çñ² = 0.14) and improved attitudes (F(1, 119.1) = 32.91, p < 0.01, çñ² = 0.09) compared to the control group. Both the intervention and control groups adhered to the MMR vaccination schedule; however, substantial delays (15.8%) and defaults (2.4%) were reported in the control group. Conclusion: This study provides evidence that a newly developed PaHE-Measles using combined educational brochures and framing messages via text can be implemented in a healthcare setting and improves parental vaccine confidence in measles vaccination. Further studies are required to determine whether similar outcomes could be achieved in communities with different health settings, socioeconomic backgrounds, and geographical areas.
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@phdthesis{drph-Tengku-Nuraihan-Zafirah-2024,
title = {Effectiveness of an Improved Leprosy Lakar Training on Knowledge and Skills Among Healthcare Workers in Primary Healthcare in Pahang Malaysia},
author = {Tengku Nuraihan Zafirah Tengku Zainal Abidin},
year = {2024},
date = {2024-10-16},
abstract = {Introduction: Despite the progress made in Malaysia\'s vaccination programmes, measles continues to persist. Parental confidence in measles vaccines plays a pivotal role in ensuring successful immunisation. However, there is currently limited research on effective interventions to measure outcomes related to parental trust in MMR (measles, mumps, rubella) vaccination programmes in Malaysia. Hence, this study aims to determine the effectiveness of Parent\'s Health Education as an intervention to improve MMR vaccination confidence among parents in Malaysian urban settings. Methods: The research was conducted in three phases based on the Logical Framework Approach from June 2022 to March 2024. The phases include systematically developing and validating a Parental Health Education (PaHE-Measles) consisting of MMR brochures and framing messages for measles (MMR) vaccination. The Heuristics Framework\'s guiding principles were used to develop PaHE-Measles. The Emory Vaccine Confidence Index and MMR Attitude Measurement Instruments were adapted, translated, and validated to suit the Malaysian populace. Lastly, the effectiveness of Parent Health Education Intervention was delivered and assessed in a quasi-experimental study design with a control group in Government Maternal Child Health clinics in Kepong, Kuala Lumpur. Participants in the intervention group received PaHE-Measles to reinforce behavioural change. Participants in the control group received standard care from primary healthcare providers in the clinics. The pre- and post-intervention questionnaires were administered to determine parental MMR vaccination confidence. Ultimately, the uptake of the MMR vaccine at 9 and 12 months of age in children of follow-up parents was determined. The primary outcome was the proportion of parental vaccine confidence in MMR vaccination. The secondary outcome included the between-group mean difference for change in parental vaccine confidence and the uptake of MMR vaccine at 9 and 12 months of age. Participants\' demographic characteristics and baseline values were compared using an independent t-test for normality-distributed variables and continuous data. Conversely, the Mann-Whitney test was used for non-normality-distributed variables, and a Chi-square test was used for the categorical data. Repeated measures of ANCOVA were used to measure the difference in MMR vaccination confidence score between the two groups. The proportion of children who received their MMR vaccinations on-time was compared at 9 and 12 months of age in children of follow-up parents. Results: The newly developed PaHE-Measles intervention exhibits strong content validity and clarity. The intervention significantly improved parental confidence in measles vaccination, as evidenced by the increase in trust (F(1, 247.8) = 53.34, p \< 0.001, \c{c}\~{n}² = 0.14) and improved attitudes (F(1, 119.1) = 32.91, p \< 0.01, \c{c}\~{n}² = 0.09) compared to the control group. Both the intervention and control groups adhered to the MMR vaccination schedule; however, substantial delays (15.8%) and defaults (2.4%) were reported in the control group. Conclusion: This study provides evidence that a newly developed PaHE-Measles using combined educational brochures and framing messages via text can be implemented in a healthcare setting and improves parental vaccine confidence in measles vaccination. Further studies are required to determine whether similar outcomes could be achieved in communities with different health settings, socioeconomic backgrounds, and geographical areas.},
keywords = {},
pubstate = {published},
tppubtype = {phdthesis}
}
