Date of Award

12-17-2024

Thesis Type

PhD

Document Type

Thesis

Divisions

Faculty of Medicine

Department

Department of Social and Preventive Medicine

Institution

Universiti Malaya

Abstract

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 Health Education Intervention in improving MMR vaccination confidence, attitude, and uptake among parents attending Public Health Clinics in Kuala Lumpur. Methods: This multi-phase quantitative study, conducted from June 2022–March 2024, utilised the Health Belief Model to assess parental vaccine confidence and attitudes, while the Logical Framework Approach guided the planning, implementation, and evaluation of interventions. The first phase focused on adapting, translating, and validating the Emory Vaccine Confidence Index (EVCI) and MMR Attitude Measurement Instruments for the Malaysian populace, including expert content validation (n=6), parent pretesting (n=30), and psychometric properties evaluation of Exploratory Factor Analysis (n=151), Confirmatory Factor Analysis (n=200) and Test-Retest (n=62) in government Maternal Child Health (MCH) clinics in Titiwangsa, Kuala Lumpur. Second, the PaHE-Measles, integrating MMR brochure and framed text messages, was systematically developed and validated using the Heuristics Adaptation Framework with experts (n=5), healthcare providers (n=10), and end-users (n=30). Finally, the effectiveness of Parent Health Education Intervention was delivered and assessed in a quasi-experimental study design with a control group in MCH clinics in Kepong, Kuala Lumpur. The intervention group received PaHE-Measles (n=165); conversely, the control group received standard care (n=165) consisting of a Ministry of Health immunisation pamphlet. The MMR vaccine uptake at 9 and 12 months among participants's children was evaluated. Pre- and post-intervention questionnaires assessed parental MMR vaccination confidence and attitude, with primary outcomes being vaccine confidence and attitude proportions and between-group differences. The secondary outcomes included the between-group comparison of MMR vaccine uptake at 9 and 12 months among children of follow-up parents. Demographic characteristics and baseline comparisons used independent t-tests for normally distributed and continuous data, Mann-Whitney tests for non-normal distributed data, and Chi-square tests for categorical data. Generalized Linear Model (GLM) analyses identified factors associated with vaccine confidence and attitude, and repeated measures ANCOVA assessed group differences. Descriptive analysis was used to compare MMR vaccination uptake at follow-up. Results: The Malay-adapted EVCI (8 items) and MMR Attitude Measurement Instrument (14 items) are valid and reliable. GLM analysis revealed a positive association between vaccine confidence, attitudes, and factors such as female gender, partner's education, and prior vaccine awareness. The PaHE-Measles demonstrated strong content validity and significantly improved parental vaccine confidence (F(1, 317) = 34.64, p < 0.01, ηρ2 = 0.14) and attitudes (F(1, 317) = 32.79, p < 0.01, ηρ2 = 0.09) after adjusted, with substantial delays (15.8%) and defaults (2.4%) observed in the control group's MMR vaccine uptake. Conclusion: This study demonstrates that the PaHE-Measles intervention, combining MMR brochures and framed text messages, enhances parental vaccine confidence, attitudes, and MMR vaccine uptake in healthcare settings, with further research needed for diverse contexts such as socioeconomic backgrounds and geographical areas.

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Thesis (PhD) - Faculty of Medicine, Universiti Malaya, 2024

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