Decreasing the Number of Vaccinated Children in Sicily

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Literature study is one of the most effective ways to gain new knowledge. A detailed analysis of sources allows one to broaden horizons and collect a foundation for drawing conclusions and recommendations for improving almost any professional activity. Nursing research, in this context, is the process of generating credible evidence that will allow for a more detailed consideration of issues of importance to nursing activities (Polit & Beck, 2017). In addition, this process is part of a larger framework, evidence-based practice, which enables the most effective medical decisions to be made, taking into account the patients’ needs and the latest medical research (“Evidence-based practice,” n.d.). Hence, finding and reviewing medical articles is a nurse’s most essential skill. A detailed approach to the literature and careful analysis of sources can lead to better quality services. This paper aims to prove this thesis through a critical study of research by Facciola et al.

Although the benefits of vaccination are scientifically proven and confirmed by many studies, this issue remains controversial in many societies, even in the context of serious diseases. As statistics show, almost half of the studied population has doubts about vaccination against COVID-19, and about 15% of those surveyed refused to take it completely (Khubchandani et al., 2021). The situation is similar to conventional vaccines, especially for children. The reason for the study by Facciola et al. (2019) is a trend of decreasing the number of vaccinated children in Sicily below the optimal value. Since the problem with children’s vaccination lies in the parents’ behavior, they became the leading group of the study. Thus, the main objective of the research was to study the mood of parents regarding vaccination.

Researchers’ stated reasons and goals are articulated clearly, making it easier to understand the focus of the work. The paper’s introduction provides enough background information that guides the reader toward the goal at hand (Facciola et al., 2019). However, it should be noted that there is no research question as such in the work. The reason for this, perhaps, is the formulation of the set research objective since the authors do not try to confirm or deny any hypothesis. Instead, they collect all possible information for further analysis without limiting themselves to one narrow direction. In this case, the absence of a research question is justified since this research is not looking for a specific answer but forms a database for analysis.

The authors chose qualitative analysis as the type of research. According to the text of the article, it was implemented in the form of a survey through the distribution of pre-formed questionnaires (Facciola et al., 2019). The choice of this type of research is due to the stated objective. The answers to the existing questions can only be obtained quantitatively, and questionnaires are best suited to discover common reasons (Busetto et al., 2020). Therefore, the authors’ choice is fully justified and relevant to the research topic. To collect enough data for analysis, Facciola et al. (2019) used a questionnaire examining parents’ opinions of children aged 13-14 years, since, by this age, all vaccinations should be completed.

The authors pay special attention to the HPV vaccine since the rate of vaccination with it in the study area is deficient. The compiled surveys were distributed to 6 schools in the city of Messina on the island of Sicily through meetings with parents. The data was then analyzed using Prism 4.0 software and descriptive statistics (Facciola et al., 2019). In addition, for further evaluation, several tests were used at once: Lilliefors, Shapiro-Wilk, and Pearson. This detailed approach to statistical analysis can be identified as one of the strengths of this study. Also, the authors used a relatively large group of people selected according to criteria suitable for solving the task at hand. The authors themselves do not highlight any additional strengths of their work, but at the same time, indicate the source of the data as limitations since they were obtained through self-reports (Facciola et al., 2019). In addition, they used a non-validated survey, which could negatively affect the survey results.

The research process itself can be considered, for the most part, quite logical and in line with general standards. After considering the theoretical background in the form of world and regional statistics on vaccination, the authors moved on to formulating and substantiating goals and describing the methodology. From the perspective of logical consistency, this study, at first glance, is relatively easy to perceive and analyze. However, it lacks several rather essential elements that make detailed analysis difficult. First of all, the analysis lacks a literature review as such, and its elements are only included in the introduction in the background section. The description of the theoretical framework used was made rather briefly and succinctly without detailed descriptions. Also, while there is a limitations section, there is no similar strengths section. However, these remarks do not violate, for the most part, the logic of the entire study. They can be explained by the peculiarities of constructing the goal and methods, which do not require extensive preliminary analysis.

The authors prepared 1,300 questionnaires distributed in six schools among parents of children of suitable ages to obtain enough information. Back with answers, 84% of the original 1093 questionnaires were received and processed. When conducting such studies, it is necessary to highlight three critical components regarding the sample: correctly determine the size, choose the sampling type and frame. These criteria are usually selected based on research needs and capabilities (Shantikumar & Barrat, 2018). For example, non-probability sampling is usually cheaper, but probability sampling allows for better generalizations.

However, there is no direct indication of any of these components in this paper. All that can be learned from the description of the study design is that parents of schoolchildren 13-14 years old in six schools were taken as a sample, and they took part in the study based on a personal meeting with the paper’s authors (Facciola et al., 2019). Due to the lack of sufficient information, it is impossible to say how the number of parents who underwent the study was determined. It is also impossible to establish the sample type since there is no detailed information about the meeting.

In this case, it can be assumed with equal probability that both all eligible parents and only a certain number of them, chosen randomly or voluntarily, were interviewed. Due to the lack of information, it is also impossible to draw conclusions regarding ethical considerations’ compliance. Although such questionnaires are suitable for research purposes due to the logically correctly identified target audience, it is impossible to evaluate them thoroughly. Thus, sampling details are one of the weak points of this paper, leading to accusations about the quality of the research and adherence to all necessary ethical considerations.

As mentioned above, the only way to collect data for analysis was through the distribution of pre-prepared questionnaires. The text of the article does not provide access to questions directly, instead grouping them into categories for general description (Facciola et al., 2019). Parents were asked both demographic questions and specific ones related to the topic under study. Since the exact wording is hidden, it is impossible to establish whether the given questions were open- or closed-ended, which is an essential factor affecting the accuracy of the answers (“Writing survey questions,” n.d.). It is only known that the data were collected in a qualitative form based on parents’ knowledge of the topics under study.

In the “Results” section, the authors nevertheless refer to rather specific formulations. However, this may be a consequence of the averaging and standardization of the results. In addition, questions were handed out and then collected through face-to-face meetings. This approach dramatically increases the response rate, as demonstrated in a survey (“Online versus offline surveys,” 2020). Since general questions were used in the work, it is impossible to single out any specific studied variables and parameters.

Thus, on the one hand, the article’s authors indicate the tool they used and give its general description. The use of questionnaires with general questions in the task context is more than justified since it allows one to get the opinion of the studied category. However, the approach taken by the authors has several significant flaws. Facciola et al. (2019) noted that the questionnaire used is non-validated, which indicates its unreliability. The questions included were not adequately reviewed, which could affect the final results. In addition, the reader does not have access to the questions themselves, only their categories, which makes it difficult to objectively assess the quality of both the tool and the process being carried out. Finally, a substantial drawback is that this survey gives self-reported data, which is notable for its unreliability.

However, this information has been statistically analyzed using a variety of tools. Due to the essence of the questions asked, qualitative indicators in parental opinions and answers are used as data. Because the reader does not know exactly how the questions were formulated, it is difficult to assess what data should have been obtained. In the “Results” section, the authors demonstrate several statistical blocks divided by the questions asked (Facciola et al., 2019). The data presented correspond to each of the topics of the questions stated earlier. However, they are presented in an extremely difficult form for analysis. The provided graphs reflect only part of the questions asked and provide little information without context.

Since within the framework of this study, there was no literary review as such, the authors refer mainly to background information and analyze the results presented in the discussion. Accordingly, the information collected is practically in no way correlated with the data already available. However, it corresponds to the goals put forward by the authors. Since they were faced with obtaining parental views on vaccination, high-quality self-reported data in the form of answers to questions perfectly suits the study’s objectives. All the presented and analyzed results correspond to the study of parents’ opinions. In addition, the authors compile this data and perform an examination demonstrating general vaccination trends.

Thus, the authors conduct a reasonably detailed study and form fairly detailed conclusions at first glance. However, in this context, several points should be noted. First of all, the authors did not note the parameters of the reliability and severity of the obtained data and the formed conclusions (Facciola et al., 2019). Moreover, they note that the reliability of the entire study is significantly reduced due to the use of self-reported data, insufficient knowledge of parents, and a non-validated questionnaire. These factors have been highlighted as weaknesses in the ongoing investigation, which require further work. However, in this context, to improve future results, only the use of an additional source in the form of the immunization registry is mentioned (Facciola et al., 2019). This factor somewhat further reduces the reliability of the research.

In the “Discussion” section, the authors demonstrate sufficient knowledge and qualifications to conduct a comparative analysis of the available qualitative and percentage data. By comparing data, they make a logical conclusion about trends in vaccination attitudes and their reasons (Facciola et al., 2019). However, the analysis of these types of data is comparatively easy, and in this process, the authors do not refer to the validity or rigor of the study. These factors interfere with the entire critical appraisal of results and findings.

It can be noted that the authors effectively summarized the study results in the form of several general observations regarding vaccination trends. Such a compilation of data not only allows them to transfer it to other studies and use it in the future but also fully corresponds to the stated goals and objectives. Starting this study, Facciola et al. (2019) aimed to provide an overview of parents’ views on vaccinations and highlight the apparent reasons for refusal. The paper’s conclusion is consistent with these themes, but not entirely. Since the conclusion is a fairly positive attitude toward vaccines, the reasons for refusals are not considered in sufficient detail (Facciola et al., 2019). Accordingly, although the recommendations put forward to make sense in the context of the study, not all of the objectives were fully reflected, affecting the credibility of this source.

This paper has a rather low value for practical use, considering the arguments above. According to the authors, the issue of vaccine withdrawal is primarily due to fear of adverse reactions and a lack of factual knowledge about their effectiveness (Facciola et al., 2019). Accordingly, it is proposed to improve parental vaccination knowledge to combat low vaccination rates. However, the authors do not indicate how exactly this should be done. In addition, in the context of such a large-scale study, they provide an extremely limited conclusion with a narrow application in future practice. The main complaint about practice implications is that they are challenging to implement in the context of ordinary healthcare professionals. Raising parental awareness should be an ambitious goal for the entire health sector. At the same time, the authors do not indicate to whom they are addressing their paper nor what measures should be taken.

Thus, it can be concluded that this paper has a relatively low value from the perspective of nursing research. Despite considering the relevance of, especially in pandemic times, topics, the authors make many inaccuracies both in the research format and in the development of conclusions. For example, the paper lacks a full-fledged literary review and assessment of the available data, making it difficult to link the research with the historical context. In addition, there is no data on sampling principles and detailed information on questionnaires. All these elements, coupled with rather general and meager conclusions, allow concluding that the research has practically no connection with actual nursing practice. Although some of the data obtained by the authors can be used as general guidance on parental opinions about vaccination, they need to be approached with great caution.

References

Busetto, L., Wick, W., & Gumbinger, C. (2020). How to use and assess qualitative research methods.Neurological Research and Practice, 2, 1-10.

Evidence-based practice (EBP). (n.d.). ASHA.

Facciolà, A., Visalli, G., Orlando, A., Bertuccio, M.P., Spataro, P., Squeri, R., Picerno, I., & Di Pietro, A. (2019). Vaccine hesitancy: An overview on parents’ opinions about vaccination and possible reasons of vaccine refusal. Journal of Public Health Research, 8(1).

Khubchandani, J., Sharma, S., Price, J. H., Wiblishauser, M. J., Sharma, M., & Webb, F. J. (2021). COVID-19 vaccination hesitancy in the United States: a rapid national assessment. Journal of Community Health, 46(2), 270-277.

Online versus offline surveys. Does the medium still matter in 2020? (2020). LimeSurvey.

Polit, F.D., & Beck, C.T. (2017). Nursing research: Generating and assessing evidence for nursing practice. Wolters Kluwer.

Shantikumar, S., & Barrat, H. (2018).Methods of sampling from a population. Health Knowledge.

Writing survey questions. (n.d.). Pew Research Center.

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Decreasing the Number of Vaccinated Children in Sicily

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