Identifying knowledge– attitude–practice gaps in parental acceptance of adolescent vaccinations in Appalachian Kentucky: Implications for communication interventions

Rural Appalachian Kentucky adolescents are less likely to receive age-appropriate vaccinations compared with other populations and these low vaccination rates represent a major public health risk. This study investigates parental acceptance of adolescent vaccinations by examining their knowledge, attitudes, and behaviors related to vaccinating their adolescents with both state required and recommended vaccines. Using the integrated behavioral model as a guiding framework, the researchers conducted 21 in-depth interviews with parents of 11–18-year-old children in Appalachian Kentucky. Three salient findings emerged. First, knowledge was not strongly related to a parent’s behavior, as both vaccinating parents and nonvaccinating parents expressed varying degrees of accurate knowledge. Second, attitudes emerged as an important predictor of behavior, such that parents with positive preventive health attitudes had the desire to protect their children’s future through vaccination, indicating risk protection behavior could precede knowledge acquisition. Third, opinion leaders in the community served as important motivators for parents vaccinating their children, contributing to the knowledge–attitude–- practice gap in that their influence seemed to be enough to drive behavior. The paper concludes with a discussion of the findings and appropriate communication strategies to use with parents of adolescents and local healthcare providers in order to improve both state required and recommended vaccination rates. The implications from this study could provide insights for designing similar interventions in other underserved, rural areas.