BACKGROUND: Personal Belief Exemptions (PBEs) are non-medical exemptions from mandatory school immunizations. Marin County, located in the San Francisco Bay Area, has historically had a relatively high Kindergarten PBE rate (6% in 2015-16). Approximately 15% of Marin County adults (18-64 years) speak Spanish in the home; little is known about this population’s vaccine perceptions and behaviors. A prior vaccine beliefs survey distributed electronically in Marin County received very few responses in Spanish. We conducted an updated vaccine decision making survey with increased outreach to the Spanish-speaking population to better understand vaccine beliefs and behaviors in our community.
METHODS: A survey was developed from existing vaccine beliefs survey instruments and input from local stakeholders. Topics included immunization status, sources of immunization information, and influenza vaccination behavior. The survey was disseminated electronically and by paper in winter 2015 in English and Spanish to all elementary schools through the Marin County Office of Education and school-based personnel. We collaborated with school-based health liaisons in the school district with the largest Spanish-speaking population to increase distribution of Spanish surveys. We distributed approximately 1,000 paper surveys, with some households also receiving an electronic survey request. Approximately 2,260 total kindergarten households received the survey in paper and/or electronic form, representing about 80% of potential kindergarten households. Respondents were classified as Spanish or English-speaking based on the language in which they chose to complete the survey. Responses were stratified by survey language and analyzed using proportions and Fisher’s exact tests.
RESULTS: Among the 740 responses received, 128 (17%) were completed in Spanish. Most (95%) Spanish-speaking respondents completed a paper version of the survey. Among Spanish-speaking parents, 0% reported a PBE compared to 7% of English-speaking parents. Spanish-speaking respondents were significantly more likely to report obtaining vaccination information from a family member (p=0.03) and less likely to report obtaining vaccination information from the news (p<0.001) than English-speaking respondents. Additionally, Spanish-speaking respondents were significantly more likely to report vaccinating their kindergartener for influenza that year (p=0.01) than English-speaking respondents.
CONCLUSIONS: There was a high level of support for vaccines among the Spanish-speaking population in our community. We received a robust response from the Spanish-speaking population on a community survey through working with school-based health liaisons and distributing paper versions of the survey. Collaborating with school-based health liaisons may be helpful in distributing health information and assessing health behaviors in the Spanish-speaking population.