Parental Autonomy Support in the Context of Parent–Child Negotiation for Children’s Independent Mobility: ‘I Always Feel Safer With My Parents’ to ‘Boom! Bust Down Those Walls!’

Autonomy – acting volitionally with a sense of choice – is a crucial right for children. Given parents’ pivotal position in their child’s autonomy development, we examined how parental autonomy support and children’s need for autonomy were negotiated and manifested in the context of children’s independent mobility – children’s ability to play, walk or cycle unsupervised. We interviewed 105 Canadian children between 10 and 13-years-old and their parents ( n = 135) to examine child-parents’ negotiation patterns as to children’s independent mobility. Four patterns emerged, varying on parental autonomy support and children’s need/motivation for independent mobility: (1) child/parent dyad wants to increase independent mobility; (2) child only wants to increase independent mobility while parents do not; (3) child does not want to increase independent mobility while parents do; and (4) child/parent dyad does not want to increase independent mobility. Findings illuminate the importance of recognizing children as active and capable agents of change.

What Influences Health Professionals’ Recommendations for Non-Scheduled Childhood Vaccinations? A Qualitative Study of Health Professionals’ Perspectives in Three Provinces of China

Recommendations by health professionals are important for vaccines that are not included in national schedules. This study explored health professionals’ perspectives on recommending non-scheduled (user-fee) childhood vaccinations in China, identifying key influences on professionals’ interactions with caregivers. We conducted individual semi-structured interviews with 20 health professionals from three provinces in China and analyzed data thematically using deductive and inductive coding. Health professionals from all three provinces were uncomfortable about being perceived to encourage parents to accept vaccines that incurred a fee. They provided information about non-scheduled vaccines but emphasized parental autonomy in decision-making. Rural parents were less aware of unscheduled vaccines and health professionals were more likely to encourage parents living in more affluent areas to consider these vaccines; varicella vaccine was preferred by parents as a way of preventing school absence. Economic incentives for unscheduled vaccines were given to staff at most study sites, although the amount given varied widely. These variations meant that staff receiving lower incentives were not motivated to promote non-scheduled vaccines if their workload was high; on the contrary, those receiving higher incentives were more likely to promote these vaccines. Health professionals need more guidance on how to recommend unscheduled vaccines in an informative, positive and appropriate manner. It is evident that parents’ awareness of these vaccines, and their economic circumstances, influence vaccinators recommendation practice. Economic incentives prompted health professionals to recommend non-scheduled vaccines; however, the application of such staff incentives varied widely in China. To adopt appropriate economic incentives, professional organizations should develop protocols for the use of incentives that account for their influence on recommendation practices. Suitable recommendation policy needs to balance basic salaries with performance-based incentives, consider overall workload, and include monitoring and evaluation of economic incentives.

Understanding mechanisms that may underlie the development and maintenance of anxiety in children and adolescents: Cognitive biases and parenting behaviours

<p>Anxiety is one of the most common forms of psychopathology in children and adolescents. Understanding the mechanisms that underlie the development and maintenance of this disorder is therefore critical. A variety of factors that interact with one another are likely to contribute to the risk and perpetuation of anxiety in young people. Moreover, risk and maintaining factors can occur at both an individual and environmental level. Cognitive biases are one such factor occurring at an individual level that are investigated in Study 1 and Study 2 of this thesis. Cognitive biases are also predicted to have associations with particular kinds of parenting behaviours, and Study 3 investigated these parenting behaviours. Study 3, therefore, provides a bridge between individual level cognitive mechanisms and possible environmental contexts that may contribute to the risk and maintenance of anxiety in young people. In Study 1, the relationships amongst anxiety, interpretation bias, and memory bias were investigated in children (M = 10.1 years, SD = 0.8). Children with higher levels of anxiety exhibit interpretation biases; a tendency to interpret ambiguous information in a negative manner. Moreover, interpretation biases are predicted to create negative memories for ambiguous information. In Study 1, 62 children heard ambiguous information about a novel animal and their interpretation and recall for this information was assessed. Interpretation bias was significantly associated with memory bias; children who interpreted the ambiguous information in a negative way also reported a greater number of negative memories for this information. Children with higher levels of anxiety also reported a greater number of negative memories. In Study 2 the relationship between interpretation bias and memory bias was investigated within an experimental paradigm, to understand whether there was evidence for a causal relationship between these cognitive biases. Children (M = 9.7 years, SD = 1.1) heard a series of ambiguous vignettes, and each vignette was followed by either a negative or a benign interpretation. Children were subsequently asked to recall the vignettes and children who had heard negative interpretations reported a greater number of negative memories. Children with higher levels of anxiety also reported a greater number of negative memories in their recall of the ambiguous vignettes. In Study 3, I investigated parental autonomy restriction and support in the context of parent-adolescent (M = 15.3 years, SD = 0.8) conversations, and their associations with anxiety, interpretation biases, and parental attributions. Higher levels of parental autonomy restriction may contribute to the risk and maintenance of anxiety in young people by signalling that the world is dangerous. Sixty-four mother-adolescent dyads were asked to discuss a recent conflict, and from this interaction maternal autonomy restriction and autonomy support were assessed. Adolescents with higher levels of anxiety and adolescents who exhibited interpretation biases to a greater extent, had mothers who demonstrated a greater amount of autonomy restriction within the conversations. Yet maternal variables were not significantly associated with either autonomy restriction or support. The results support predictions that these characteristics of young people may determine the extent of autonomy restriction parents engage in. In turn, autonomy restrictive parenting behaviours potentially play a role in the risk and maintenance of cognitive biases and anxiety. Overall this thesis contributes to an understanding of the complex and multiple relationships amongst factors that may be involved in the aetiology and perpetuation of anxiety in young people.</p>

Understanding mechanisms that may underlie the development and maintenance of anxiety in children and adolescents: Cognitive biases and parenting behaviours

<p>Anxiety is one of the most common forms of psychopathology in children and adolescents. Understanding the mechanisms that underlie the development and maintenance of this disorder is therefore critical. A variety of factors that interact with one another are likely to contribute to the risk and perpetuation of anxiety in young people. Moreover, risk and maintaining factors can occur at both an individual and environmental level. Cognitive biases are one such factor occurring at an individual level that are investigated in Study 1 and Study 2 of this thesis. Cognitive biases are also predicted to have associations with particular kinds of parenting behaviours, and Study 3 investigated these parenting behaviours. Study 3, therefore, provides a bridge between individual level cognitive mechanisms and possible environmental contexts that may contribute to the risk and maintenance of anxiety in young people. In Study 1, the relationships amongst anxiety, interpretation bias, and memory bias were investigated in children (M = 10.1 years, SD = 0.8). Children with higher levels of anxiety exhibit interpretation biases; a tendency to interpret ambiguous information in a negative manner. Moreover, interpretation biases are predicted to create negative memories for ambiguous information. In Study 1, 62 children heard ambiguous information about a novel animal and their interpretation and recall for this information was assessed. Interpretation bias was significantly associated with memory bias; children who interpreted the ambiguous information in a negative way also reported a greater number of negative memories for this information. Children with higher levels of anxiety also reported a greater number of negative memories. In Study 2 the relationship between interpretation bias and memory bias was investigated within an experimental paradigm, to understand whether there was evidence for a causal relationship between these cognitive biases. Children (M = 9.7 years, SD = 1.1) heard a series of ambiguous vignettes, and each vignette was followed by either a negative or a benign interpretation. Children were subsequently asked to recall the vignettes and children who had heard negative interpretations reported a greater number of negative memories. Children with higher levels of anxiety also reported a greater number of negative memories in their recall of the ambiguous vignettes. In Study 3, I investigated parental autonomy restriction and support in the context of parent-adolescent (M = 15.3 years, SD = 0.8) conversations, and their associations with anxiety, interpretation biases, and parental attributions. Higher levels of parental autonomy restriction may contribute to the risk and maintenance of anxiety in young people by signalling that the world is dangerous. Sixty-four mother-adolescent dyads were asked to discuss a recent conflict, and from this interaction maternal autonomy restriction and autonomy support were assessed. Adolescents with higher levels of anxiety and adolescents who exhibited interpretation biases to a greater extent, had mothers who demonstrated a greater amount of autonomy restriction within the conversations. Yet maternal variables were not significantly associated with either autonomy restriction or support. The results support predictions that these characteristics of young people may determine the extent of autonomy restriction parents engage in. In turn, autonomy restrictive parenting behaviours potentially play a role in the risk and maintenance of cognitive biases and anxiety. Overall this thesis contributes to an understanding of the complex and multiple relationships amongst factors that may be involved in the aetiology and perpetuation of anxiety in young people.</p>

Immunisation and the law : slippery slope to a healthy society

<p>The immunisation of children against communicable diseases is a crucial public health intervention with both individual and collective outcomes. Current New Zealand immunisation policy prioritises parental autonomy, but has not succeeded in actively targeting all of the factors that prevent parents from ever making informed immunisation decisions. Consequently, our coverage rates are unsatisfactory both in absolute (by reference to the goal of 'population immunity') and relative terms. In order to have a realistic chance of meeting the Ministry of Health's optimistic coverage targets, it is necessary to consider whether New Zealand's comparatively weak immunisation law could be strengthened to eliminate the phenomenon of 'passive' non-immunisation without fatally undermining the decision-making capacity of parents. If this is not possible, then either the goal of population immunity or the prioritisation of individual choice must be abandoned. Of the three options for law reform explored by this paper, two are thought to be unworkable because they would, or should, be perceived as failing to achieve the delicate balance between individual freedom and public good. These are, first, a universal mandatory immunisation requirement, which may be justifiable in principle but would almost certainly encounter prohibitive public opposition; and, secondly, a targeted law that would require beneficiaries to make active decisions about immunisation, and (it is submitted) represents an unwarranted misuse of the vulnerability of those dependent upon taxpayer support. The reform option recommended is more moderate and more equitable. Creating a legal presumption in favour of immunisation, at the point of entry into primary school, would shift New Zealand from its current paradigm of 'informed consent' - whereby parents must actively opt in to immunisation - to a United States-style model that required parents who wished to opt out of immunisation to undergo a 'informed refusal' process. The stringency of this process would depend upon the degree to which policy-makers were satisfied that only those parents whose deeply held convictions prevented them from being open to persuasion were attempting to invoke it. Unless the size of the anti-immunisation lobby significantly increases, it is suggested that an informed refusal requirement could successfully tackle the problem of passive non-immunisation, thereby discharging the State's responsibility to further the interest of all New Zealanders in achieving and maintaining population immunity levels.</p>

Immunisation and the law : slippery slope to a healthy society

<p>The immunisation of children against communicable diseases is a crucial public health intervention with both individual and collective outcomes. Current New Zealand immunisation policy prioritises parental autonomy, but has not succeeded in actively targeting all of the factors that prevent parents from ever making informed immunisation decisions. Consequently, our coverage rates are unsatisfactory both in absolute (by reference to the goal of 'population immunity') and relative terms. In order to have a realistic chance of meeting the Ministry of Health's optimistic coverage targets, it is necessary to consider whether New Zealand's comparatively weak immunisation law could be strengthened to eliminate the phenomenon of 'passive' non-immunisation without fatally undermining the decision-making capacity of parents. If this is not possible, then either the goal of population immunity or the prioritisation of individual choice must be abandoned. Of the three options for law reform explored by this paper, two are thought to be unworkable because they would, or should, be perceived as failing to achieve the delicate balance between individual freedom and public good. These are, first, a universal mandatory immunisation requirement, which may be justifiable in principle but would almost certainly encounter prohibitive public opposition; and, secondly, a targeted law that would require beneficiaries to make active decisions about immunisation, and (it is submitted) represents an unwarranted misuse of the vulnerability of those dependent upon taxpayer support. The reform option recommended is more moderate and more equitable. Creating a legal presumption in favour of immunisation, at the point of entry into primary school, would shift New Zealand from its current paradigm of 'informed consent' - whereby parents must actively opt in to immunisation - to a United States-style model that required parents who wished to opt out of immunisation to undergo a 'informed refusal' process. The stringency of this process would depend upon the degree to which policy-makers were satisfied that only those parents whose deeply held convictions prevented them from being open to persuasion were attempting to invoke it. Unless the size of the anti-immunisation lobby significantly increases, it is suggested that an informed refusal requirement could successfully tackle the problem of passive non-immunisation, thereby discharging the State's responsibility to further the interest of all New Zealanders in achieving and maintaining population immunity levels.</p>

Vaccine Hesitancy in Parents: Role of Social Networks, Social Media, and Parental Autonomy

Introduction. Vaccine hesitancy in parents is a composite of multiple dimensions such as confidence, complacency, and convenience. A large proportion of parents can be deemed vaccine hesitant, meaning that their vaccine behaviors can range from delaying vaccines, skipping select vaccines, to refusal of all vaccinations. Furthermore, parental vaccine uptake rates and patterns can reflect their decisions based on the balance of parental autonomy versus protecting population health. The current manuscript uses Social Network Theory to explain some of the external influences on parental autonomy. Social networks, both private and public, play a role in vaccine decision making through providing information and support for parents in their choices. This influence, in turn, is mediated by parents’ health literacy and local vaccination policy. Discussion. Social media is an important type of public network that has an outsized influence on vaccine hesitancy. The rhetoric used on anti-vaccine websites often denigrates scientific evidence while at the same time endorsing poor-quality evidence that supports the anti-vaccine point of view. The websites continually propose new hypotheses of how vaccines can cause harm when studies refute their previous assertions, censor critics, and attack people with opposing viewpoints. The contentious nature of vaccine hesitancy based on beliefs, opinions, and attitudes needs a solution much deeper than simply providing factual knowledge or pointing people to reliable websites. Recommendations. Public health practitioners and researchers should try segmenting audiences, targeting private and public social networks, and then testing which persuasive strategies towards vaccinations appeal to different community groups.