COSSI research projects


Title of project Researchers Project Dates Host Institution and collaborating agencies Description of Project
Understanding Parenting, Community and Vaccination (UPCAV) Julie Leask, Stacy Carter, Paul Ward, Lesley Barclay, Kerrie Wiley, Katie Attwell, Catherine Helps, Adam Dunn, Angus Dawson, Claire Hooker, Paul Corben 2017 - 2020 University of Sydney School of Public Health and Flinders University We will interview parents who don’t vaccinate their children to learn what influences their decisions. We will
then hold community juries and a public engagement process to refine strategies for responding to vaccination rejection that are acceptable to a
well informed citizenry, practical and ethically justified. This is an NHMRC funded project.
Monitoring the gap between evidence and vaccination behaviour by sampling the location-specific consumption of health information from news and social media Adam Dunn, Julie Leask,
Maryke Steffens, Amalie Dyda, Zubair Shah, Aditi Dey, Enrico Coiera, Kenneth Mandl, Mark Johnson
2017-2019 Macquarie University
University of Sydney

This NHMRC funded project grant will refine the ways that machine learning and network science can automatically classify vaccine information presented in news and social media, and estimate location-specific differences in the consumption of that information.
Understanding parental (mis)trust in vaccines for children: a qualitative study Paul Ward, Julie Leask, Samantha Meyer, Philippa Rokkas, (Stacy Carter), Katie Attwell 2015-2017  Flinders University This project uses qualitative analysis to engage with the interview transcripts of 20 vaccine hesitant or rejecting parents from Adelaide. A series of articles from the data explore parental (dis)trust in vaccination expert systems; trust in complementary and alternative medicine, parsing of risk, parenting and lifestyle choices, social milieus and construction of the ‘vaccinating herd.’
Conversations between complementary and alternative medicine practitioners and vaccine-hesitant parents: A qualitative study Jane Frawley, Kerrie Wiley, Jon Adams, Kirsty McKenzie 2016-2017 University of Technology, Faculty of Health; University of Sydney School of Public Health Studies show Complimentary Medicine practitioners are influential in the health care decisions of vaccine-hesitant parents, however we still know little about the daily routine care approaches and behaviours of CM practitioners in relation to vaccination advice. This research project will provide the first examination of the ways CM practitioners influence and communicate with parents about vaccination, with a view to directly helping manage consultations in the interests of safe, effective patient care.
Exploring attitudes of parents, from alternative lifestyle communities in Western Australia, towards immunisation. (“I Immunise”) Colleen Fisher, Jane Jones, Katie Attwell, Michael Wise, Melanie Freeman 2014 – present Immunisation Alliance of WA This project gathered data from parents in Fremantle, WA, who were the target audiences of the “I Immunise” campaign. It uses qualitative analysis to explore semi-structured interview data obtained from 13 participants. This data has been combined with the project “Understanding parental (mis)trust in vaccines for children: a qualitative study” to contribute to the publications listed under that project.
Why do children get severe influenza and whooping cough? Samantha Carlson, Kristine Macartney, Julie Leask, Camilla Scanlan, Helen Marshall, Nigel Crawford, Jim Buttery, and the Paediatric Active Disease Surveillance Network (PAEDS) 2016 – 2019 NCIRS, PAEDS, University of Sydney, and funded by an NHMRC Partnership Project Grant with with contributions from the state health departments of New South Wales, Victoria, South Australia, Western Australia, Queensland and the Northern Territory This project uses mixed-methods research with parents of children who have been hospitalised for influenza and pertussis. It is uses the social ecological model (SEM) as a framework to determine how social networks, organisations, communities, and policies influence a parent’s decision and action to vaccinate their child against pertussis and influenza. Results will be used to develop a causal pathway as well as practical recommendations to prevent children acquiring these vaccine preventable diseases. 
Gaining insight into childhood vaccination refusal in the Byron Shire Community Catherine Helps, Julie Leask, Lesley Barclay 2015- 2019 University of Sydney School of Public Health and the Byron Shire Community This study will aim to develop a greater understanding of parents who chose not to vaccinate their children. It examines the Byron Shire community where childhood vaccination rates are lower than the Australian average and involves in-depth interviews with parents, health and education providers and focus groups with high school students.
Persuasive Communication Challenges in Increasing Vaccine Uptake Lynne Eagle, Stephan Dahl, David R. Low 2016 - ongoing James Cook University Using the examples of the measles, mumps and rubella (MMR) and human papilloma virus (HPV) vaccines, we are examining the factors that may inhibit vaccine uptake and discuss strategies that may improve acceptance and thus uptake of recommended vaccines across a range of population sectors. Particular emphasis is placed on the way that information from a range of electronic platforms, including social media is used in decision making and whether, and in what ways, social marketing strategies can be used to improve vaccination rates.
Aceso Project Bronwyn Harman Ongoing Edith Cowan University The Aceso Project is an ongoing research project that examines psychosocial factors in relation to vaccination and non-vaccination. Its main focus is on why parents in Australia do not vaccinate their children. Recent research has examined non-vaccination in Denmark, WA, and parents who vaccinate, partially vaccinate, and do not vaccinate their children (both papers under review).
Sharing Knowledge About Immunisation (SKAI) Julie Leask, Nina Berry, Margie Danchin, Lyndal Trevena, Kristine Macartney, Tom Snelling, Paul Kinnersley, Holly Witteman 2014-2018 University of Sydney; NCIRS; Murdoch Childrens Research Institute; Melbourne University; Telethon Kids Institute; Laval University; Cardiff University The SKAI Project will develop and evaluate a suite of tailored communication tools and resources for use in primary health care consultations about childhood vaccination. This intervention is designed to equip primary health care providers to address the communication and information needs of parents who are cautious, hesitant, or resistant to routine childhood vaccination
Randomised Controlled Evaluation of a Complex Intervention to Promote Uptake of School-based HPV Vaccination Rachel Skinner, Cristyn Davies, Spring Cooper, Tanya Stoney, Helen Marshall, Jane Jones, Joanne Collins,Heidi Hutton, Adriana Parrella, Gregory Zimet, David G. Regan, Patti Whyte, Julia M. L. Brotherton, Peter Richmond, Kirsten McCaffrey, Suzanne M. Garland, Julie Leask, Melissa Kang, Peter Richmond, Annette Braunack-Mayer, John Kaldor, Kevin McGeechan 2012-current Discipline of Child and Adolescent Health, & Children’s Hospital Westmead, Sydney Medical School, University of Sydney, Australia The National Human Papillomavirus (HPV) Vaccination Program in Australia commenced in 2007 for females and in 2013 for males, using the quadrivalent HPV vaccine (HPV 6,11,16,18). The study aims to examine: 1) student knowledge about HPV vaccination; 2) psycho-social outcomes and 3) vaccination uptake. is a cluster randomised trial of a complex intervention in schools aiming to recruit 40 schools with year-8 enrolments above 100 students. Intervention schools received the complex intervention, which includes an adolescent intervention, a decisional support tool for parents and adolescents and logistical strategies. Careful process evaluation including an embedded qualitative evaluation was undertaken to explore in depth possible mechanisms for any observed effect of the intervention on primary and secondary outcomes.

The study aims to improve vaccination-related psychosocial outcomes, including adolescent knowledge and attitudes, decision-making involvement, self-efficacy, and to reduce fear and anxiety. The study also aims to improve school vaccination program logistics including reduction in time spent vaccinating adolescents and increased number of consent forms returned (regardless of decision).
Increasing maternal and childhood vaccine uptake: managing the challenge and opportunity of complementary medicine practitioners Jane Frawley, Elizabeth Sullivan

2017-2020 Australian Centre of Public and Population Health Research, Faculty of Health, University of Technology Sydney This is an NHMRC Early Career Fellowship. The three objectives of this program of research are:
1. Determine the attitudes of CM practitioners towards vaccination and understand if and what they communicate to parents about maternal and childhood vaccination  
2. Investigate the willingness and confidence of Australian CM practitioners to answer parents’ questions about vaccination
3. Develop, test and evaluate education resources to support positive, evidence-based conversations about vaccination between CM practitioners and parents.
Exploration of vaccine-hesitant parents’ beliefs, information seeking and intentions Jane Frawley, Elizabeth Sullivan

2016-2017 Australian Centre of Public and Population Health Research, Faculty of Health, University of Technology Sydney This work aims to:
1. Determine the attitudes and beliefs of vaccine-hesitant parents towards childhood vaccination
2. Determine the information sources parents trust when making decisions about vaccination
3. Determine what affect the recent Australian legislative changes have had on vaccine-hesitant parents’ intentions regarding vaccination.
The role of midwives in increasing maternal and childhood vaccination uptake Jane Frawley, Cathrine Fowler, Jon Wardle, Helen Hall, Lynn Sinclair, Allison Cummings 2017-2018 Australian Centre of Public and Population Health Research, Faculty of Health, University of Technology Sydney.
Nursing and Midwifery, Monash University, Melbourne
This work will explore the facilitators and barriers to effective, evidence-based conversations between midwives and parents about vaccination. It will also determine if midwives have any information needs in relation to maternal and childhood vaccination. This is particularly important now that pertussis (dTpa) and influenza vaccines are routinely recommended during pregnancy.
The utilisation of complementary and alternative medicine for children: an examination of parental attitudes and information sources Jane Frawley, Debra Jackson, Sandy Davidson

2015-2017 Australian Centre of Public and Population Health Research, Faculty of Health, University of Technology Sydney.
Oxford Brookes University
Endeavour College of Natural Health
The objective of this project is to explore parental decision-making in relation to health care options and services for their children, including complementary medicine (CM). This project will also evaluate parental attitudes to vaccination amongst CM users.
Decision making around vaccination in the attachment parenting community Jon Wardle, Amie Steel, Jane Frawley

2016-2018 Australian Centre of Public and Population Health Research, Faculty of Health, University of Technology Sydney This qualitative project aims to assess factors which support and impose barriers to vaccination, amongst the attachment-parenting community
Community vaccine hesitancy service Shaun Hosein, Sandi Grant, and Andrew Langley TBD Queensland Health - Sunshine Coast Public Health Unit This is a pilot project, where our goal is to provide an in-person consultation service to vaccine hesitant individuals whom require further information and time to discuss concerns with a health care practitioner. This is expected to provide beyond what can be achieved in a busy General Practice, and is intended to support local GP services.

With a successful pilot, we hope to further aid the community through: practical education of health practitioner including students.
Understanding vaccine attitudes in context Tomas Rozbroj, Anthony Lyons, Jayne Lucke 2015-2018 La Trobe University We are using survey data (N≈4,400) to compare 5 vaccine attitude groups in terms of their vaccination behaviour, socio-cultural profiles, broader views, information engagement patterns and knowledge about vaccines. We are also conducting in-depth interviews with vaccine-rejecting Australians to better understand how their attitudes were formed and maintained, and how negative reactions to their vaccine attitudes impact their views.
Examining the facilitators and barriers impacting on immunisation uptake amongst Aboriginal and Torres Strait Islanders Jalil Aqel, Rob Menzies, Holly Seale, Telphia-Leanne Joseph, Sally Nathan June 2017 onwards School of Public Health and Community Medicine, UNSW Sydney This study will include three phases and will incorporate a sequential mixed methods approach:
1. In-depth interviews with health service providers
2. Cross sectional survey of Aboriginal and/or Torres Strait Islanders aged 18 years and above
3. In-depth interviews with a sample of participants from phase 2
Testing Cognitive and Affective Interventions to Improve Public Understanding and Affective Reactions to Pandemic Risk Aaron Scherer 2015-2017 National Science Foundation The purpose of this project is to develop and test communication methods that increase knowledge and best calibrate responses to the risks of infectious diseases—such as Ebola, influenza, MERS, and Zika—by resolving simultaneous contradictory responses (conflicts between beliefs about risk and feelings of risk)
Improving uptake and acceptance of maternal and childhood vaccines in pregnancy in Victoria - a novel and sustainable approach Margie Danchin, Katie Attwell, Michelle Giles, Helen Marshall, Kirsten Perrett, Julie Leask, Tom Snelling and Saad Omer 2017 Murdoch Children’s Research Institute and Melbourne University; University of Western Australia and Telethon Kids Institute, WA; Monash University; The University of Adelaide; University of Sydney; Emory University This project aims to design and pilot a novel, evidenced-based, multi-component vaccine promotion package to be delivered in pregnancy by obstetricians and midwives to assess feasibility and acceptability by providers and mothers. The MumBubVax vaccine promotion package will be targeted at three levels - the practice, provider and parent level - to improve uptake of both maternal and childhood vaccines. This approach capitalises on pregnancy as a key vaccine decision-making time point and will normalise vaccine discussions in Australian antenatal care for the first time. The pilot will inform an NHMRC project grant application in 2019.
Immunisation of young people with disabilities in specialist school settings in Victoria, Australia Jenny O'Neill, Fiona Newall, Margie Danchin, Giuliana Antolovich, Sally Lim 2016-2019 The Royal Children's Hospital; Melbourne The University of Melbourne Department of Paediatrics; The Murdoch Children's Research Institute The aim of this project is to explore and describe acceptance and delivery of immunisation in specialist schools for young people in Victoria, Australia using a socio-ecological framework.
Phase 1 is a prospective cohort study collecting immunisation information at specified time points for immunisation delivery at specialist schools in Victoria who support young people with intellectual and/or physical disability. Phase 2 is planned as a qualitative study, consisting of key informant interviews and focus groups with a numbers of stakeholders recruited through state and local government and schools.
The use of the socio-ecological model will allow for an examination of the wider environmental, social and systemic influences on the acceptance and delivery of immunisation in specialist school settings. It is expected that this research will map the experience of the School Immunisation Program in specialist schools with respect to all those involved from a policy, institutional, family and individual level.
Khusela Immunisation Study: Strengthening Clinic Level Immunisation Service Delivery in Western Cape Province, South Africa Andrea Timothy, Margie Danchin, Margaret Kelaher, Ross Bailie, David Coetzee, Neil Cameron, Chris Morgan 2015 - 2018 The University of Melbourne; Murdoch Children’s Research Institute; University of Sydney; University of Cape Town; Stellenbosch University; City of Cape Town; Western Cape Department of Health; The World Health Organization This project aims to strengthen immunisation service delivery for children aged 12-24 months at the clinic level in the Western Cape by (1) assessing the functioning of immunisation systems at the clinic level to determine barriers and facilitators to service delivery, (2) developing and implementing strategies to strengthen immunisation service delivery and vaccine uptake through careful ongoing monitoring and engagement with the key stakeholders. The key difference in this approach to previous approaches is the focus on the local service delivery context; and the engagement of both health care staff and community members, especially mothers. An integrated analysis of supply and demand side issues can lead to changes in practice that improve efficiency and follow-up of children, and that also promotes dialogue to enable mothers and carers to become more active participants in the process.
As this project will aim to reflect the reality of the immunisation providers, community health leaders and mothers’ experience, it is hoped that the engagement between clinic staff and parents will be strengthened so that both groups are encouraged to take ownership of improving immunisation services and coverage in their community.
Impact of the new Immunisation policies, ‘No Jab No Play’ and ‘No Jab No Pay’, on the Specialist Immunisation Clinic (SIC) and Immunisation Drop in Centre (DIC), Royal Children’s Hospital, Melbourne Margie Danchin, Raffaela Armiento, Nigel Crawford, Kirsten Perrett 2016 – 2017 Royal Children’s Hospital, SAEFVIC, Murdoch Children’s Research Institute This is a prospective, survey-based evaluation of the impact of the ‘No Jab, No Pay’ and ‘No Jab, No Play’ policies on families and immunisation services at the Royal Children’s Hospital (RCH). The primary objective is to assess the proportion of parents attending our services, motivated by the policies. We will also assess immunisation uptake by linkage to the Australian Immunisation Register (AIR) at 1, and 7 months after the encounter, evaluate parents’ attitudes toward immunisation acceptance, and evaluate the number and type of presentations and referrals to our services, compared to prior to the policies’ implementation.
Exploring Reasons for Vaccine-Hesitancy among High-SES Parents of Children <5 Years of Age who Live in Perth, WA Sharon Swaney, Sharyn Burns 2017 – 2018 Curtin University The aim of this project is to explore reasons for vaccine-hesitancy in high-socioeconomic communities in Perth, Western Australia.
The project objectives include exploring:-
• Attitudes and beliefs toward vaccination
• Trust and influences in sources of knowledge about vaccination
• Barriers and enablers associated with vaccination
This qualitative study will conduct semi-structured interviews with Health Care Providers and Parents from high-socioeconomic areas in Perth, Western Australia. A Grounded Theory approach will be employed with sampling continuing until saturation is reached, however, it is anticipated up to 15 Health Care Providers and 15 high-socioeconomic parents will be interviewed.
The outcome of this research will be to gain rich, in-depth information focusing on reasons for vaccine-hesitancy in high-socioeconomic parents of children <5 in Perth, and the development of a theoretical model which will be useful to inform health promotion and public health interventions specific to this demographic.
Monitoring, promoting and responding to the flow of health information in the public domain – insights from public health organisations and populations Maryke Steffens, Julie Leask, Adam Dunn 2017 - 2020 Centre for Health Informatics, Australian Institute for Health Innovation, Macquarie University Investigating how public health organisations monitor, promote and respond to public health information in the public domain, with a focus on their use of social media.
Improving Vaccination Rates in Australia: Analysing Media, Religion and Policy Tom Aechtner 2018 – 2021 Westpac Bicentennial Foundation;
University of Queensland
In an effort to improve vaccination rates this project will identify Australian-specific sources of vaccine hesitancies, including media persuasion and religious concerns. It will report on anti-vaccination media attributes, stakeholder
feedback, Australian immunisation hesitancies, and provide recommendations for positively addressing vaccine objections.
Increasing influenza vaccination uptake among student healthcare workers Jelena Maticevic, Donna Mak, David Macey, Maree Hose, Lauren Bloomfield, Max Bulsasra, Caroline Bulsara 2018 – 2022 The University of Notre Dame, Fremantle (Host)
Murdoch University, Perth, WA
North Metropolitan Public Health Unit, Perth, WA
Edith Cowan University, Perth, WA
This 5-year project aims to increase influenza vaccination uptake among student healthcare workers at two universities in Perth, Western Australia, using a mixed-methods design. Following the collection of baseline data on influenza vaccination uptake in 2018 using both quantitative and qualitative methods of data collection, a multi-layered intervention will be implemented annually at the two Universities from 2019-2022, with an aim to increase influenza vaccination uptake rates among healthcare worker students over subsequent years.
Supporting communication with vaccine-hesitant and declining parents attending two specialist immunisation clinics. Julie Leask, Nina Berry, Pen Robinson, Margie Danchin, Paul Kinnersley, Jo Lander, Lyndal Travena, Sue Randall Current University of Sydney Consultations between clinicians at Specialist Immunisation clinics and hesitant and declining parents  have been recorded before and after “Sharing Knowledge about Immunisations” (SKAI)  training and  the introduction of parent friendly resources to explore the use of tips for health care professionals and their use of resources with parents following SKAI training.
Effective Communication Outbreak Management for Europe Aaron Scherer 2014-2016 European Union The goal of the ECOM project is to develop an evidence-based behavioural and communication package for health professionals and agencies throughout Europe in case of major outbreaks of infectious diseases
'Hesitant Compliers': Qualitative analysis of concerned fully-vaccinating parents Stephanie Enkel, Hayley Christian, Katie Attwell, Tom Snelling February 2015-October 2015 School of Population and Global Health, the University of Western Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute; Sir Walter Murdoch School of Public Policy and International Affairs, Murdoch University Guided by a constructivist paradigm, this project aimed to better understand the perspective of ‘Hesitant Compliers’ in Perth, Western Australia. Hesitant compliers were parents identified as adhering to the childhood vaccination schedule but expressed concerns about the immunisation process. Our findings indicated that while parents recognised vaccinations as a method of preventing illness in their children, they were more likely to focus on possible risks than the benefits. Local vaccination events were also identified as fostering adherence or justifying concerns.
‘The Midwife Project’ Katie Attwell, Kerrie Wiley, Tom Snelling, Claire Waddington, Julie Leask 2015-2016 Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute; National Centre of Immunisation Research and Surveillance, University of Sydney In this project the team sought to ascertain what midwives think and feel about childhood vaccination, to discover any interventions trialled in developed countries and to develop and test an educational intervention for midwifery students in Western Australia. A review of the international literature found a spectrum of views deriving from whether midwives were a mainstream or ‘fringe’ provider of maternity care. There have been no interventions to address vaccine hesitancy in midwives. The team developed a research project to address this at the university education level. The project was provisionally conceptualised, constructed and costed but stalled because funding applications were unsuccessful. Some of this knowledge is now being utilised in the MumBubVax project.

Last updated December 2017