TUESDAY, May 5 (HealthDay News) -- Scheduling issues, communication problems and a lack of belief in the importance of vaccinations have been identified as some of the biggest hurdles to getting parents to bring their children in for immunization appointments, U.S. researchers report.

Missed appointments were linked to children being 2.5 times more likely to be behind in their immunization requirements, according to investigators in New York City.

"The good news is that the immunization barriers that we have identified are all modifiable factors," lead investigator Dr. Melissa Stockwell, an assistant professor of clinical pediatrics and population family health with Columbia University's College of Physicians and Surgeons and Mailman School of Public Health, said in a school news release. "Interventions need to be designed and implemented to ensure that all parents have a health-care provider with whom they communicate well, that they have reasonable flexibility with scheduling doctors' appointments for their children, and that there is individual and community-wide education to emphasize the importance of immunization."

The study, based on interviews with 705 New York City moms and dads with children under age 3, found that:

• Parental rescheduling of immunization appointments led to the parent being four times as likely not to keep the new date
• Parents who questioned the importance of vaccines were more than three times as likely not to immunize their child
• If parents had difficulty communicating with the health-care provider, they were almost three times as likely to miss their child's scheduled immunization appointments
• Children who are not the first-born in the family are nearly three times more likely to miss immunization appointments
• Mothers under age 31 were twice as likely to not to make immunization appointments

The findings are scheduled to be presented May 5 at the Pediatric Academic Societies annual meeting, in Baltimore.

The interviews were conducted in English and Spanish at clinics, and health-care provider offices in communities heavily populated by Latino and black families, which previous research has found tend to have the country's lowest immunization rates.

"Going forward, we plan to analyze the data from this study by racial and ethnic groups to see if there are differences," Stockwell said. "Additionally, we plan to design intervention strategies, such as bilingual educational materials focusing on the importance of vaccinations, and information to help health-care professionals address barriers to immunizations, including difficulty scheduling appointments and establishing an open dialogue with parents, to address these causes of missed immunizations."

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