Three years into the COVID-19 pandemic, approximately 81% of the US population has received at least 1 vaccine and 69% are fully vaccinated. However, that percentage goes way down when looking at rates of vaccination among children (5-11 years, 39%; 2-4 years, 8%; <2 years, 6%).1

Can an educational video and handout for parents improve COVID-19 vaccine rates in pediatric primary care clinics, especially among hesitant parents? Yes, according to research presented at the National Association of Pediatric Nurse Practitioners (NAPNAP) National Conference on Pediatric Health Care held March 15 to 18, 2023, in Orlando, Florida.2 

Alison W. Bray, DNP, APRN, CPNP-PC, led a quality improvement (QI) initiative out of a pediatric primary care clinic in Rockwall, Texas, to increase rates of COVID-19 vaccination among children and adolescents aged 6 to 18 years.

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The clinic had a pediatric COVID-19 vaccination rate of approximately 10% prior to implementing the QI initiative. To raise this rate, researchers considered the volume of misinformation about COVID-19 vaccines that parents consumed, which led parents to believe that COVID-19 vaccines were unsafe, ineffective, or not worth the side effects their child may experience.

“Misinformation from the internet is a large contributor to parents’ hesitancy to vaccinate their children,” Dr Bray said. “Clinicians must focus on vaccine facts from credible sources such as the CDC, American Academy of Pediatrics (AAP), or NAPNAP and share these facts with parents during the valuable clinical time. Clinicians should take the time to answer any parental vaccine questions and not assume parents already have the correct information. A few extra minutes of explanation can make a world of difference as parents highly value their child’s health care provider’s knowledge and opinions.”

Parents Watched Video in Pediatric Waiting Room on Smartphones

The researchers surveyed the parents of 107 patients at the clinic over 3 months. At well-child visits, the parents watched a video about COVID-19 vaccines, received an educational handout, and discussed the vaccine with their provider. The parents were able to access and watch the short AAP mRNA vaccine video in the office examination rooms by scanning a QR code posted on the wall in the rooms with their smartphones while awaiting the provider for their child’s well check-up, Dr Bray explained.

Of these 107 patients, 23 (21.5%) received a COVID-19 vaccine after the educational intervention, indicating a 7.4% increase in the clinic’s COVID-19 vaccination rate. A significant positive relationship between receiving the educational materials and receiving the COVID-19 vaccine was demonstrated (P =.001).

The most impactful aspect of the educational materials was the explanation of how mRNA vaccines do not contain a live virus, according to parental survey data.

“Interestingly, many parents believed that by giving their child a COVID-19 vaccine, they were being injected with the live COVID virus, which would cause the child to “catch COVID” and become ill from the vaccine,” Dr Bray said.

Though this study was limited by a small sample size and the study was conducted over the summer when there were absences among clinic staff, this QI initiative underscores the importance of parental education about vaccines.

Increased pediatric COVID-19 vaccination rates have implications for improved health outcomes in children and for greater community protection against COVID-19, Dr Bray concluded.

Visit Clinical Advisor’s meetings section for more coverage of NAPNAP 2023.


1. US Coronavirus Vaccine Tracker. What percentage of people in each age range received the COVID-19 vaccine? USA Facts, accessed March 8, 2023.

2. Bray AW. Improving COVID-19 vaccine compliance in pediatric primary care. Presented at: NAPNAP National Conference; March 15-18, 2023; Orlando, FL.