Is the cultural context of MMR rejection a key to an effective public health discourse?

Jackie Cassell*, M. Leach, M. S. Poltorak, C. H. Mercer, A. Iversen, J. R. Fairhead

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

55 Citations (Scopus)


Objectives: (1) To explore the social and cultural influences, and health beliefs associated with low uptake of MMR (measles, mumps and rubella vaccine). (2) To describe and explore the prevalence of health beliefs associated with non-compliance with MMR, with a view to improving the personal relevance and impact of information for parents, in the context of persisting low uptake following public controversy. Methods: We undertook a survey of mothers' experiences of and attitudes to the MMR, developed through ethnographic study, which was linked to maternal and child information on the Child Health Database in Brighton, England. Results: Mothers interpret MMR risk through concepts of child health embedded in family health history, with a majority both of compliers and non-compliers holding that each child's immune system is unique. Cultural 'risk factors' for non-compliance relate strongly to the use of complementary healthcare, such as homeopathy, with evidence that rejection of vitamin K is associated with MMR non-compliance. Forty per cent, both of compliers and non-compliers, did not consider the possible benefits to other children of MMR. Conclusions: These findings have paradoxical and challenging consequences for the promotion of immunization in the policy context of increasing emphasis on healthy choices. They demonstrate the need for immunization information that acknowledges and addresses lay concepts of immunity.

Original languageEnglish
Pages (from-to)783-794
Number of pages12
JournalPublic Health
Issue number9
Publication statusPublished - Sep 2006

Bibliographical note

Funding Information:
We would like to thank our advisory group (Graham Bickler, Mark Jones, Martina Pickin, Tom Scanlon, Isabella Thomas and Joanne Yarwood) for helpful comments. We would also like to acknowledge practical support from Surrey and Sussex Health Protection Agency, South Downs NHS Health Trust, and Brighton and Hove City Primary Care Trust). The study was funded by the Economic and Social Research Council. Peter Trail provided assistance with data management and Hannah Evans assisted in the statistical analyses.


  • Choice
  • Homeopathy
  • MMR
  • Survey
  • Vitamin K


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