Pediatric Immunization Distress: A Cluster Analyses of Children's, Parents', and Nurses' Behaviors During the Anticipatory Phase.

OBJECTIVE: Using cluster analysis, we aimed to identify a typology of nurses', parents', and young children's behaviors during the anticipatory phase of pediatric immunizations to explore the associations between these different typologies and to determine whether these groups differed with respect to the child's procedural distress as rated by the child and the parents and with respect to the adults' self-rated distress. MATERIALS AND METHODS: Immunizations given by 23 nurses to 220 children aged 3 years and 10 months to 7 years were recorded with behaviors being scored according to Child-Adult Medical Procedure Interaction Scale-Revised, to which 3 new codes were added, and rated with a 6-point Likert scale. Parents' and nurses' ratings of their own distress and of the child's distress, in addition to children's self-rating of distress were obtained. Nine adult and 12 child behavioral codes were submitted for cluster analysis. RESULTS: A solution with 4 clusters for children, 5 clusters for parents, and 5 clusters for nurses was retained. Our results show high consistency between child and adult clusters. During the anticipatory phase, less distressed children, characterized by either low activity or high coping, interacted with adults who showed low activity or high coping support patterns. More distressed children, characterized by resistance and behavioral distress, interacted with adults who displayed either low activity or less efficient support behaviors, such as reassurance and criticism. DISCUSSION: The results confirm previous dimensional studies and add relevant knowledge concerning typologies of participant behaviors that may be useful in understanding such behaviors and in helping providers in their management of child immunizations.