{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T17:04:29Z","timestamp":1772557469177,"version":"3.50.1"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Childhood vaccination is a very effective public health intervention. Fear of pain during vaccination reduces vaccine willingness and can be addressed by interventions. We aimed to identify behavioural determinants of the use of pain-reducing interventions by Preventive Child Healthcare (PCH) physicians and nurses and the associations of sociodemographic characteristics with these behavioural determinants. We invited all PCH professionals of one municipal health service (Groningen, the Netherlands;\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009180) to fill in an online questionnaire on behavioural determinants of the use of pain-reducing interventions, based on the ASE (Attitude\u2013Social influence\u2013self-Efficacy) model of behaviour. We evaluated the associations of their background characteristics with their responses using logistic regression analyses. Of the 83 PCH professionals, 95% considered it important to reduce pain during vaccination, 90% intended to liaise with children and parents about pain mitigation, and 85% reported a high self-efficacy regarding the use of pain-reducing interventions. Lack of time and knowledge about pain reduction, and difficulties in the use of pain mitigation were negatively associated with the use of pain-reducing interventions. Nurses were more likely than physicians to liaise with children and parents about pain mitigation during vaccination (odds ratio, 95% confidence interval 8.86, 1.62 to 48.4) and believe they are competent to mitigate pain during vaccination (6.27, 1.65 to 23.9).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusion<\/jats:italic>\n                    :\u00a0Most PCH professionals acknowledge the importance of reducing pain during vaccination but experience various barriers in the use of pain-reducing interventions. Education of professionals might contribute to the adherence to guidelines regarding pain reduction.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Childhood vaccination is a very effective public health intervention.<\/jats:italic>\n                              \u2022\n                              <jats:italic>Fear of pain during vaccination reduces vaccine willingness and can be addressed by interventions.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Most Preventive Child Healthcare physicians and nurses acknowledge the importance of reducing pain during vaccination but experience various barriers in the use of pain-reducing interventions.<\/jats:italic>\n                              \u2022\n                              <jats:italic>Education of professionals might contribute to the adherence to guidelines regarding pain reduction.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-025-06740-2","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T01:42:07Z","timestamp":1768268527000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Behavioural determinants of the use of pain-reducing interventions\u2014a survey among professionals who vaccinate children"],"prefix":"10.1007","volume":"185","author":[{"given":"Bianca","family":"van Vreeswijk","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sijmen A.","family":"Reijneveld","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Netty","family":"Bos-Veneman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"6740_CR1","unstructured":"World Health Organization (2023) Immunization coverage. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/immunization-coverage. Accessed 23 January 2025"},{"key":"6740_CR2","unstructured":"Rijksinstituut voor Volksgezondheid en Milieu (2024) Vaccination coverage National Immunisation Programme in the Netherlands. Reporting year 2024. [in Dutch] https:\/\/www.rivm.nl\/bibliotheek\/rapporten\/2024-0044.pdf. Accessed 23 January 2025"},{"key":"6740_CR3","unstructured":"Rijksinstituut voor Volksgezondheid en Milieu (2023) Concerns over falling vaccination coverage within National Immunisation Programme. https:\/\/www.rivm.nl\/en\/news\/concerns-over-falling-vaccination-coverage-within-national-immunisation-programme. Accessed 23 January 2025"},{"key":"6740_CR4","unstructured":"World Health Organization (2019) Ten threats to global health in 2019. https:\/\/www.who.int\/news-room\/spotlight\/ten-threats-to-global-health-in-2019.\u00a0Accessed 23 January 2025"},{"key":"6740_CR5","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1007\/s12452-021-00246-7","volume":"53","author":"MR Van Heuvel","year":"2021","unstructured":"Van Heuvel MR, van Es N, Ruijs WLM, Mollema L (2021) Decision-making, doubts, and information needs regarding the meningococcal ACWY vaccination. [in Dutch]. Tijdschr Jeugdgezondheidsz 53:104\u2013110. https:\/\/doi.org\/10.1007\/s12452-021-00246-7","journal-title":"Tijdschr Jeugdgezondheidsz"},{"key":"6740_CR6","doi-asserted-by":"publisher","first-page":"4807","DOI":"10.1016\/j.vaccine.2012.05.011","volume":"30","author":"A Taddio","year":"2012","unstructured":"Taddio A, Ipp M, Thivakaran S, Jamal A, Parikh C, Smart S, Sovran J, Stephens D, Katz J (2012) Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine 30:4807\u20134812. https:\/\/doi.org\/10.1016\/j.vaccine.2012.05.011","journal-title":"Vaccine"},{"key":"6740_CR7","doi-asserted-by":"publisher","first-page":"3629","DOI":"10.1016\/j.vaccine.2015.11.005","volume":"34","author":"Reducing pain at the time of Vaccination","year":"2015","unstructured":"Reducing pain at the time of Vaccination (2015) WHO position paper, September 2015 \u2013 Recommendations. Vaccine 34:3629\u20133630. https:\/\/doi.org\/10.1016\/j.vaccine.2015.11.005","journal-title":"Vaccine"},{"key":"6740_CR8","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1503\/cmaj.150391","volume":"187","author":"A Taddio","year":"2015","unstructured":"Taddio A, McMurtry CM, Shah V et al (2015) Reducing pain during vaccine injections: clinical practice guideline. CMAJ 187:975\u2013982. https:\/\/doi.org\/10.1503\/cmaj.150391","journal-title":"CMAJ"},{"key":"6740_CR9","unstructured":"European Centre for Disease Prevention and Control (2016) Let\u2019s talk about protection. https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/media\/en\/publications\/Publications\/lets-talk-about-protection-vaccination-guide.pdf. Accessed 23 January 2025"},{"key":"6740_CR10","unstructured":"Centers for Disease Control and Prevention (2024) Make shots less stressful for your child. https:\/\/www.cdc.gov\/vaccines-children\/before-during-after-shots\/less-stress.html. Accessed 23 January 2025"},{"key":"6740_CR11","unstructured":"Rijksinstituut voor Volksgezondheid en Milieu (2025) Guideline National Immunisation Programme 2025. [in Dutch] https:\/\/rijksvaccinatieprogramma.nl\/professionals\/richtlijnen\/uitvoering-2025\/9-vaccinatietechniek. Accessed 23 January 2025"},{"key":"6740_CR12","volume":"161","author":"B Van Vreeswijk","year":"2017","unstructured":"Van Vreeswijk B, Bos-Veneman N, Reijneveld SA (2017) Pain reduction during vaccination of young children. Ned Tijdschr Geneeskd 161:D1405","journal-title":"Ned Tijdschr Geneeskd"},{"key":"6740_CR13","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.vacune.2018.03.003","volume":"19","author":"MA Carrasco","year":"2018","unstructured":"Carrasco MA, Munoz LC, Merino AG, Perruca MM, Besada MJR (2018) Can primary care nurses contribute to the reduction of pain when vaccinating? Vacunas (English Edition) 19:8\u201311. https:\/\/doi.org\/10.1016\/j.vacune.2018.03.003","journal-title":"Vacunas (English Edition)"},{"key":"6740_CR14","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1177\/0009922810384721","volume":"50","author":"K Brady","year":"2011","unstructured":"Brady K, Avner JR, Khine H (2011) Perception and attitude of providers toward pain and anxiety associated with pediatric vaccine injection. Clin Pediatr 50:140\u2013143. https:\/\/doi.org\/10.1177\/0009922810384721","journal-title":"Clin Pediatr"},{"key":"6740_CR15","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.pedhc.2020.12.007","volume":"35","author":"C Cwynar","year":"2021","unstructured":"Cwynar C, Cairns C, Eden L, Vondracek H, Eller B (2021) Barriers to the use of pain prevention techniques during immunization. J Pediatr Health Care 35:e1\u2013e3. https:\/\/doi.org\/10.1016\/j.pedhc.2020.12.007","journal-title":"J Pediatr Health Care"},{"key":"6740_CR16","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-13-400","volume":"13","author":"AJM Schellart","year":"2013","unstructured":"Schellart AJM, Zwerver F, Anema JR, van der Beek AJ (2013) Relationships between the intention to use guidelines, behaviour of insurance physicians and their determinants. BMC Health Serv Res 13:400. https:\/\/doi.org\/10.1186\/1472-6963-13-400","journal-title":"BMC Health Serv Res"},{"key":"6740_CR17","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1093\/her\/3.3.273","volume":"3","author":"H De Vries","year":"1988","unstructured":"De Vries H, Dijkstra M, Kuhlman P (1988) Self-efficacy: the third factor besides attitude and subjective norm as a predictor of behavioural intentions. Health Educ Res 3:273\u2013282. https:\/\/doi.org\/10.1093\/her\/3.3.273","journal-title":"Health Educ Res"},{"key":"6740_CR18","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1006\/pmed.2000.0787","volume":"32","author":"MR Crone","year":"2001","unstructured":"Crone MR, Reijneveld SA, Burgmeijer RJ, Hirasing RA (2001) Factors that influence passive smoking in infancy: a study among mothers of newborn babies in the Netherlands. Prev Med 32:209\u2013217. https:\/\/doi.org\/10.1006\/pmed.2000.0787","journal-title":"Prev Med"},{"key":"6740_CR19","doi-asserted-by":"publisher","first-page":"81","DOI":"10.5409\/wjcp.v6.i1.81","volume":"6","author":"JV Schurman","year":"2017","unstructured":"Schurman JV, Deacy AD, Johnson RJ, Parker J, Williams K, Wallace D, Connelly M, Anson L, Mroczka K (2017) Using quality improvement methods to increase use of pain prevention strategies for childhood vaccination. World J Clin Pediatr 6:81\u201388. https:\/\/doi.org\/10.5409\/wjcp.v6.i1.81","journal-title":"World J Clin Pediatr"},{"key":"6740_CR20","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1093\/pch\/18.7.367","volume":"18","author":"S Chan","year":"2013","unstructured":"Chan S, Pielak K, McIntyre C, Deeter B, Taddio A (2013) Implementation of a new clinical practice guideline regarding pain management during childhood vaccine injections. Paediatr Child Health 18:367\u2013372. https:\/\/doi.org\/10.1093\/pch\/18.7.367","journal-title":"Paediatr Child Health"},{"key":"6740_CR21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.nedt.2016.03.022","volume":"41","author":"C Petrucci","year":"2016","unstructured":"Petrucci C, La Cerra C, Aloisio F, Montanari P, Lancia L (2016) Empathy in health professional students: a comparative cross-sectional study. Nurse Educ Today 41:1\u20135. https:\/\/doi.org\/10.1016\/j.nedt.2016.03.022","journal-title":"Nurse Educ Today"},{"key":"6740_CR22","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1093\/eurpub\/ckac114","volume":"32","author":"PL Kocken","year":"2022","unstructured":"Kocken PL, Van Kesteren NMC, Van Zoonen R, Reijneveld SA (2022) Availability and implementation of guidelines in European child primary health care: how can we improve? Eur J Public Health 32:670\u2013676. https:\/\/doi.org\/10.1093\/eurpub\/ckac114","journal-title":"Eur J Public Health"},{"key":"6740_CR23","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1016\/j.pmn.2022.12.002","volume":"24","author":"F Achaliwie","year":"2022","unstructured":"Achaliwie F, Wakefield AB, Mackintosh-Franklin C (2022) Does education improve nurses\u2019 knowledge, attitudes, skills, and practice in relation to pain management? An integrative review. Pain Manag Nurs 24:273\u2013279. https:\/\/doi.org\/10.1016\/j.pmn.2022.12.002","journal-title":"Pain Manag Nurs"},{"key":"6740_CR24","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1007\/s00103-019-03063-0","volume":"63","author":"KB Habersaat","year":"2020","unstructured":"Habersaat KB, Jackson C (2020) Understanding vaccine acceptance and demand - and ways to increase them. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 63:32\u201339. https:\/\/doi.org\/10.1007\/s00103-019-03063-0","journal-title":"Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz"},{"key":"6740_CR25","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-6-42","volume":"6","author":"S Michie","year":"2011","unstructured":"Michie S, van Stralen MM, West R (2011) The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 6:42. https:\/\/doi.org\/10.1186\/1748-5908-6-42","journal-title":"Implement Sci"},{"key":"6740_CR26","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-4-50","volume":"4","author":"LJ Damschroder","year":"2009","unstructured":"Damschroder LJ, Aron EC, Keith RE (2009) Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation 4:50. https:\/\/doi.org\/10.1186\/1748-5908-4-50","journal-title":"Implementation"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-025-06740-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-025-06740-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-025-06740-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T15:25:48Z","timestamp":1772551548000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-025-06740-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,13]]},"references-count":26,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["6740"],"URL":"https:\/\/doi.org\/10.1007\/s00431-025-06740-2","relation":{},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,13]]},"assertion":[{"value":"23 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 October 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 December 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 January 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The protocol was approved by the Central Ethics Review Board non-WMO studies (CTc UMCG). The study was conducted in accordance with the research code of the University Medical Center Groningen.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"This is not applicable: this manuscript does not contain data from any individual person.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"74"}}