This recently published Cochrane Review, published by Cochrane Effective Practice and Organisation of Care, explores how parents and carers make decisions regarding vaccinating their children. Cochrane EPOC have also produced a short implementation guide related to this review.
- Many factors influence parents’ vaccination views and practices, including those related to individual perceptions, social relationships, and the wider social and political context in which parents live.
- When parents make decisions about vaccination for their children, they are often communicating not just what they think about vaccines, but also who they are, what they value, and with whom they identify.
Why is it important to understand what affects parents’ and carers’ decisions around vaccinating their children?
Childhood vaccination is one of the most effective ways to prevent serious illnesses and deaths in children. To be successful, vaccination programmes depend on high levels of vaccination uptake.
However, worldwide, many children do not receive all recommended vaccinations. There are several potential reasons for this. Vaccines might be unavailable, or parents may experience difficulties in accessing vaccination services; for instance, because of poor-quality health services, distance from a health facility, or lack of money. Some parents may not accept available vaccines and vaccination services.
Increasing our understanding of what influences parents’ views and practices around childhood vaccination, and why some parents may not accept vaccines for their children will allow healthcare services to tailor their programmes and information to particular groups of people. This should help to promote acceptance and uptake of childhood vaccination and improve child health worldwide.
What did we want to find out?
We wanted to know what factors influence parents’ views and practices around routine childhood vaccination and how these factors influence parents. We were interested in factors that may ‘enhance’ or ‘reduce’ acceptance of vaccination.
What did we do?
We searched for studies that assessed parents’ views, experiences, and practices of childhood vaccination. Studies could take place anywhere in the world where childhood vaccination is provided. People in the study had to be parents or carers who were responsible for deciding whether a child should be vaccinated.
What did we find?
We found 145 relevant studies and analysed the results from 27 of them. Studies took place in Africa, the Americas, South-East Asia, Europe, and the Western Pacific, and included urban and rural locations, as well as high-, middle-, and low-income settings.
Many complex factors influence what parents think about vaccination and what actions they take. We divided these into 4 themes.
- Parents’ vaccination ideas and practices may be influenced by their broader ideas and practices about health and illness generally, and specifically about their children and the role of vaccination in their health care.
- Many parents’ vaccination ideas and practices were influenced by the people they mix with socially. At the same time, shared vaccination ideas and practices helped some parents establish social relationships, which in turned strengthened their views and practices around vaccination.
- Parent’s vaccination ideas and practices may be influenced by wider political issues and concerns, and particularly their trust (or distrust) in those associated with vaccination programmes.
- Parent’s vaccination ideas and practices may be influenced by their access to and experiences of vaccination services and their frontline healthcare workers.
We developed two concepts for understanding possible pathways to reduced acceptance of childhood vaccination.
- ‘Neoliberal logic’, suggests that many parents, particularly from high-income countries, understood health and healthcare decisions to be matters of individual risk, choice, and responsibility. Some parents experienced this understanding as in conflict with vaccination programmes, which emphasise generalised risk and population health. This perceived conflict led some parents to be less accepting of vaccination for their children.
- ‘Social exclusion’, suggests that some parents, particularly from low- and middle-income countries, were less accepting of childhood vaccination due to their experiences of social exclusion. Social exclusion may damage trustful relationships between government and the public, generate feelings of isolation and resentment, and give rise to demotivation in the face of public services that are poor quality and difficult to access. These factors in turn led some parents who were socially excluded to distrust vaccination, to refuse vaccination as a form of resistance or a way to bring about change, or to avoid vaccination due to the time, costs, and distress it creates.
What are the limitations of the evidence?
Our confidence in the evidence is mainly moderate to high. Some studies did not report their findings or methods very well, and some focused on one vaccine, type of participant or country, so were not relevant for other vaccines, participants or countries. All of the included studies were published in English, so we we may have missed findings not published in English. The studies were often quite long with a lot of data, so we had to make practical decisions about how best to manage our analysis, which may have affected interpretations of the evidence.
How up to date is this evidence?
The evidence is up to date to July 2020.