Factors that influence parents' and informal caregivers' views and practices regarding routine childhood vaccination: a qualitative evidence synthesis

Review aim

This Cochrane synthesis of qualitative evidence aimed to explore the factors that influence parents’ views and practices around routine childhood vaccines. To do this, we searched for and analysed qualitative studies of parents’ views, experiences, and practices.

This synthesis complements other Cochrane Reviews assessing the effect of strategies to improve the uptake of childhood vaccination.

Key messages

Many factors influence parents’ vaccination views and practices, including those related to individual perceptions, social relationships, and the wider 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.

What was studied in this synthesis?

Childhood vaccination is one of the most effective ways to prevent serious illnesses and deaths in children. 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. Some parents may not accept available vaccines and vaccination services.

Our understanding of what influences parents’ views and practices around childhood vaccination, and why some parents may not accept vaccines for their children is still limited. Qualitative research explores how people perceive and experience the world around them, and is therefore well‐placed for examining these issues.

What are the main findings of the review?

We included 27 studies in our analysis. Studies were conducted in Africa, the Americas, South‐East Asia, Europe, and the Western Pacific, and included urban and rural settings, as well as high‐, middle‐, and low‐income settings.

Many complex factors were found to influence parents’ vaccination views and practices, which we divided into four themes.

Firstly, parents’ vaccination ideas and practices may be influenced by their broader ideas and practices surrounding health and illness generally, and specifically with regards to their children, and their perceptions of the role of vaccination within this context. Secondly, many parents’ vaccination ideas and practices were influenced by the vaccination ideas and practices of 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. Thirdly, 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. Finally, 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.

The first concept, ‘neoliberal logic’, suggests that many parents, particularly from high‐income countries, understood health and healthcare decisions as 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.

The second concept, ‘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.

How up‐to‐date is this review?

We searched for studies published before 3 June 2020.