Decision-making processes and health care experiences of parents who chose not to vaccinate their children

Introduction: In the past decade, there has been an increase in personal, nonmedical exemptions from mandatory school entry vaccinations. To better understand this trend, this study was designed to qualitatively assess the decision-making processes and health care experiences of parents who decline vaccinations for their children.

Methods: We conducted four focus groups (n = 13) with parents who declined vaccinations for their children. All parents were current Kaiser Permanente Colorado members. Focus groups were audio recorded, transcribed, and coded using open coding methods followed by axial coding.

Results: The focus groups revealed insights into the parents' decision making processes. Many parents had made their decision to decline childhood vaccinations either during pregnancy or while making their birth plan. They believed they could control the health of their children “holistically” through diet, nutrition, and alternative medicines. Parents expressed concerns for their unvaccinated child and indicated it was an evolving decision making process. Parents also wanted physicians to present “both sides” or a “balanced” view of the risks and benefits of vaccination. They wanted the physicians to acknowledge that they “had choices” in the vaccination decisions for their child. Empowerment was a key theme to emerge from these discussions.

Conclusions: Parents are continuously evaluating their vaccination decision for their child, creating an opportunity for effective risk communication strategies to address vaccine hesitancy. These strategies should be designed to empower parents and help them make informed decisions about vaccinating their children. These strategies may be most effective if implemented during pregnancy.