Understanding parental decisions about childhood vaccination

Introduction: Parental concerns about the childhood vaccination schedule and requests for alternative schedules have increased dramatically in recent years. To preserve herd immunity against vaccine-preventable childhood diseases, a nuanced understanding of how and when parents make the vaccination decision is needed. The goal of this study was to understand the context of the vaccination decision (including who is involved and what sources of information are used), and how parents explain their vaccine decisions to others. Methods: Twenty-five parents of children ages 18 months-6 years recruited from an upper-middle class neighborhood in a large northeastern city were interviewed individually or as a couple for approximately 45 minutes about their vaccine decisions. Interviews were recorded and transcribed. A codebook was developed using a grounded theory approach, and relevant themes were extracted from coded transcripts. Results: Three key themes emerged from the interviews: (1) Parents do not identify themselves as “alternative vaccinators” even if their choice of childhood vaccine schedule differs from the recommended ACIP schedule. (2) Parents who do vaccinate according to the recommended schedule remain confused and concerned about vaccines, and are often dissatisfied with the vaccine information they receive from providers or their own research. (3) Parents may articulate a preference for making the vaccine decision based on scientific or “rational” data, but simultaneously identify an emotional or instinctual basis to their decisions.

Conclusions: This study reveals important incongruities between the way parents conceptualize their attitudes and preferences around vaccines and their actual vaccine behavior.