Associated Factors with Vaccine Hesitancy in Mothers of Children up to Two Years Old in a Brazilian City
Affiliation
University of Sao Paulo (Garcia, de Souza, Waldman, Sato); Federal University of Minas Gerais (Matozinhos, da Silva)
Date
Summary
"...this may be the first research identifying maternal vaccine hesitancy in Brazil using an established and validated tool, expanding the applicability of this methodology in different contexts of the country. The findings will be useful for understanding maternal behavior and providing the possibility to develop better vaccination promotion strategies."
The Brazilian national immunisation programme (NIP) has worked to ensure high vaccination coverage for almost all immunobiologicals for decades, but, in 2019, seven childhood vaccines showed a reduction in the doses applied when compared to the previous year. The objective of this study is to evaluate factors associated with vaccine hesitancy in mothers of children up to two years old and to investigate whether these factors can the influence maternal decision to vaccinate children.
This is a cross-sectional study of a probabilistic sample of 450 mothers of children born in 2015, living in Araraquara, São Paulo state. Data collection was carried out from August 15 to October 30 2018. The 10-item Vaccine Hesitancy Scale developed by the Strategic Advisory Group of Experts Working Group (SAGE-WG) from the World Health Organization (WHO), in which each item is evaluated on a 5-point Likert scale, was used to assess vaccine hesitancy. In addition, sociodemographic variables and information about aspects related to behaviour, health services, and vaccination were collected. The researchers then performed linear regression models to evaluate the factors associated with vaccine hesitancy.
The study showed that mothers have a positive perception towards vaccination and that they trust the vaccination programme. A large proportion of mothers showed positive behaviour towards the items: Vaccines are important for my child's health (99.5%); vaccines are effective (97.7%); having my child vaccinated is important for the health of others in my community (94.9%); all childhood vaccines offered by the government are beneficial (93.0%); I trust the information I receive about vaccines from the vaccination programme (93.1%); getting vaccines is a good way to protect my child from disease (99.3%); and generally, I do what my healthcare provider recommends about vaccines for my child (97.2%). On the other hand, some mothers showed negative attitudes concerning these items: New vaccines carry more risks than older vaccines (50.8%); I am concerned about the serious adverse effects of vaccines (92.0%); and my child does not need vaccines for diseases that are not common anymore (93.5%).
High family income was associated with lower vaccine hesitancy (greater confidence in vaccines and lower risk perception of vaccines), while the presence of other children, regardless of birth order, in the family was associated with lower confidence in vaccines. A good rapport with health professionals, willingness to wait for the vaccination, and the getting vaccinated through campaigns were associated with greater confidence in vaccines. The deliberate delay or decision not to vaccinate their children and previous experience with adverse reactions to the vaccine were associated with lower confidence in vaccines and greater risk perception of vaccines.
Reflecting on the findings, the researchers propose several public policies and public health interventions to reduce hesitation, such as: (i) strengthening NIPs; (ii) strengthening health systems so they have a basic network with free and universal access; (iii) strengthening surveillance of post-vaccine adverse events; (iv) mobilising health professionals; (v) developing new applied technologies that increase the adherence of families; and (vi) using electronic immunisation systems more widely, among others.
One communication-specific series of recommendations to emerge from these findings is that a good rapport between mothers and health professionals is essential to build trust and to bring parents closer to vaccination services and programmes, ensuring, as consequence, that the information about this subject comes from a reliable source. Per the researchers, extra time must be made available to interact and communicate for parents who are hesitant or abstain from vaccinating their children. In addition, repeated meetings and dialogue are essential, as well as the repetition of information about the benefits of vaccination.
The Brazilian national immunisation programme (NIP) has worked to ensure high vaccination coverage for almost all immunobiologicals for decades, but, in 2019, seven childhood vaccines showed a reduction in the doses applied when compared to the previous year. The objective of this study is to evaluate factors associated with vaccine hesitancy in mothers of children up to two years old and to investigate whether these factors can the influence maternal decision to vaccinate children.
This is a cross-sectional study of a probabilistic sample of 450 mothers of children born in 2015, living in Araraquara, São Paulo state. Data collection was carried out from August 15 to October 30 2018. The 10-item Vaccine Hesitancy Scale developed by the Strategic Advisory Group of Experts Working Group (SAGE-WG) from the World Health Organization (WHO), in which each item is evaluated on a 5-point Likert scale, was used to assess vaccine hesitancy. In addition, sociodemographic variables and information about aspects related to behaviour, health services, and vaccination were collected. The researchers then performed linear regression models to evaluate the factors associated with vaccine hesitancy.
The study showed that mothers have a positive perception towards vaccination and that they trust the vaccination programme. A large proportion of mothers showed positive behaviour towards the items: Vaccines are important for my child's health (99.5%); vaccines are effective (97.7%); having my child vaccinated is important for the health of others in my community (94.9%); all childhood vaccines offered by the government are beneficial (93.0%); I trust the information I receive about vaccines from the vaccination programme (93.1%); getting vaccines is a good way to protect my child from disease (99.3%); and generally, I do what my healthcare provider recommends about vaccines for my child (97.2%). On the other hand, some mothers showed negative attitudes concerning these items: New vaccines carry more risks than older vaccines (50.8%); I am concerned about the serious adverse effects of vaccines (92.0%); and my child does not need vaccines for diseases that are not common anymore (93.5%).
High family income was associated with lower vaccine hesitancy (greater confidence in vaccines and lower risk perception of vaccines), while the presence of other children, regardless of birth order, in the family was associated with lower confidence in vaccines. A good rapport with health professionals, willingness to wait for the vaccination, and the getting vaccinated through campaigns were associated with greater confidence in vaccines. The deliberate delay or decision not to vaccinate their children and previous experience with adverse reactions to the vaccine were associated with lower confidence in vaccines and greater risk perception of vaccines.
Reflecting on the findings, the researchers propose several public policies and public health interventions to reduce hesitation, such as: (i) strengthening NIPs; (ii) strengthening health systems so they have a basic network with free and universal access; (iii) strengthening surveillance of post-vaccine adverse events; (iv) mobilising health professionals; (v) developing new applied technologies that increase the adherence of families; and (vi) using electronic immunisation systems more widely, among others.
One communication-specific series of recommendations to emerge from these findings is that a good rapport between mothers and health professionals is essential to build trust and to bring parents closer to vaccination services and programmes, ensuring, as consequence, that the information about this subject comes from a reliable source. Per the researchers, extra time must be made available to interact and communicate for parents who are hesitant or abstain from vaccinating their children. In addition, repeated meetings and dialogue are essential, as well as the repetition of information about the benefits of vaccination.
Source
PLOS Global Public Health 3(6): e0002026. https://doi.org/10.1371/journal.pgph.0002026. Image credit: Edward Eyer via Pexels (free download)
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