Mothers' Misconceptions about Hepatitis B Disease and Hepatitis B Vaccine

Hepatitis B virus (HBV) vaccination has been utilised in Vietnam through the Expanded Program on Immunization (EPI) since 1997 for children under 1 year of age. However, birth-dose coverage declined dramatically to 55% in 2013 and in 2014 following media reports of alleged adverse events following immunisation (AEFIs). Low knowledge and misconceptions about HBV among parents/caregivers have been shown to affect the rates of immunisations. Grounded in the Health Belief Model (HBM), this qualitative cross-sectional study sought to assess misconceptions about HBV and HBV vaccinations among mothers of children under 1 year of age in Ho Chi Minh City, Vietnam, as well as barriers to mothers getting their children vaccinated.

From April to October 2015, the researchers carrried out 10 one-on-one interviews and 5 focus group discussions (FGDs) among a total of 35 mothers whose infants were completely or incompletely immunised. Questions were drawn from the 4 elements of the HBM; selected findings include:

1. Perceived susceptibility (likelihood of getting the disease) - Over half of the mothers (51.4%) were unaware that HBV could be transmitted during childbirth, which in actuality is the main mode of transmission.
2. Perceived severity (perception of how serious an outcome or consequence is from the disease) - 65.7% of mothers said HBV was not life threatening (it is), 42.9% said HBV can be cured (it can), and 31.4% said that it is transmitted genetically from mother to child (it is).
3. Perceived benefits (efficacy of preventive action undertaken) - Only 70.0% of mothers knew that the HBV vaccination programme is free, and 34.3% of mothers believed vaccines that were purchased were more effective than free vaccines from the EPI. The majority (71.4%) believed HBV vaccination would only reduce the risk of disease and not guarantee prevention.
4. Perceived barriers - Barriers to adhering to the vaccination schedule included children being sick (74.3%), the child being a premature infant (20.0%), or vaccination days coinciding with holidays (48.6%); only 17.1% and 14.3%, respectively, cited costs and travel distance as difficulties. Other reasons that influenced a mother's decision included: fear of side effects (94.3%), unprofessional healthcare workers (HCWs) in local clinics (48.6%), wrong vaccine administered (42.9%), no physician at clinic (28.6%), and lack of belief in the EPI programme because their children were not examined before and after vaccination (34.3%).

Mothers' reasons for attending the private vaccination service at the public hospitals (so-called cues to action) were: (i) they believe that HCWs at these hospitals are well trained; (ii) their neighbours had good experiences at these hospitals and suggested they go there; and (iii) they believe that the paid vaccine is of better quality.

Regarding sources of information about HBV vaccination, mothers reported: television (60.0%), internet and children's hospital website (71.4%), vaccination record (54.3%), and brochure (20.0%); 91.4% of participants stated that the best source of information was the medical staff.

Reflecting on the findings, the researchers note that, despite previous media campaigns focused on vaccination for children, levels of reported awareness and knowledge about HBV vaccination within the community were consistently low. Numerous barriers and misconceptions were identified among the respondents, most of which were similar to the misconceptions found in a literature review of relevant studies conducted among Asian populations.

Thus, the researchers conclude that interventions are needed in order to "raise parents' perceptions regarding HBV vaccination through education, encourage them to follow their children's immunization schedule, reassure them that the vaccines are safe, and let them know that both the EPI vaccine and paid vaccine are of the same quality."