Muslim Parents' Beliefs and Factors Influencing Complete Immunization of Children aged 0-5 Years in a Thai Rural Community: A Qualitative Study

"Using a campaign model in the context of community, such as enhancing awareness through respected role models and combining religious teaching with scientific knowledge for overcoming religious misinformation to promote completed immunization behavior, is required."

In Southern Thailand, Muslims are predominant and have one of the lowest coverages of overall childhood vaccines and the highest risk of measles outbreak. Vaccine acceptance and lifestyles of residents of this area are heavily influenced by Islamic standards and religious leaders. Their characteristics are different from those of other communities in Thailand, where people are mainly Buddhist and are not against vaccination. The purpose of this study was to investigate Muslim parents' beliefs and factors influencing them to complete immunisation of children aged 0–5 years in rural Yala province, Thailand.

A descriptive qualitative study was conducted from September to November 2021, using focus group discussions with 26 participants. They included parents (all mothers) - 12 of whom accepted all vaccines for their children, while 7 parents hesitated for some and one refused all vaccines - and community/religious leaders (all men). Four major themes emerged from the analysis:

1. Positive vaccine beliefs - 15 parents had knowledge of vaccine-preventable diseases and the need for immunisation; 12 parents and 5 leaders trusted in efficacy and safety of vaccines; and 13 parents and 6 leaders trusted in the halal (permissible by Islam) nature of vaccines following a religious verdict (fatwa) by the chief religious leader of Thailand. Parents in the completed vaccination (CV) group and leaders believed that illness and remedies come from God (Allah). Islam encourages prevention of diseases by vaccines. Hence, all Muslims are responsible for accepting the illness and finding ways of disease prevention and treatment that are within the boundaries of religious law.
2. Positive factors influencing positive beliefs and vaccine acceptance - Parents in the CV group had positive experiences with childhood vaccination. Parents in this group, especially the educated, younger generation of parents, mostly sought information on vaccines from village health volunteers (VHV); after that, they obtained information from social media platforms and television. Vaccines were verified halal from the standard laboratory of The Halal Science Center of Chulalongkorn University, Thailand. This official statement was published on social media platforms. Therefore, people who accessed this information had more trust in halal vaccines. All leaders expressed that the leaders and community-health-networks act as role models (e.g., of getting COVID-19 vaccination) and could strongly promote vaccine trust in people. However, 11 parents only believed and followed the community leaders they respected.
3. Negative vaccine beliefs, including bias in vaccine efficacy and safety, personal beliefs about sources of vaccines, and religious misconceptions regarding the value of vaccines and halal concerns. For example, one parent believed that vaccines had been produced by some countries to destroy the global Muslim population (ummah). Another parent believed that vaccines were pathogens that made the child worse and perceived that some Muslim countries did not provide the Expanded Programme on Immunization (EPI) for children. These beliefs could be traced to misinformation from influential people.
4. Negative factors influencing negative beliefs and refusal of vaccination, which were perception of disadvantages of vaccines spread by word of mouth, trust in influential peers over empirical evidence, religious views based on self-interpretation, and lack of public information on halal vaccines. One leader expressed that the halal official report was unclear and inaccessible to all people. People who were urban, less educated people, the elderly, and those who did not use social media platforms were often unable to access this report. "Some know halal, but some do not...I want religious leaders and halal institutes to certify halal issues. It is important to broadcast clearly that vaccines are a good thing."

In reflecting on the findings, the researchers note that the Islamic view is that illnesses and remedies both come from God, and all Muslims are responsible for finding ways of disease prevention and treatment. This Islamic teaching has well-enhanced the vaccine acceptance among parents who accessed credible information sources and obtained deep understanding of Islam. Community/religious leaders who are role models, as well as proactive vaccination campaigns by community-health-networks, could stimulate and encourage parental awareness. Combining religious issues with scientific knowledge through sermons or community events may be effective in promoting immunisation behaviour.

Per the researchers, future studies should include additional data from all refusal groups and individual in-depth interviews to focus on sensitive information that participants are unable to provide in large groups. In addition, data should be collected from fathers, the elderly, and local and traditional medical staff to explore health values in the community.

In conclusion: "To enhance vaccine acceptance, health care providers should understand Muslim cultural beliefs by offering parents a chance to express their attitudes and encourage vaccination via religious leaders and community role models."