Understanding Parents' Decisions to Vaccinate Children

Background: Over the past decade, parental concerns about the childhood vaccination schedule and requests for alternative scheduled have increased dramatically. Parents seek information about vaccines from multiple sources, including peers, medical providers, and the internet. To preserve herd immunity against vaccine-preventable childhood diseases, we must develop a nuanced understanding of how and when parents make the vaccination decision, and how vaccination decisions are associated with choice of a pediatric medical provider

Objectives: To understand the parental decision-making process around vaccine adherence, including: Who are the main players involved in the decision? In what context is the decision being made? How do parents explain their vaccine decisions to others?

Methods: Researches recruited 23 parents of children ages 18 months- 6 years from an upper-middle class neighborhood in a large northeastern city through an online parent listserv. Respondents were interviewed for approximately 45 minutes about their vaccine decisions and choice of medical provider. Interviews were digitally recorded and transcribed. A codebook was developed using a grounded theory approach, and transcripts were coded using nVivo 8.0. Relevant themes were then 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 often articulate a preference for making the vaccine decision based on scientific or rational data, but simultaneously identify an emotional or instinctual basis to their own vaccine decisions.

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