The Effect of Maternal Decisional Authority on Children's Vaccination in East Asia

"Even though they are important determinants for increasing vaccination rates in advanced and developing nations alike, maternal capacity and decisional authority have not been fully elucidated in diverse countries and cultural spheres."

This study examined the effects of South Korean, Chinese, and Japanese mothers' health literacy, self-efficacy, mass media use, and decisional authority on their children's vaccination after adjustment for their socioeconomic statuses. Parents' socioeconomic characteristics - including insufficient education and lack of decision-making capacity - are associated with the failure to receive vaccination or with incomplete vaccination (for example, the oral polio vaccine (OPV) must be received 4 times up to the age of 5). In East Asia, patriarchal and Confucian characteristics remain and could be relevant to vaccination behaviour.

For the study, computer-assisted web interviews were conducted with married women in their 20s-40s of South Korean, Chinese, or Japanese nationality (n = 1,571). Dependent variables were generated for the following 4 vaccinations: Bacillus Calmette-Guérin (BCG), diphtheria+pertussis+tetanus (DPT), OPV, and measles, mumps, and rubella (MMR). For statistical processing, cases where all 4 types of vaccines had been recorded were scored as 1 and other cases were processed as 0. The study measured the women's decisional authority using the following 5 questions: "Who usually makes decisions on how to spend your income?" "Who usually makes decisions on how to spend your spouse's income?" "Who makes decisions on your use of medical services?" "Who usually purchases objects in your house?" "Who usually makes decisions on visits to family members or relatives?" The women's self-efficacy using the following 5 statements: "I am confident," "I can perform my duties as planned," "Even when something goes wrong at the beginning, I try to finish a task," "I can accomplish important goals when I set them," and "I start right away when there is something to do."

The results for media use showed that women from all 3 countries primarily located health information from the internet and the television. By nationality, South Korean mothers used the internet, Chinese mothers read newspapers or listened to the radio, and Japanese mothers used the internet.

According to the results of the pooled model, the researchers found that for East Asian mothers, decisional authority, self-efficacy, and health literacy all increased the likelihood that they would vaccinate their children. Furthermore, women who searched for health information through media such as the radio were more likely to vaccinate their children. Specifically,

• In Model I, after researchers adjusted for the respondents' socioeconomic characteristics, mothers with high health literacy were more likely to have their children immunised (adjusted odds ratio (aOR): 1.210; 95% confidence interval (CI): 1.067-1.373).
• In Model II, to which media use was added, getting health information from the radio increased the likelihood that the women would immunise their children (aOR: 1.518; 95% CI: 1.013-2.276).
• In Model III, to which maternal capacity was added, mothers who had high decisional authority in terms of their control of the household finances were more likely to immunise (aOR: 1.264; 95% CI: 1.097-1.458).
• In contrast, in Model IV, high health literacy and radio use were important predictors of East Asian mothers' likelihood of having their children immunised.

However, when elaborate analyses were conducted by country, there were considerable differences in those characteristics by country. For example, in South Korea, mothers who watched TV for health information were significantly more likely to have their children immunised (aOR: 1.670; 95% CI: 1.008-2.766). In China, mothers who either listened to the radio (aOR: 1.670; 95% CI: 1.008-2.766) or had high decisional authority (aOR = 1.540; 95% CI: 1.192-1.990) were more likely to have their children immunised. In Japan, mothers who had both high health literacy (aOR: 1.337; 95% CI: 1.096–1.631) and high decisional authority (aOR: 1.391; 95% CI: 1.075-1.800) were more likely to immunise their children. Unusually, in China, mothers who used the internet for information were less likely to have their children immunised (aOR: 0.546).

According to the researchers, this study has 3 central implications for strategies to increase worldwide vaccination rates under the Global Vaccine Action Plan (GVAP).

1. Behavioural science approaches are necessary for mothers in addition to addressing vaccination constraints such as socioeconomic status or low access. The issue of maternal capacity can be addressed even with limited financial resources.
2. It is necessary to establish locally tailored strategies in order to raise vaccination rates under the GVAP. Even mothers who live in advanced countries but have low socioeconomic status may not vaccinate their children because of low health literacy and low maternal capacity.
3. Social contexts must be taken into consideration in order to raise vaccination rates. The reluctance to vaccinate could be reduced through in-depth approaches to sociocultural factors that determine individual attitudes. "Health communication strategies that transparently convey vaccination effects and expected risks to vulnerable maternal groups with low decisional capacity, health literacy, and self-efficacy through various media channels are among such strategies."