Ethno-Cultural Origins, Health Beliefs and Mothers' Behavior Regarding Infant Vaccinations in Israel

"Policy makers should be aware that mothers' vaccination behaviors vary according to ethno-cultural groups to establish culturally tailored intervention programs."

Israel is comprised of various ethno-cultural groups, mainly Jewish (75%) and Israeli Arabs (20%). Since 1989, over 1 million immigrants from various countries have arrived in Israel, predominantly from the Former Soviet Union (FSU) and Ethiopia. Findings from previous studies have shown that immigrants tend to preserve values and norms regarding child care over several generations. One of the models that explains preventive health behaviour, such as infant vaccination, is the interpersonal behaviour model of Triandis (hereafter: TIB). The TIB model emphasises the differences between individualistic and collectivist societies in predicting health behaviour. In that context, the present study examines health beliefs and behaviours of mothers from 4 different ethno-cultural groups: Israeli-born Jewish and Arab-Bedouin women and immigrants born in the FSU and Ethiopia.

The cross-sectional, comparative study was conducted from 2010-2012 among a quota sample of 100 mothers from each ethno-cultural group. A previous study showed that mothers from minority groups felt uncomfortable responding to questions on their health beliefs and health service utilisation when approached in the health clinic. Therefore, the researchers approached mothers leaving the health clinic and asked for their consent to participate in this study following a brief explanation. Participants completed a health belief questionnaire.

Only perceived benefits and susceptibility were found to have significant between-group differences: Bedouin mothers reported the lowest mean values for benefits and susceptibility. Perhaps surprisingly, then, Bedouin mothers had the highest mean rate of vaccination behaviour. A possible explanation is the high regard that Muslim mothers have toward medical and other authorities. For example, findings from previous studies showed that in spite of women's traditional roles in the Arab culture as infant caretakers, decisions about children's well-being remain under the authority of the fathers.

Both immigrants from FSU and Ethiopia had low rates of vaccination behaviour, though the reasons for this may differ. FSU mothers immigrated from an authoritative society where health-related decisions were under the authority of the state. Upon arriving in Israel, where the state allows parents to make decisions with respect to preventive health behaviour, their low rate of vaccination may be an expression of the growing individualistic tendencies permitted in the new society. However, among Ethiopian mothers, results from a previous study showed that African immigrants to Western societies were less aware of the importance of infant vaccinations and tended to vaccinate their children at lower rates than native-born mothers.

A mother's education was a significant predictor of vaccinations among Jewish native-born Israelis and Ethiopian immigrants. Apparently, education enhances mothers' knowledge and understanding on the importance of vaccination as preventive factor in infant mortality and morbidity. Thus, the researchers propose that, going forward, these groups receive education on preventive medication in childhood, starting in pregnancy.

No statistically significant differences were found between the groups regarding sources of information; the majority of mothers from all cultural groups chose to receive information through conversing with the medical team, and relatively few used other sources of information, e.g. 8.5% use the internet and 5% use pamphlets and friends or family.

According to the researchers, the study's findings "have implications for the quality of care and the development of ethnically sensitive health policies. They emphasize the importance of timely initiation of vaccinations in the first months of an infant's life, according to the Ministry of Health regulations. For example, there is a need to disseminate information on the importance of vaccinations to Ethiopian and FSU immigrant mothers....Understanding health beliefs and behaviors within the ethno-cultural context may also help healthcare professionals provide a more culturally sensitive service based on knowledge, awareness and cultural skills....Therefore, we should include these findings in training programs and continuing education for healthcare professionals."

In terms of future avenues for research, further studies could incorporate a health literacy measure to better unravel the links between ethno-culture, health literacy, and vaccination behaviour. In addition, prospective studies that follow a cohort of mothers from pregnancy through age three could provide knowledge for understating mothers' health beliefs and behaviours regarding infant vaccinations as it develops over time.