Factors Affecting Childhood Immunization: Thematic Analysis of Parents and Healthcare Workers' Perceptions

"It is important that vaccine providers are aware of specific barriers to immunization in their parts of the world."

Healthcare workers (HCWs) have an important role in immunisation of children, as they tend to be the main trusted source of vaccine-related information. Their own attitudes toward immunisation can impact parental perceptions. This review of existing literature explores the perceptions of parents and HCWs toward childhood immunisation. By understanding immunisation-related barriers and attitudes, policymakers and HCWs may be better equipped to address parental concerns and develop strategies to increase immunisation rates.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used as a search strategy for this review. All types of studies (qualitative, quantitative, and mixed-method) published globally in English between 2000 and 2021 were considered. Forty-four studies met the review criteria and were summarised and categorised into 4 themes:

1. Barriers to immunisation: In addition to practical issues (e.g., distance to the health facility), communication-related issues emerged in the studies, including: poor interaction between HCWs and mothers during sessions; perceived adverse reactions; and a lack of proper information. Negative perception and negative publicity can create fear and doubts about the vaccines.
2. Parental knowledge, attitude, and behaviour (KAB): Some of the parental factors identified in the literature were: parental education, religious beliefs, limited knowledge about vaccines, and socioeconomic factors.
3. Health system factors: One paper highlighted that supply and health system barriers and demand-related barriers can act to impede immunisation coverage. For example, factors such as language barriers, HCW information not being clear enough for the parents, low quality of service, and a poor recall or reminder system reportedly impede adequate immunisation coverage. One paper suggested that a one-size-fits-all approach to immunisation information and intervention is not appropriate.
4. HCWs' KAB: Eight articles emphasised how trust in HCWs is integral, and 3 articles highlighted the importance of proper and correct communication and imparting of vaccine information. Two articles stressed how HCWs' own beliefs and attitudes toward vaccines and immunisations can impact services and coverage. Two other articles found that factors such as rudeness, poor attitude, insensitivity, and poor respect of client rights can deter parents from coming in for their next appointment.

Among the recommendations to emerge from the review: HCWs need to be more vigilant in identifying and addressing the factors that affect immunisation adversely; this could be done by surveys and proper communication. HCWs need to have more in-service training and workshops to improve their skills and attitudes. Health ministries should work in partnership with media to impart correct information to the public about childhood vaccination. Finally, the health ministry in a country should include other stakeholders such as community leaders and groups in efforts to spread awareness and correct information about immunisation.