Factors Influencing Vaccination in Korea: Findings From Focus Group Interviews

The purpose of this study was to understand the remaining barriers to immunisation in Korea, as well as unmet needs, despite improvements in the economic and geographical accessibility of vaccination through the expansion of the National Immunization Program. Focus group interviews were conducted to explore a deeper understanding of barriers to vaccination than would be provided from quantitative questionnaires.

Immunisation administrators at Korea Centers for Disease Control and Prevention (KCDC)-referred community health centres, paediatricians, and experts on multicultural families, one of the most vulnerable groups, received an explanation of the purpose of the study and a letter soliciting participation. A total of 15 participants, including 10 community health centre staff members, 2 paediatricians, and 3 multicultural family experts, were selected, and no participants dropped out during the research. The research team and the subjects met for the first time at the focus group interview site and had no personal relationships or interests with each other, allowing the experts to exchange ideas as candidly and freely as possible.

The top 4 main reasons for non-vaccination included:

• Vaccine hesitancy: Participants pointed to vaccine hesitancy as a major barrier, adding that this sentiment tends to be very strong. The subtopics for refusing vaccination were distrust in its safety, suspicion regarding its necessity, and fear of adverse effects or abnormal reactions. Paediatricians said that skepticism against vaccination is often rooted in distrust of the overall medical system, and people with such views often rely on information obtained from online communities and websites rather than by consulting doctors when making decisions. The experts agreed that parents can become extremely anxious and choose not to vaccinate their child when community health centres and medical institutions fail to provide consistent information on the safety of vaccination. This indicates the need to deliver accurate and consistent guidance to parents about when vaccinations can be carried out as scheduled and when they should be delayed.
• Personal circumstances that impede vaccination: Representative examples included frequent overseas travel, double-income families, and low accessibility of medical institutions.
• Lack of information: Multicultural family experts pointed to the language barrier and insufficient information as the biggest obstacles for such families. Immigrant women often go through pregnancy and birth without having enough time to adjust to Korean culture. They also tend to have limited social circles, which is another factor preventing them from accessing appropriate information. Furthermore, text messages and other guidelines sent by the KCDC are only in Korean, meaning that such families miss essential advice. According to the researchers, it is vital to encourage these immigrants to visit the Multicultural Family Support Center or to contact the call centre to obtain relevant information at an early stage of immigration and to make information available in both Korean and their mother tongue.
• Misclassification: Missing records were indicated as the major reason for missed vaccinations in certain regions where many of the residents have homes both in Korea and abroad or have recently returned to Korea. In some cases, vaccinations performed by private institutions may not be reflected in the system. The paediatricians blamed the hard-to-navigate immunisation history log system for such mistakes.

When comparing the conclusions of this study to previous studies, the researchers observe that the major factors influencing vaccination have changed over time. Traditional barriers, including financial burdens and geographical accessibility, have been mostly replaced by new barriers, such as vaccine hesitancy, as a result of the implementation of the National Immunization Program, the increased number of institutions providing free vaccination, and the notification service about upcoming vaccinations.

As noted here, the younger generation, who has not experienced firsthand the risk of infectious diseases thanks to the successful vaccination programmes, tend to fear such diseases less. The same population is widely exposed to myths online regarding the risks and side effects of vaccines, leading them to become suspicious and distrustful toward immunisation in general. In this context, more parents seem to refuse vaccination for their children due to fears of possible side effects, suspicions regarding the necessity and effectiveness of vaccination, distrust of vaccination, and a preference for natural immunity.

The study also reinforced the findings of previous studies that educated parents make up a surprisingly high percentage of the population with vaccine hesitancy. They are known to request accurate information regarding side effects and efficacy directly from healthcare workers. Thus, efficient communication guidelines should be provided to healthcare workers to promote efforts to build reliable relationships with patients and parents and to deliver interventions via interactive communication.

The researchers conclude that the results have implications for establishing tailored interventions that target context- and group-specific barriers to improve timely and complete vaccination coverage in Korea. This study also confirmed that various factors prevent individuals from receiving vaccinations, with each affecting a particular vulnerable group. Therefore, a tailored approach targeting each vulnerable group is advisable for addressing the unmet needs and improving vaccination coverage rates. Furthermore, "An individual's attitudes and behaviors regarding vaccination are influenced by a combination of complex factors at multiple levels, including the cultural, social, and political context. Therefore, an integrated strategy including interactive communication through respected community organizations, legal groundwork, and structural reforms will be vital to address the unmet needs of vaccination..., in addition to individual-level health communication...."