Encountering Parents Who Are Hesitant or Reluctant to Vaccinate Their Children: A Meta-Ethnography

"...it is important to create interventions with multidisciplinary approaches and to improve the communication skills of professionals..."

Health workers are frequently viewed as trusted advisors on and influencers of parental decision-making. Accordingly, they play an important role in addressing parents who are hesitant or reluctant to immunise their children. This meta-ethnography aimed to synthesise the available body of qualitative work about the care experiences of community and hospital health professionals in encounters with parents who are hesitant or reluctant to vaccinate their children. The aim is to provide key information for the creation of strategies that address vaccine hesitancy or refusal and ensure public trust in vaccination programmes.

The researchers conducted a systematic search of the PubMed, Scopus, CINAHL, Web of Science and PsycINFO databases in January 2020, updated in December 2020. An interpretive meta-ethnography of 12 studies was followed; Table 4 in the paper outlines the main characteristics of these studies, which were conducted in Australia, Canada, Israel, the Netherlands, Pakistan, Slovakia, Sweden, the United States, and the United Kingdom.

The metaphor "the stone that refuses to be sculpted", accompanied by three themes, symbolises the care experiences of health professionals in their encounters with parents that hesitate or refuse to vaccinate their children. In the metaphor, healthcare professionals are represented as sculptors and parents as the stones to be sculpted. The sculpting process is construed as necessary to achieve a common good and a low-risk environment for society.

• The first theme, stone hardness, symbolises the degree of deep-rootedness of the parents' decision not to vaccinate. Decisions of non-vaccination were constructed based on false beliefs about vaccination, cultural and religious context, and/or lack of information. The influence of pharmaceutical companies and the existence of economic interests also contributed to hesitant parents justifying their decision of non-vaccination, since the information brochures were sometimes sponsored by large pharmaceutical companies.
• Healthcare professionals often lacked the resources, support, and training to deal with hesitancy or rejection of immunisation; the constant changes in immunisation programmes and their lack of awareness of them did not help. This lack of means was represented in the metaphor as the lack of modelling tools.
• Health professionals felt that it was a matter of professional responsibility and duty to address the care of parents hesitant or reluctant to vaccinate. Metaphorically, this topic is represented as rudimentary sculpting; in the absence of other resources, health professionals had to develop their own strategies to convince and guide these parents. Several said their strategies were based on respect for the opinions, values, and decision-making power of parents. Avoiding confrontation and favouring a respectful relationship of trust were believed to have a positive influence on the long-term results obtained. Health professionals reported that the objective of their recommendations was to convey the safety of vaccines and to make parents see that the risks of contracting the diseases vaccines prevent were much higher than the adverse effects caused by vaccination. There were also professionals in favour of rescheduling visits, delaying vaccinations, or implementing alternative calendars. Despite their efforts, health professionals did not always achieve their goal, and eventually some parents ended up refusing the vaccine. This situation triggered feelings such as anger, indignation, helplessness, and personal failure.

In conclusion: "These results expand the body of knowledge of the disciplines related to childhood vaccination and provide key information to help promote a change in clinical practice, such as the creation of clearer communication strategies, the establishment of a therapeutic alliance, health literacy and the empowerment of parents. In addition, the incorporation of health professionals in decision making and the strengthening of the multidisciplinary teams that encounter these parents are highlighted."