A systematic review of parental vaccine hesitancy and refusal in childhood vaccination

Abstract

Background Acceptance of vaccines is an important predictor of vaccine uptake. This has public health implications as those who are not vaccinated are at a higher risk of infection from vaccine preventable diseases. We aimed to systematically review studies of parental attitudes and beliefs in childhood vaccination, with a focus on the methods used to measure hesitancy and refusal.Methods We identified and reviewed primary research studies using quantitative methods and investigating vaccine attitudes and beliefs published between January 2012 and May 2018. Studies were included if they involved a quantitative survey of the attitudes and beliefs of parents about vaccinations recommended for children. We undertook a narrative synthesis of the results with a focus on evaluating variation in the use of behavioural theories, validated survey instruments, and localisation and adaptation of questions to suit local context.Results A total of 116 studies met the inclusion criteria; 99 used a cross sectional study design, 5 used a case control study design, 4 used a pre-post study design and 8 used mixed methods study designs. Sample sizes of included studies ranged from 49 to 12,259. Thirty-six countries were represented in the included studies. The most commonly used tool was the Parent Attitudes about Childhood Vaccines (PACV) Survey. Questions eliciting vaccination attitudes and beliefs varied widely.Conclusions There was heterogeneity in the types of measures used in studies investigating attitudes and beliefs about vaccination in parents. Broader and more consistent use of validated survey instruments for measuring parental attitudes and beliefs about childhood vaccination would help to better understand localised differences in the reasons for vaccine hesitancy and refusal.