Parent-level barriers to uptake of childhood vaccination: a global overview of systematic reviews

Abstract

IntroductionUnderstanding barriers to childhood vaccination is crucial to inform effective interventions for maximising uptake. Published systematic reviews include different primary studies, producing varying lists of barriers. To make sense of this diverse body of literature, a comprehensive level of summary and synthesis is necessary. This overview of systematic reviews maps all potential parent-level barriers to childhood vaccination identified in systematic reviews. It synthesises these into a conceptual framework to inform development of a vaccine barriers assessment tool.MethodsWe applied Joanna Briggs methodology, searching the Epistemonikos review database and reference lists of included reviews to June 2020. Systematic reviews of qualitative or quantitative data on parent-level barriers to routine vaccination in preschool-aged children were included. Reviews addressing influenza, reporting non-modifiable determinants or reporting barriers not relevant to parents were excluded. Where possible, we extracted review details, barrier descriptions and the number, setting and design of primary studies. Two authors independently screened search results and inductively coded barrier descriptions.ResultsWe screened 464 papers, identifying 30 relevant reviews with minimal overlap. Fourteen reviews included qualitative and quantitative primary studies, seven included quantitative and seven included qualitative studies only. Two did not report included study designs. Two-thirds of reviews (n=20; 67%) only included primary studies from high-income countries. We extracted 573 barrier descriptions and inductively coded these into 64 unique barriers in six overarching categories: (1) Access, (2) Clinic or Health System Barriers, (3) Concerns and Beliefs, (4) Health Perceptions and Experiences, (5) Knowledge and Information and (6) Social or Family Influence.ConclusionsA global overview of systematic reviews of parent-level barriers to childhood vaccine uptake identified 64 barriers to inform development of a new comprehensive survey instrument. This instrument will assess both access and acceptance barriers to more accurately diagnose the reasons for under-vaccination in children in different settings.

Determinants of immunisation dropout among children under the age of 2 in Zambézia province, Mozambique: a community-based participatory research study using Photovoice

“…Primary barriers identified in our study included: practical issues related to health facility access, unreliable and poorly perceived service quality, negative interactions with health workers, caregiver misunderstandings about vaccine side effects and unsupportive household dynamics. Our findings are consistent with many of the dropout determinants that have previously been identified in systematic reviews that included LMIC settings, including: access, health worker availability, missed opportunities, service reliability, family and gender dynamics, childcare challenges for siblings, lack of motivation, fear of side effects, mistrust of the health system and health staff attitudes and behaviour 14 22–25. Other studies in sub-Saharan Africa have identified specific vaccination barriers very similar to ours, including poor interactions with health workers, such as being verbally abused if the child did not look presentable, as well as incurring expenses to reach a facility only to find vaccine stockouts 23.…”

Parents’ intention to vaccinate their child for COVID-19: a cross-sectional survey (CoVAccS – wave 3)

“…24 The discrepancy between these findings and our results may be because of the increased debate surrounding child COVID-19 vaccination, 1 and decreased perceived risk of COVID-19 between January and October 2021, 25 itself associated with vaccination intention. 20 Having had a COVID-19 vaccine oneself was strongly associated with parents' vaccine intentions for their child, in line with systematic review results. 21,22 This is the same pattern of results seen in previous pandemics, with intention to be vaccinated for pandemic influenza being associated with previous seasonal influenza vaccination during the 2009/2010 H1N1 influenza pandemic.…”

“…Previous research indicates that uptake of child vaccination is associated with: perceived vaccine safety, generally positive vaccine attitudes, perceived susceptibility of the child to infection and greater social norms for vaccination. 19, 20 Much research has been carried out on parents’ COVID-19 vaccine intention for their children, including two systematic reviews and meta-analyses. The first review searched papers published up to November 2021 (29 studies included; one conducted in the UK), 21 while the second searched papers published up to December 2021 (44 studies included; two conducted in the UK; data collected March 2020 to September 2021).…”

Factors Influencing Australian Healthcare Workers’ COVID-19 Vaccine Intentions across Settings: A Cross-Sectional Survey

“…Low uptake due to access barriers is often misconstrued as vaccine hesitancy. In future vaccine rollouts, it is key to assess both access and acceptance [43] and proactively develop strategies to address both.…”