Perspectives on the Measles, Mumps and Rubella Vaccination among Somali Mothers in Stockholm

Abstract

Background: Vaccination hesitancy and skepticism among parents hinders progress in achieving full vaccination coverage. Swedish measles, mumps and rubella (MMR) vaccine coverage is high however some areas with low vaccination coverage risk outbreaks. This study aimed to explore factors influencing the decision of Somali parents living in the Rinkeby and Tensta districts of Stockholm, Sweden, on whether or not to vaccinate their children with the measles, mumps and rubella (MMR) vaccine. Method: Participants were 13 mothers of at least one child aged 18 months to 5 years, who were recruited using snowball sampling. In-depth interviews were conducted in Somali and Swedish languages and the data generated was analysed using qualitative content analysis. Both written and verbal informed consent were obtained from participants. Results: Seven of the mothers had not vaccinated their youngest child at the time of the study and decided to postpone the vaccination until their child became older (delayers). The other six mothers had vaccinated their child for MMR at the appointed time (timely vaccinators). The analysis of the data revealed two main themes: (1) barriers to vaccinate on time, included issues surrounding fear of the child not speaking and unpleasant encounters with nurses and (2) facilitating factors to vaccinate on time, included heeding vaccinating parents’ advice, trust in nurses and trust in God. The mothers who had vaccinated their children had a positive impact in influencing other mothers to also vaccinate. Conclusions: Fear, based on the perceived risk that vaccination will lead to autism, among Somali mothers in Tensta and Rinkeby is evident and influenced by the opinions of friends and relatives. Child Healthcare Center nurses are important in the decision-making process regarding acceptance of MMR vaccination. There is a need to address mothers’ concerns regarding vaccine safety while improving the approach of nurses as they address these concerns.

Resurgence of Measles in Europe: A Systematic Review on Parental Attitudes and Beliefs of Measles Vaccine

“…This Swedish study showed that acceptors followed immunization recommendations because they trusted experts [28]. Swedish parents with greater trust were more likely to vaccinate on time, dismiss MMR rumors, and ask more questions [25]. A questionnaire showed more acceptors and vaccine-hesitant parents in Italy considered their pediatrician to be competent, and to have spent enough time discussing MMR uptake, compared with rejectors [29].…”

“…The most common reason for hesitancy or refusal was concern about adverse effects, revealed in 13 of 20 studies. This was mentioned by participants in relation to fear of autism in 10 studies [22][23][24][25][26][29][30][31][32][33] across three countries (UK, Italy, and Sweden). Rejectors and vaccine-hesitant parents were more likely to perceive adverse effects as highly probable and severe [29,34].…”

“…Participants were mainly mothers [22][23][24][25][26], and also included parents with anthroposophical world views [27,28]; some studies included Gypsies, Roma, and Traveler (GRT) parents [22,24], with a history of nomadism and temporary residency, and longterm resident Somali mothers living in Europe [25]. Most studies used a retrospective design in which attitudes and predictors were assessed after they had made their vaccination decision using subjective self-reported behavior.…”

“…Some GRT mothers believed that immune systems would mature with age, and reduce risks of vaccination [24]. However, some mothers from studies in the UK and Sweden used stages of development to inform timeliness of uptake, and therefore delayed vaccination until the child began speaking and socializing normally [23,25].…”

“…Differences between acceptors and rejectors in Switzerland emerged in terms of the perceived reliability of pediatricians [34]. Rejectors blamed mistrust on negative experiences with healthcare professionals [23,25,32]. Many GRTs reported experiencing regular discrimination and exclusion within the healthcare system, which generated hostility and discouraged use of health services [24].…”