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Table 2 Parental positions on vaccination according to attitudes and behaviours

From: Communicating with parents about vaccination: a framework for health professionals

Unquestioning acceptor 30–40% These parents vaccinate, or want to, vaccinate their children and have no specific questions about the safety and necessity of vaccines. In Gust’s study, they corresponded with the ‘immunisation advocates’ or ‘go along to get along’ groups who see the importance of childhood vaccination and are confident in its safety [28]. They report a good relationship with their healthcare provider and agree that medical professionals have their child’s best interests at heart. This group tend to have less detailed knowledge about vaccination [29, 30].
Cautious acceptor 25–35% These parents vaccinate their children despite minor concerns. They may exhibit a ‘hope and pray’ mentality recognising that vaccines carry rare but serious side effects and hoping that their child is not affected [45]. Both this category and ‘unquestioning acceptors’ were drawn from Benin’s category of ‘vaccination acceptors’ [29].
The hesitant 20–30% These parents vaccinate their child but have significant concerns [29]. In Gust’s study, they most closely correspond to the ‘fence-sitter’ who only slightly agrees about the benefits and safety of vaccination and is neutral about their relationship and trust with their healthcare provider [28]. Hesitants are also more focused towards vaccine risk, and are aware of issues surrounding the MMR vaccine and of other parents not vaccinating their children [30]. Trust in their doctor or nurse is key for this group who are keen to have discussions in which their questions are answered satisfactorily and completely by knowledgeable health professionals with relevant information [29].
Late or selective vaccinator 2–27% Concerns about vaccination result in this group choosing to delay or select only some recommended vaccines [38]. This group most closely correspond with Gust’s ‘worried’ category with significant doubts about the safety and some doubt about the necessity of vaccines [28]. They have concerns about the number of vaccines children have [39]. They experience conflicting feelings about how to get their questions answered and who to trust, [39] and are similar to the vaccine hesitant in actively seeking information [29, 46]. Probably because they actively seek information, in Benin’s study they had the highest levels of knowledge about vaccination [29] and in Downs' study prefer red statistical arguments to anecdotal information [30]. With a specific vaccine scare hesitant parents may ‘select-out’ the vaccine and move to this category, as was the case with MMR vaccine in the UK [40].
Refuser <2% Parents in this group refuse all vaccines for their child. This results from either their existing philosophical position on vaccination, negative experiences with the medical system, or religious beliefs [9]. Contact with the medical establishment and doctors often results in feelings of alienation and disenchantment and they tend to prefer the advice of alternative health professionals [29, 41]. Respondents in Benin’s study indicated a desire for a doctor with whom they could enjoy a trusting relationship and who would accept their decisions about vaccination. Benin’s sample of 33 mothers had less accurate knowledge about vaccination than all other groups except ‘acceptors’ [29]. These parents tend to cluster in communities who share certain religious, philosophical or alternative beliefs [47].