Attitudes, hesitancy, concerns, and inconsistencies regarding vaccines reported by parents of preschool children

Olbrich Neto, Jaime; Olbrich, Sandra Regina Leite Rosa

doi:10.1590/1984-0462/2023/41/2022009

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Brasil

Revista Paulista de Pediatria

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Brasil

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ORIGINAL ARTICLE • Rev. paul. pediatr. 41 • 2023 • https://doi.org/10.1590/1984-0462/2023/41/2022009 copy

Attitudes, hesitancy, concerns, and inconsistencies regarding vaccines reported by parents of preschool children

Atitudes, hesitações, preocupações e inconsistências relacionadas a vacinas relatadas por pais de crianças pré-escolares

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

This study aimed to assess attitudes, concerns, information and knowledge about vaccines among parents of preschool children attending kindergartens in a city in the interior of São Paulo, Brazil, using a self-administered questionnaire.

Methods:

Cross-sectional, questionnaire-based study of knowledge and attitudes regarding vaccination among parents of children aged up to 72 months from public and private schools, between 2018 and 2019.

Results:

Among the 2,528 questionnaires, 1,261 were answered and grouped by respondents’ educational level. According to information, 96.6% of the children were up to date with vaccines. The prevalence of vaccine hesitancy was 5.0%. The lower the educational level, the lower was the income, the larger the number of household members, and the greater the lack of knowledge about vaccines. The higher the educational level, the lower was the vaccine hesitancy, and the greater the dissatisfaction with the information received.

Conclusions:

Generally, parents consider vaccines to be important for preventing diseases and to be safe, with their benefits outweighing the risks. Positive comments were accompanied by doubts, concerns, hesitancy, and inconsistencies. The level of educational attainment makes a difference in the access to information, medical care provided by pediatricians, and the feeling of obligation to vaccinate. Parents have vaccinated and still intend to vaccinate their children, but ensuring adequate levels of vaccination coverage will be a post-pandemic challenge.

Keywords:
Vaccines; Attitudes; Parents; Vaccine hesitancy

Question	Responses (%)	Educational level*						Overall
Question	Responses (%)	IES	CES	IHS	CHS	IHE	CHE	Overall
Are your child’s vaccines up to date?	Yes	94.7^a	96.8^a	96.4^a	96.8^a	98.0^a	96.0^a	96.5^a
	No	5.3	3.2	3.0	3.2	2.0	4.0	3.4
	Did not get vaccinated	0	0	0.6	0	0	0	0.1
Where does your child get vaccinated (service)?	Only SUS	100.0^a	98.9^a	100.0^a	97.9^a	91.9^b	73.2^c	90.8
	Only private	0	0.0	0	0.4	1.0	7.0	2.1
	SUS and private	0	1.1	0	1.7	7.1	19.7	7.1
How many vaccines did your child get?	Reported	36.0	28.7	45.2	57.2	54.6	59.7	52.4
How many vaccines did your child get?	Does not know	64.0^a	71.3^a	54.8^ab	42.8^bc	45.5^c	40.3^d	47.6
How many diseases is your child protected against?	Reported	21.3	20.2	31.0	37.9	44.4	58.7	40.2
How many diseases is your child protected against?	Does not know	78.7	79.8	69.1	62.1	55.6	41.3	59.8
Has your child ever had a reaction to vaccines?	Yes	24.0^a	26.6^a	30.5^a	32.2^a	43.4^b	49.7^b	36.3
Has your child ever had a reaction to vaccines?	No	76.0	73.4	69.5	67.8	56.6	50.3	63.7
Who decides about the vaccination?	Mother and father	17.3	31.2	29.8	38.2	36.4	56.9	39.7
Who decides about the vaccination?	Predominantly the mother	82.7^a	68.8^ab	70.2^ab	61.8^b	63.6	43.1^c	60.4
Can we take a picture of the vaccine card?	Yes	0	0	0.6	0	0	0	0.1
Can we take a picture of the vaccine card?	No	100.0^a	98.9^a	100.0^a	97.9^a	91.9^b	73.2^c	90.8

Question	Responses (%)	Educational level*						Overall
Question	Responses (%)	IES	CES	IHS	CHS	IHE	CHE	Overall
Would you say: my child may have a severe illness if he or she is not vaccinated?	I strongly agree	63.0	76.3	65.1	70.8	72.5	83.7	73.3
	I partially agree	13.7	15.1	13.9	17.2	23.5	14.2	16.1
	I do not agree	2.7	2.2	4.2	2.8	1.0	1.4	2.4
	I don’t know	20.6^a	6.5^b	16.9^a	9.3^b	3.1^c	0.7^c	8.2
Would you say: it is important to vaccinate my child to prevent the spread of the disease in the community?	I strongly agree	70.3	76.3	72.9	75.4	80.6	87.1	78.1
	I partially agree	13.5	19.4	16.9	16.7	17.4	10.2	15.2
	I do not agree	0.0	1.1	0.6	2.8	1.0	2.0	1.8
	I don’t know	16.2^a	3.2^b	9.6^ab	5.1^bc	1.0^cd	0.7^d	4.9
If children are not vaccinated, what is the risk that they will have a disease that vaccines prevent?	Very high	72.2^a	71.3^a	72.5^a	60.3^ab	59.6^ab	55.3^b	62.3
	Low	2.8	2.1	2.4	4.1	4.0	5.5	3.9
	High	20.8^a	25.5^a	22.2^a	33.7^b	33.3^ab	37.5^b	31.6
	Very low	4.2	1.1	3.0	1.9	3.0	1.7	2.2
How important do you think immunizations are in keeping children healthy?	Extremely important	78.4^a	83.7^a	80.2^a	78.2^a	84.7^a	77.7^a	79.3
	Important	0.0	1.1	0.6	0.2	0.0	0.0	0.3
	Fairly important	0.0	2.2	0.0	0.6	2.0	1.0	0.8
	Not important	21.6	13.0	19.2	21.0	13.3	21.3	19.6
If only your child is not vaccinated, what is the risk of having a disease that vaccines prevent?	Very high	63.5^ab	68.1^a	64.1^a	54.9^bc	44.4^cd	37.6^d	52.6
	Low	5.4	8.5	5.4	7.7	15.2	21.0	11.2
	High	31.1	22.3	29.3	35.1	37.4	37.0	33.7
	Very low	0.0	1.1	1.2	2.3	3.0	4.4	2.5

Question	Responses (%)	Educational level*						Overall
Question	Responses (%)	IES	CES	IHS	CHS	IHE	CHE	Overall
Are they too many vaccines?	Yes	21.3^a	20.2^a	26.2^a	19.3^a	25.3^a	21.7^a	21.5
Are they too many vaccines?	No	78.7	79.8	73.8	80.7	74.8	78.3	78.5
I thought a lot about vaccinate	I didn’t think much	52.8	58.7	61.5	57.1	58.1	52.2	56.5
	I thought a lot and I agree	16.7^a	8.7^ab	8.4^ab	6.5^b	7.2^b	8.8^ab	8.2
	I didn’t think about	30.6^a	32.6^a	30.1^a	36.4^a	34.7^a	38.9^a	35.4
As to your certainty about vaccinating your child	# I was not sure and so I did not vaccinate	2.8	1.0	1.2	1.1	2.0	0.34	1.1
	# I was sure and I did not vaccinate	1.4	2.2	1.2	1.3	2.0	0.4	1.2
	# I was not sure and I postponed some vaccines	5.6	2.2	1.8	2.4	4.1	2.7	2.7
	I was not sure but I vaccinated	13.9	11.8	14.5	11.2	12.2	8.5	11.3
	I was sure and vaccinated	76.4^a	82.8^ab	81.3^ab	84.1^ab	79.6^ab	88.1^b	83.8
About your plans for vaccinating your child	Will receive all	90.4^a	91.1^a	96.3^a	95.1^a	92.9^a	94.2^a	94.3
	Will receive if I think they are necessary	8.2	6.7	3.7	4.1	5.1	5.8	5
	Will not receive all vaccines	1.4	2.2	0.0	0.9	2.0	0.0	0.8**

Question	Responses (%)	Educational level*						Overall
Question	Responses (%)	IES	CES	IHS	CHS	IHE	CHE	Overall
Where do you look for information?	SUS	81.3^ab	87.1^a	80.8^ab	74.9^b	62.6^c	37.0^d	66.8
	Pediatrician	0.0	1.1	0.6	2.3	5.1	12.7	4.6
	Various sources	18.7^ab	11.9^b	18.6^ac	22.7^ac	32.3^ac	50.3^d	28.7
The immune system could be weakened by too many vaccines.	I agree	24.4	19.1	20	22.2	20.6	15.3	19.9
	I do not agree	35.1^a	50.0^abc	46.1^ab	55.1^bc	62.9^c	76.3^d	58.1
	I don’t know	40.5^a	30.9^ab	33.9^a	22.8^b	16.5^bc	8.5^d	22
The benefits of vaccines outweigh their risks.	I strongly agree	42.5^ab	53.2^ab	42.9^a	45.9^a	57.6^b	70.7^c	52.9
	I partially agree	15.1	21.3	22.0	24.5	30.3	24.6	23.8
	I do not agree	4.1	1.1	1.2	3.0	4.0	0.7	2.2
	I don’t know	38.4	24.5	33.9	26.6	8.1	4.1	21.1
How safe do you think vaccines are?	Very safe	67.1^a	66.7^a	62.5^a	57.1^a	62.7^a	55.6^a	59.3
	Safe	1.4	3.2	4.8	3.8	3.0	2.0	3.3
	Fairly unsafe	0.0	0.0	1.2	1.3	1.0	0.7	0.9
	Unsafe	31.5	30.1	31.6	37.7	33.3	41.7	36.5
Have you ever felt obligated to vaccinate your child?	Yes. I felt obligated (job. health service. school)	31.0	23.3	27.0	19.2	19.2	11.6	19.4
Have you ever felt obligated to vaccinate your child?	I did not feel obligated	69.0a	76.7ab	73.0abc	80.8bc	80.8cd	88.4d	80.6

Sociedade de Pediatria de São Paulo R. Maria Figueiredo, 595 - 10o andar, 04002-003 São Paulo - SP - Brasil, Tel./Fax: (11 55) 3284-0308; 3289-9809; 3284-0051 - São Paulo - SP - Brazil
E-mail: rpp@spsp.org.br

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[1] *Corresponding author. E-mail: jaime.olbrich-neto@unesp.br (J. Olbrich Neto).