P4.048: Qualitative Attitudes Towards Pediatric Vaccination

Background: Vaccination rates are suboptimal in children, resulting in poor health outcomes for patients and communities. The objective of this study is to better understand drivers of vaccine decision-making in the pediatric setting.

Methods: Zoom interviews were conducted in patients’ preferred language (English or Spanish) with 31 caregivers and 2 adolescent patients, recruited from four academic pediatric ambulatory sites. A semi-structured interview guide explored facilitators and barriers, individual attitudes and perceptions of childhood vaccines including influenza and COVID-19 vaccines, and trusted and distrusted sources of vaccine information. Spanish interviews were translated, and all interviews were transcribed. Interviews were analyzed through Maguire and Delahunt’s thematic analysis method, coded in NVivo, and assessed with panel consensus. Findings were mapped to a social ecological model.

Results: Interviewees had positive, negative, and neutral attitudes towards vaccination often within the same interview. Through thematic analysis, we identified both common perceptions as well as unique or outlier ideas. Drivers of vaccine perspectives occurred at all 5 levels of the social ecological model (Figure 1).

At an individual level, most participants described vaccines as protective, but there was misinformation regarding false side effects, misunderstanding of vaccine mechanics, and confusion surrounding protection versus prevention (Figure 2). Many caregivers reported conducting independent research to guide their decision making.

Within interpersonal networks of family and friends, "social norming” around vaccination encouraged many individuals to get themselves and their children vaccinated. However, many caregivers flagged social connections and social media as untrusted sources of information.

At the healthcare organizational level, almost all interviewees reported trusting healthcare providers, especially doctors, for vaccine information. As a barrier to care, many interviewees felt their providers did not provide sufficient information on vaccination, especially across language barriers. Feeling pressured, judged, or pushed into vaccinations created negative sentiments towards providers. Exploration of practice factors found that physical access was rarely a barrier to vaccination, and almost all interviewees were interested in receiving reminders from the office across multiple communication formats.

Within community frameworks, mandates for school attendance were discussed in both positive and negative ways, but in general increased vaccination.

At the national society level, interviewees cited mistrust of government institutions as a driver of vaccine hesitancy.

Conclusion: To mitigate vaccine hesitancy, providers and public health officials may consider addressing commonly cited barriers to vaccination, such as online misinformation, while in parallel building on positive drivers of vaccination, such as social-norming and school mandates. Finally, avoiding generalization and understanding each patients’ unique perspectives will build trust and improve vaccination rates.