The thesis analyzes the requirement-based childhood vaccination programs of Ontario, New Jersey and the recommendation-based programs of UK and Australia. It complicates the prima facie distinction between the requirement and recommendation-based programs by applying the common law requirement of the voluntariness of consent to the vaccination programs. In particular, the voluntariness light is shone on the nature of the “requirement” and “recommendation” to vaccinate distinction; exemptions from the requirement to vaccinate; the choice to refuse vaccination; and financial incentives to doctors and parents. The thesis concludes that on a spectrum of “most voluntary” to “least voluntary,” the aforementioned programs would be located close to each other in terms of actual, practical presence of voluntariness, demonstrating the complexity of the dichotomy between the requirement and recommendation-based vaccination programs.

Vaccinations are among the greatest accomplishments of public health. However, many parents are choosing not to vaccinate. The purpose of this study was to explore the association between social media influence and parents' decisions to vaccinate their children. The health belief model indicates that individuals' likelihood of engaging in a health-related behavior is determined by their perceptions of susceptibility, severity, benefits, and barriers. The research questions addressed whether there is an association between parents' perception of their children's disease susceptibility and their decisions about vaccination, and whether there is an association between exposure to messaging from social media and parents' decision to vaccinate. A quantitative, cross-sectional research design was used. The primary dependent variable was vaccination choices, and the primary independent variable was exposure to information about vaccination through social media. Data were gathered through a questionnaire administered to 269 White parents residing in Illinois with their own children between the ages of 0 and 18 years living with them. Binomial logistic regression showed that there was not a statistically significant relationship between parents' perception of disease susceptibility and vaccination choice or between parents' vaccination choice and exposure to online antivaccine advertisements. These study findings help in defining an overall picture of vaccine hesitancy in the United States. By focusing on the predictors of this behavior, it may be possible to implement interventions to combat the antivaccine movement with the goal of increasing vaccine compliance among parents.

Bakgrund: Vaccinationer räknas till sjukvårdens mest effektiva hälsoåtgärd och räddar cirka 1.5 miljoner liv årligen. Trots möjligheten att utnyttja vaccin väljer somliga att inte vaccineras. Detta fenomen kallas för vaccintveksamhet är ett av de tio största hoten mot den globala folkhälsan. Syfte: Syftet var att beskriva vilka motiv som leder till att föräldrar är tveksamma till att vaccinera sina barn. Metod: En allmän litteraturstudie med en deskriptiv design genomfördes. En litteratursökning utfördes i databaserna Cinal och Pubmed, vilket resulterade i elva kvalitativa studier som var relevanta för denna studies syfte. Travelbees omvårdnadsteori användes som teoretisk referensram. Resultat: Resultaten från artiklarna presenterades i 6 olika teman: oro gällande vaccinets säkerhet, misstro till myndigheter, påverkan av social miljö och normer, naturlig immunisering och sjukdomars allvarlighetsgrad och hälsosam livsstil. Föräldrar ifrågasatte vaccinets säkerhet och upplevde otillräcklig information från myndigheter. En del påverkades av samhällets normer. Somliga ansåg att en naturlig immunisering var att föredra och en del trodde att sjukdomarna var ofarliga. Vissa ansåg att en hälsosam livsstil gav ett tillräckligt skydd mot sjukdomarna. Slutsats: Föräldrarnas tveksamhet till att vaccinera sina barn grundas huvudsakligen i en ofullständig förståelse för vaccinets säkerhet och effektivitet. Många kände misstro till sjukvården och föredrog naturlig immunisering framför vaccinering. Den ofullständiga förståelsen bottnade i många fall i informationsbrist och resulterade i att föräldrar kände oro inför vaccin. Sjuksköterskan har en viktig roll i att inta god handlingsberedskap och att i vårdmötet säkerställa att föräldrarna ges förutsättningar att förstå nyttan och nödvändigheten med vaccin. / Background: Vaccine is one of the most effective tools to prevent diseases and saves around 1,5 million lives yearly. Despite access to vaccines, some individuals choose to not vaccinate. This phenomenon known as vaccine hesitancy, is one of the ten biggest threats to global public health. Purpose: The purpose of this study was to describe the motives behind parents’ hesitancy to vaccinate their children. Method: A litterature study with a descriptive design was performed. A literature search was conducted using Cinahl and PubMed databases, leading to eleven qualitative studies relevant to the purpose of this study. Travelbee's nursing theory was used as a theoretical model. Results: The results from all articles are presented in six themes: Concerns regarding the vaccine’s safety, Distrust of authorities, Impact of social environment and norms, Natural immunization and disease severity and Healthy lifestyle. Parents questioned the safety of the vaccine and experienced lack of information from authorities. Some were influenced by norms of the society. Multiple parents considered that a natural immunization was preferable to the actual diseases. Several believed that a healthy lifestyle would provide enough protection against the diseases. Conclusion: Parents hesitancy to vaccinate their children are mainly based on an incomplete understanding of the vaccine's safety and effectiveness. The incomplete understanding was due to a lack of information which led parents to worry about the vaccine. The nurse has an important role in taking good action readiness and to ensure that parents are given the conditions to understand the benefit and necessity of the vaccine.

Bakgrund Barn som genomgår vaccination enligt allmänt vaccinationsprogram upplever smärta under injektioner. Smärtlindrande metoder som bedövningskräm och sötningsmedel finns, men används inte rutinmässigt. Detta utgör ett onödigt lidande för dessa barn. Syfte Syftet är att undersöka om bedövningskräm alternativt sötningsmedel, ensamt eller i kombination med andra interventioner, kan minska smärtresponsen hos barn mellan 0–6 år i samband med vaccination enligt allmänt vaccinationsprogram. Metod För att besvara studiens syfte gjordes en deskriptiv litteraturöversikt med kvantitativ ansats. Artiklar med RCT som metod kvalitetsgranskades, analyserades och syntetiserades till ett resultat. Resultat Resultatet visar att bedövningskräm respektive sötningsmedel minskar smärtresponsen hos barn som vaccineras enligt allmänt vaccinationsprogram. Bedövningskräm i kombination med amning var ännu mer effektivt än att använda antingen bara bedövningskräm eller bara amning. Vid jämförelse av sötningsmedel och amning pekar forskningen i olika riktningar. Slutsats Resultatet från denna litteraturöversikt visade att bedövningskräm och sötningsmedel kunde minska smärtresponsen hos barn vid rutinmässiga vaccinationer. Även amning kunde minska smärtan, och en kombination av bedövningskräm och amning minskade smärtan ytterligare. Andra interventioner som kunde minska smärtan var fysiskt tröstande metoder, kylspray ochatt suga på napp eller finger. Resultatet skulle kunna leda till ett ökat användande av dessasmärtlindrande metoder på BVC. / Background Children undergoing vaccination according to general immunization programs experience pain during injections. Analgesic methods such as anesthetic cream and sweetening agents are available but are not used routinely. This is an unnecessary suffering for these children. Aim The aim is to investigate whether anesthetic cream or sweetening agents, alone or in combination with other interventions, can reduce pain response in children between 0-6 years of age, during vaccination according to general immunization programs. Method To answer the purpose of the study, a descriptive literature review was done with a quantitative approach. Articles with RCT as a method were quality reviewed, analyzed and synthesized to a result. Results The results show that anesthetic cream and sweetener respectively reduce the pain response in children during vaccination according to general immunization programs. Anesthetic cream in combination with breastfeeding was even more effective than using either just anesthetic cream or just breastfeeding. When comparing sweeteners and breastfeeding, research points in different directions. Conclusion The results from this literature review showed that anesthetic cream and sweeteners could reduce the pain response in children during routine vaccinations. Breastfeeding could also reduce the pain, and a combination of anesthetic cream and breastfeeding could further reduce the pain. Other interventions that could reduce the pain were physically comforting methods, cooling spray and sucking on a pacifier or finger. The result could lead to an increased use of these painrelief methods at childcare centers.

Bakgrund: Flera av världens länder samverkar för att uppnå hög vaccinationstäckning för att kunna kontrollera, eliminera och utrota allmänfarliga sjukdomar. Nationella barnvaccinationsprogram ses som en av de säkraste, mest kostnadseffektiva och framgångsrika interventionerna för att förebygga dödsfall och förbättra liv samtidigt som vaccintveksamhet ses som ett av de tio största hoten mot världshälsan. Syfte: Identifiera faktorer som ligger till grund för föräldrars tveksamhet inför vaccination av sina barn. Metod: En systematisk litteraturstudie där empirisk forskning analyserats och sammanställts. Sökningarna utfördes i två databaser, 19 artiklar inkluderades i litteraturstudien, 12 stycken kvantitativa och sju kvalitativa. Inkluderade artiklar är kvalitetsgranskade. Resultat: I litteraturstudiens resultat presenteras fyra huvudkategorier; Vaccinets verkan, Information, Förtroende samt Levnadsförhållanden och livsstilsval. Resultatet identifierar föräldrars oro för biverkningar och tveksamhet inför vaccinets effekt, sociodemografiska faktorer som påverkar vaccinationstäckningen samt en påverkan från religiös tro. Generellt uppgav föräldrar att det saknade information för att kunna ta beslut om att vaccinera sina barn eller inte. De saknade information om vaccinets innehåll samt engagemang i vårdpersonalens informationsöverföring. Slutsats: Vaccintveksamhet är ett komplext och mångsidigt fenomen. Oro och rädsla inför biverkningar från de olika vaccinerna kan bidra till ökad tveksamhet i beslutsprocessen hos föräldrar och en anledning till att avstå eller fördröja vaccination. Resultatet påvisar vikten av tillräcklig information för att trygga föräldrar i att vaccinera sina barn. Denna litteraturstudie ökar förståelsen inför föräldrars inställning till vaccination och ger en ökad förståelse för hur information om hälsofrämjande åtgärder tas emot av föräldrar. / Background: Several of the world’s countries work together to achieve high vaccination coverage in order to be able to control, eliminate and eradicate dangerous diseases. National childhood vaccination programs are seen as one of the safest, most cost-effective and successful interventions to prevent deaths and improve life while vaccine hesitancy are seen as one of the ten biggest threats to world health. Aim: Identify factors that underlie parents’ hesitation about vaccination their children. Method: A systematic literature review where empirical research has been analyzed and compiled. The searches were performed in two databases, 19 articles were included in the literature review, 12 were quantitative and seven qualitative. Included articles are quality reviewed. Results: In the result of the literature review, for main categories were presented; Vaccine Effect, Information, Confidence and Living Conditions and Lifestyle Choices. The result identify parents’ concerns about side effects and doubts about the vaccine’s effect, certain socio-demographic factors that affect vaccination coverage and also an influence from religious beliefs. In general, parents stated that they lacked sufficient information to be able to decide whether or not to vaccine their children. They laced information about the vaccine’s content and involvement in the healthcare workers information transfer, which led to their own information search on the internet. Conclusion: Vaccine hesitancy is a complex and versatile phenomenon. Anxiety and fear of side effects from the various vaccines can contribute to increased hesitation in the decision-making process in parents and a reason to abstain from or delay vaccination. This literature review increases the understanding of parent’s attitudes towards vaccination and provides an increased understanding of how information about health-promoting measures is received by parents.

Childhood immunization has been one of the most important public health measures in the 20th century. In the United States, 95% of avoidable childhood diseases have been prevented through vaccinations. However, there have been growing concerns around the safety of vaccines, and this increased uncertainty has led to decreases in vaccination participation and increases in cases of preventable diseases. As such, is it important to understand why parents are not vaccinating their children. A qualitative approach was utilized to conduct this study. Flyers to recruit participants were distributed by healthcare providers and were posted in church facilities. Ten parents of children ages 3 to 8 years volunteered to participate to discuss their refusal to or delay in vaccinating their children. The health belief model functioned as the theoretical context to guide this phenomenological study approach in examining the reasons parents are not vaccinating or delaying vaccination of their children. Analysis included constructing a written description of the phenomenon as experienced by the research participants using their responses to the research question, followed by developing response coding schemes, identifying themes, justifying findings, and ensuring sound analysis and reporting of information. For example, word frequency and common phrases were the first steps of the analysis. Results showed that parents had a negative reaction towards childhood vaccination and felt that either the vaccine schedule was too aggressive or contained dangerous toxins that may have side effects. These findings can be used to assist healthcare providers in the way they provide outreach and education to parents as well as potentially helping develop tools that would encourage parents to vaccinate their children.

Bakgrund Alla barn i Sverige har rätt till barnhälsovård, vars uppgift bland annat är att följa och stödja barnets hälsa och utveckling. Forskning visar att vaccination är den enskilda orsaken till att sjukdomsutbrott i samhället har minskat. Trots detta råder ibland tveksamhet hos föräldrar att vaccinera sina barn. Bristande kunskap (hälsolitteracitet) hos föräldrar om sjukdomar, vaccin och dess biverkningar har visat sig vara en orsak till tveksamheten. Syfte Syftet med denna studie är att beskriva sjuksköterskors upplevelse av hälsolitteracitet hos de föräldrar som är tveksamma till vaccination av sina barn. Metod Studien har genomförts som en kvalitativ intervjustudie och induktiv ansats. Data har samlats in från åtta sjuksköterskor i Dalarnas län med hjälp av semistrukturerade intervjuer. Data har analyserats med tematisk analys enligt Braun & Clarke. Resultat Resultatet i denna studie visar att de tveksamma föräldrarna vanligen har fått sin information från sociala medier, släkt och vänner vilket skapar en rädsla för att barnet ska få biverkningar av vaccinet eller ett förändrat immunsystem. En del föräldrar har bristande förtroende för sjuksköterskan och vården och lyssnar hellre på information från sociala medier vilket sjuksköterskorna ofta upplever har ”en stark röst”. Sjuksköterskorna önskar mer kunskap och fakta från staten för att kunna delge föräldrarna relevant och tillförlitlig information. Slutsats Samtliga sjuksköterskor i studien är överens om att det är viktigt att visa respekt och förståelse för föräldrarnas åsikter och möta dem på deras nivå för att skapa ett förtroende och därmed bidra till att öka föräldrars hälsolitteracitet. / Background In Sweden every child has the right to child health. The overall goal of Child health care is to monitor and support the child's health and development. Research shows that vaccination is the only reason why disease outbreaks in society have decreased. Despite this, some parents sometimes hesitate to vaccinate their children. A lack of knowledge (health literacy) among parents about diseases, vaccines and their side effects has been shown to be a reason for the hesitation. Aim The purpose of this study is to describe the nurse's experience of health literacy of parents who are hesitant to vaccinate their children. Method The study has been conducted as a qualitative interview study and an inductive approach. Data has been collected from eight nurses in Dalarna by using semi-structured interviews. The data analysing method was thematic according to Braun & Clarke. Results The results of this study show that the nurse is often faced with difficult challenges. The hesitant parents have usually received their information from social media, relatives and friends which lead to a fear that the child will have side effects from the vaccine or a changed immune system. Some parents have little trust in the nurse and the health care system and prefer to listen to information from social media, which the nurse often feels has "a strong voice". The nurses want more knowledge and facts from the state to be able to provide the parents with relevant and reliable information. Conclusions In this study, all the nurses agreed that it is important to show respect and understanding for parents' opinions and meet them at their level to create trust and be able to increase parents' health literacy.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / INTRODUCTION: Immunizing children from early life is an action of specific protection against infectious diseases, which contributes to improving the health status of a community. There are many vaccines that children receive in the first year of life for the prevention of various diseases, most of which are injectable. In order to reduce the number of injections at the same moment, were developed vaccines combined into a single presentation. The newer vaccines introduced in the childhood vaccination schedule were the pentavalent (DTP + Hib + HB) and polio inactivated vaccine (VIP/Salk). Despite the high standard of safety, vaccines are not entirely free to produce adverse effects, but the risk of serious complications are much smaller than those produced by the diseases against which they protect. OBJECTIVE: To describe the vaccination status of children 2-6 months of life as the vaccine adverse events and their associations. METHODS: A descriptive study of prospective cohort with a quantitative approach in the city of Aracaju, in two public hospitals, with 222 children 6 months of life covered with vaccines the child basic calendar. Two written forms were used, a socioeconomicdemographic and other research of adverse events, applied to the child´s caregiver at the time the child attended the vaccination room to start their vaccination schedule. These children were followed up monthly, until they reached the vaccination course at 6 months of life. The research about the vaccine adverse events was conducted through telephone contact with their guardians within 72 hours after vaccination. For analysis, was used the SPSS Statistics program. The results were analyzed using single frequency, percentage, mean and standard deviation. The associations were evaluated using chi-square test of Pearson or Fisher´s exact test for categorical variables and Mann-Whitney test for continuous variables. RESULTS: A total of 222 children who received a total of 1029 doses of vaccine were assessed. Most of the children were born in the city of Aracaju (95%), presented weight ≥ 2500g at birth (91%); started the vaccination program at USF at 2 months of life (93%). According to the obstetrical history, most realized the prenatal care (53%); the type of childbirth was normal (68%) and full-term pregnancies (88%). The delay in the vaccination schedule was present in 50% (110). The prevalence of adverse event was 65%. Fever 73% (480), 363 local pain (55%), irritability 348 (53%) and persistent crying (59%), are presented as the most frequent adverse events in children vaccinated with pentavalent.CONCLUSION: Half of children presenting delayed vaccination schedule, or even incomplete scheme. Prevalence of 65% post-vaccination adverse events was high. The most common adverse events in children vaccinated by the pentavalent, in our research were: fever, local pain, irritability and insistent cry, besides of local reactions. These events are known and are similar to those already caused by the tetravalent vaccine. / INTRODUÇÃO: Imunizar crianças desde o início da vida é uma ação de proteção específica contra doenças infecciosas, que contribui para melhoria das condições de saúde de uma comunidade. São muitas as vacinas que as crianças recebem no primeiro ano de vida para prevenção de diversas doenças, sendo a maioria delas injetável. Com o intuito de diminuir o número de injeções em um mesmo momento, foram desenvolvidas as vacinas combinadas numa única apresentação. As mais recentes vacinas introduzidas no calendário de vacinação infantil foram a pentavalente (DTP+Hib+HB) e vacina inativada poliomielite (VIP/Salk). Apesar do alto padrão de segurança, as vacinas não estão totalmente livres de produzir eventos adversos, porém os riscos de complicações graves são muito menores do que os produzidos pelas doenças contra as quais protegem. OBJETIVO: Descrever a situação vacinal de crianças de 2 a 6 meses de vida quanto aos eventos adversos pós-vacinais. METODOLOGIA: Estudo descritivo de coorte prospectivo, com abordagem quantitativa realizado na cidade de Aracaju com 222 crianças a partir de 2 meses de vida contempladas com as vacinas do calendário básico infantil. Foram aplicados 2 formulários, um socioeconômico-demográfico e outro de investigação de eventos adversos, no momento da vacinação na Unidade de Saúde da Família. Acompanhou-se estas crianças, mês a mês, até que completassem o esquema de vacinação aos 6 meses de vida. A investigação quanto aos eventos adversos pós-vacinais foi realizada através de contato telefônico com seus responsáveis, em até 72 horas após a aplicação da vacina. Para análise utilizou-se o programa programa SPSS Statistics. Os resultados foram analisados por meio de frequências simples, percentuais, média e desvio padrão. As associações avaliadas por meio de teste Qui-Quadrado de Pearson ou Exato de Fisher para variáveis categóricas ou Teste de Mann-Whitney para variáveis contínuas. RESULTADOS: Foram avaliadas 222 crianças, as quais receberam no total 1029 doses de vacinas. A maioria das crianças nasceu na cidade de Aracaju (95%), apresentou peso ≥ 2500g ao nascer (91%); iniciou o esquema vacinal na USF aos 2 meses (93%). Em relação aos antecedentes obstétricos, a maioria realizou o pré-natal (53%); o tipo de parto foi normal (68%) e gestação a termo (88%). O atraso no esquema vacinal esteve presente em 50% (110). A prevalência de evento adverso foi de 65%. Febre 73% (480), dor local 363 (55%), irritabilidade 348 (53%) e choro persistente (59%), apresentam-se como os eventos adversos mais frequentes em crianças vacinadas com a pentavalente, comparados às outras vacinas. CONCLUSÃO: Metade das crianças apresentam atraso no esquema vacinal, ou até mesmo esquema incompleto. A prevalência de 65% de evento adverso pós-vacinal mostrou-se alta. Os eventos adversos mais frequentes em crianças vacinadas pela pentavalente, em nossa pesquisa, foram: febre, dor local, irritabilidade e choro insistente, além das reações locais. Estes eventos já são conhecidos e assemelham-se aos já provocados pela vacina tetravalente.

Thesis (MPH.) -- University of Limpopo, 2021 / Background: Achieving high vaccination coverage is crucial in the control, prevention and elimination of childhood vaccine preventable diseases. The Expanded Program of Immunization (EPI) aims for 95% coverage for each antigen and complete vaccination schedules for 90% of children under 12 months of age. All the vaccines included in the national vaccination schedule (Bacille Calmette Guerin (BCG), Oral Polio Vaccine, Diphtheria-Pertussis-Tetanus (DPT) vaccine, Measles and Hepatitis B vaccine are provided free of charge in the primary health services in South African public health care facilities. Although the coverage of all vaccines in South Africa has increased especially in recent years, the EPI targets has not been achieved yet in some parts of the coutnry and there are still differences within provinces. Therefore, the primary objective of this study was to investigate the prevalence and determinants of childhood immunization coverage at Primary Healthcare facilities, Bushbuckridge, sub district of the Mpumalanga Province, South Africa. The mean age of the children was 1.4±2.5 years (ranged: 1 months to 12 years. Slightly more than half (56%) of the children were less than 6-months. Nearly two-thirds (63%) of the children were females and only 37% were males. Methodology: A cross-sectional descriptive study was conducted among selected Primary Healthcare facilities in Ehlanzeni District, Bushbuckridge Sub- district, Mpumalanga Province. Simple random sampling was used to get a minimum sample size of 426 mothers and/or caregivers paired with their children required for the study. The researcher administered a validated or tested self-designed questionnaires to the participants. Data analysis was done using the STATA statistical software version 12 for Windows (STATA Corporation, College Station, Texas). Results: The mean age of the participants was 34.1±9.2 years ranged from 15 to 57 years. Almost one-third (28.6%) of the mothers and/or caregivers were 40 years and older and the majority (70%) were unmarried. Majority of the participants had secondary ix education with 65.5% and 23.4% had primary education. Nearly eighty per cent (79.2%) of the maternal and/or caregivers were unemployed. The prevalence rate of fully immunized children was 88% and a significant higher proportion of children in the age group 12 years at 57% were likely not to be fully immunized (p<0.05), followed by age group 6 -11 years, 18 months – 5 years, 6-8 months and 9-11 months at 48%, 26%, 17% 13% respectively. No statistical significant relationship was found between maternal and/or caregiver age, marital status, level of education, employment status and immunization coverage of the child. However, participants aged 40 years and older, less educated and unemployed were likely to have missed immunization of their children. Mother and/or caregivers with a tertiary education were 3.46 times more likely to get their children immunized than those with none/primary education [OR = 3.46, (95% CI:0.75;15.9), p<0.2)]. The employed mother and/or caregivers were 2.01 times more likely to get their children immunized than the unemployed mother and/or caregivers [OR = 2.01, (95% CI: 0.82; 4.89), p<0.20]. In the multivariate model, level of education and employment status were found not to be significantly associated with immunization of the child. Conclusion: The overall immunization coverage in the present study was relatively high and significantly decreased with age. At 6 weeks, all age groups between 0-6 weeks were immunized, while at 10 weeks, with exception of children in the age group 10 -13 weeks and 18 months – 5 years. At 6 months, the young children (age 9-11 months) were likely to default or missed measles vaccination. At 6 and 12 years, the Td vaccination coverage was relatively low. Mothers and/ or caregivers who missed child immunization were likely to experience shortage of vaccines at health facility and said it takes the whole day to immunize a child but the result were not significant. Mother and/or caregivers with a tertiary education and employed were more likely to immunize their children than mothers and/or caregivers with primary, secondary education and the unemployed.

Introduktion: Vaccin har blivit en global framgång för folkhälsan. Vaccinationer har bidragit till att flera barnsjukdomar blivit så sällsynta att de inte längre utgör hot mot samhället. Trots detta finns fortfarande en tveksamhet hos föräldrar kring barnvaccinationer. Vaccintveksamhet finns med som en punkt i WHO:s lista över tio hot mot den globala folkhälsan. Distriktssköterskor inom barnhälsovården och elevhälsovården har en viktig roll i vaccinationsarbetet. Syfte: Syftet var att belysa orsaker till föräldrars tveksamhet eller val att avstå barnvaccination. Metod: Systematisk litteraturstudie utifrån Polit &amp; Becks niostegsmodell. Databaserna som användes var Cinahl och Pubmed. Kvalitativ innehållsanalys enligt Graneheim och Lundman användes för att analysera de 16 artiklarna som användes i studien. Resultat: Består av fyra huvudkategorier; Rädsla att barnet tar skada av vaccinet, Uppfattningar om immunisering, Misstro till auktoriteter och Alternativa livstilsåskådningar. Konklusion: Det är av stor vikt att distriktssköterskan känner till varför föräldrar är osäkra eller väljer helt att avstå att vaccinera sina barn. Det finns en utmaning i att bemöta dessa föräldrar samtidigt som det kräver en bred kompetens grundat i evidens kring vaccination och folkhälsa. Målet är att bemöta barn och föräldrar på ett respektfullt och stödjande sätt när det gäller osäkerhet kring vaccinering.