Bakgrund: Vaccin är sjukvårdens viktigaste, mest kostnadseffektiva åtgärd som räddar två till tre miljoner liv per år världen över. Hög vaccintäckning skyddar inte bara individerna utan minskar spridningen av sjukdomar i samhället. Trots detta finns det personer som tvekar på dess effektivitet, säkerhet och nödvändighet. Dessa personer väljer att avstå från att vaccinera sina barn, vilket innebär en risk för individen och samhället. Syfte: Syftet var att beskriva vilka faktorer som gör föräldrar tveksamma till att vaccinera sina barn enligt deras nationella vaccinationsprogram. Metod: Litteraturstudie baserad på tio kvalitativa artiklar publicerade mellan år 2012 och 2019. Datainsamlingen utfördes i databasen PubMed och en sekundärsökning gjordes för att få ett så täckande resultat som möjligt. Den teoretiska referensramen för den här studien grundades på Leiningers transkulturella omvårdnadsteori. Resultat: Resultatet presenteras i fem olika teman: Allvarliga biverkningar och farliga tillsatser, Brist på information, Hälsosam livsstil och naturlig immunisering, Förtroende för myndigheter och Bristande kunskap om sjukdomar. Majoriteten av deltagarna var rädda för att vaccinet kunde skada deras friska barn. Det fanns även en misstanke om att sjukdomarna som vaccin skyddar mot inte är speciellt farliga och att myndigheter som rekommenderar vaccin har finansiellt motiverade avsikter. Hälsosamma levnadsvanor och naturlig uppbyggnad av immunförsvaret ansågs tillräckligt för att skydda ett barn genom livet. Slutsats: De huvudsakliga faktorerna till varför föräldrar tvekar inför att vaccinera sina barn grundar sig i bristande förståelse för vaccin och sjukdomarna det skyddar mot. Genom att skapa sig en förståelse av alla bakomliggande faktorer som påverkar vaccinets förtroende kan varje land skräddarsy insatser som ökar vaccintäckningen. / Background: Vaccine is the most important, cost effective healthcare action that saves two-three million lives each year all over the world. High coverage of vaccine not only protects the individuals but reduces the spread of diseases in the community. Still, there are people who doubt its effectiveness, safety and necessity. These people choose to refrain from getting their children vaccinated, which puts the individual and the society at risk. Purpose: The purpose was to describe what factors make parents hesitant to vaccinate their children according to their national vaccination programme. Method: Literature study based on ten qualitative articles published between 2012 and 2019. The data collection was carried out in the PubMed database and a secondary search was done to obtain as comprehensive result as possible. The theoretical framework of reference for this study was based on Leininger's transcultural nursing theory. Results: The results are presented in five different themes: Serious side effects and dangerous additives, Lack of information, Healthy lifestyle and natural immunization, Trust in authorities and Lack of knowledge about diseases. The majority of participants were afraid that the vaccine could harm their healthy children. There was also a suspicion that what the diseases vaccines protect against are not particularly dangerous and that the authorities recommending the vaccines have financially motivated intentions. Healthy living habits and natural enhancement of the immune system were considered sufficient to protect a child through life. Conclusion: The main factors to why parents hesitate to vaccinate their children are based on a lack of understanding about the vaccines and the diseases it protects against. By creating an understanding of all the factors affecting the confidence in vaccine, each country can tailor actions that increase vaccine coverage.

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.

Bakgrund   Vaccin är en bidragande faktor till att folkhälsan hålls på en god nivå, både nationellt och internationellt. Trots det förekommer misstro till vaccin, och när föräldrar väljer att avstå vaccinationer till sina barn ökar risken att återinföra smittsamma sjukdomar i samhället. Om anledningarna till tveksamhet kan identifieras kan sjuksköterskans arbete individanpassas och personcentrerad vård tillämpas, vilket i sin tur kan bidra till att föräldrar kan göra hälsosamma val för sina barn. Syfte  Syftet med denna litteraturöversikt var att beskriva orsaker till föräldrars tveksamhet inför att vaccinera sina barn. Metod  En icke-systematisk litteraturöversikt genomfördes där 18 vetenskapliga artiklar inkluderades. Artiklarna inhämtades från databaserna PubMed och CINAHL med hjälp av olika sökord och kvalitetsgranskades därefter utifrån Sophiahemmet Högskolas bedömningsmall. Med hjälp av en integrerad dataanalys kunde resultatet redovisas i kategorier samt subkategorier. Resultat Resultatet presenterades genom tre huvudkategorier och åtta subkategorier. De tre huvudkategorierna var: sjukvård och sjukvårdsystem, föräldrars kunskapsbehov samt sociologiska faktorer. De åtta subkategorierna var: information från sjukvårdspersonal, ekonomiska faktorer, kunskapsluckor och missuppfattningar, informationskanalers inverkan, föräldrars uppfattning om vaccinets osäkerhet, oro för biverkningar, livsstil och livsåskådning samt demografi. Slutsats Resultatet visade att det fanns flera olika orsaker till varför föräldrar var tveksamma till att vaccinera sina barn. De främsta anledningarna var att föräldrar saknade tillit till sjukvården, att det förekom kunskapsluckor och missuppfattningar samt att det sociala livet påverkade föräldrars attityder kring vaccinationer. För att kunna bemöta föräldrar individanpassat och stärka föräldrarnas hälsolitteracitet bör sjukvårdspersonal arbeta personcentrerat. / Background Vaccine is a contributing factor to maintaining a good level of public health, both nationally and internationally. Despite this, there is mistrust of vaccines, and when parents choose to give up vaccinations to their children, the risk of reintroducing communicable diseases into society increases. If the reasons for doubt can be identified, the nurse's work can be individualized and person-centered care applied, which in turn can contribute to parents being able to make healthy choices for their children. Aim The aim of this literature review was to describe the reasons for parents' hesitation in vaccinating their children. Method A non-systematic literature review was conducted which included 18 scientific articles. The articles were obtained from the databases PubMed and CINAHL with the help of various keywords and were then quality checked based on Sophiahemmet University's assessment template. With the help of an integrated data analysis, the results could be reported in categories and subcategories. Results The results are presented through three main categories and eight subcategories. The three main categories were: healthcare and healthcare systems, parent´s knowledge needs and sociological factors. The eight subcategories were: information from healthcare professionals, economic factors, knowledge gaps and misconceptions, impact of information channels, parents' perceptions of the vaccine's insecurity, concerns about side effects, lifestyle and outlook on life, and demographics. Conclusions The results showed that there are several different reasons why parents are hesitant to vaccinate their children. The main reasons were that parents lack confidence in healthcare, that there were knowledge gaps and misconceptions and that social life influence parents' attitudes about vaccinations. To be able to respond to parents individually and strengthen the parents' health literacy, healthcare staff should work person-centered.

Objective: Vaccine hesitancy remains a significant public health challenge, and one that is socially patterned. This study examined whether the vaccine hesitancy effects of identifying as female, race–ethnicity, the number of children, educational attainment, and political conservatism were mediated by governmental conspiracy beliefs. Methods: Linear mediation models controlling for potential confounders were employed to analyze data from a national survey of adults (2019 Chapman University Survey of American Fears; n = 1,209). Results: Effects on vaccine hesitancy were significant and negative for educational attainment, and significant and positive for the other focal predictors. Governmental conspiracy beliefs significantly mediated each of these effects; the percent mediated was largest for Hispanic identity (79 percent), followed by female identification (69 percent), educational attainment (69 percent), number of children (55 percent), black identification (34 percent), and political conservatism (30 percent). Conclusion: This study underscores the importance of nonvaccine-related conspiracy beliefs for future interventions aimed at reducing sociodemographic disparities in vaccine hesitancy.

Introduction: COVID-19 vaccination in the United States (U.S.) has stalled, with the lowest rates observed in the southern parts of the country. Vaccine hesitancy is a primary contributor to this trend, and health literacy (HL) has been identified as a potential determinant for hesitancy. This study aims to assess the association between HL and COVID-19 vaccine hesitancy in a population residing in 14 southern states of the U.S. Methods: We utilized a web-based survey conducted in U.S. southern states between February and June 2021 that yielded 417 total responses. The outcome was “vaccine hesitancy”. The main independent variable was HL, assessed by validated measures whose responses were aggregated to an HL index score and subsequently categorized as “low or moderate HL”, and “high HL”. Descriptive statistics were performed, and multivariable logistic regression analysis was conducted, controlling for sociodemographic and other variables. Results: Of the total respondents (n=247 after data cleaning), the overall rate of vaccine hesitancy was 22.3%. The rate of vaccine hesitancy was 10.9% and 89.1% for low/moderate and high levels of HL, respectively, but the association was not significant. However, personal perception of COVID-19 threat was significantly associated with lower odds of vaccine hesitancy versus those without perception of threat [adjusted odds ratio, AOR: 0.15; 95% CI: 0.03-0.73; p = 0.0186]. Similarly, obtaining information from public health sources was significantly associated with a lower likelihood of vaccine hesitancy [AOR:0.17; 95% CI: 0.05-0.61; p=0.0064]. Conclusion: HL was not a significant predictor of vaccine hesitancy in a population residing in southern states, suggesting that low rates of vaccination in the region may not be due to knowledge about COVID-19. Personal perception of COVID-19 threats and obtaining information from public health sources were associated with decreased vaccine hesitancy. This implies that we should strengthen public health communication infrastructure in the country. We also need to unpack the contextual factors that contribute to the disproportionately high rates of vaccine hesitancy in the region.

BACKGROUND: The widespread use of vaccines led to significant decline in multiple potentially fatal infectious diseases. Recently, there has been an increase in vaccine hesitancy. Measles and pertussis outbreaks throughout the United States have put a spotlight on this urgent healthcare issue. Motivational interviewing is a counseling tactic that is gaining popularity and is being studied for its efficacy in preventative medicine and psychological disorders. It aims to inspire people to make behavioral changes through collaborative relationships with their provider by understanding how current actions do not translate into their health goals. LITERATURE REVIEW FINDINGS: Vaccine hesitancy is growing. Communities with decreased immunization rates are associated with a higher risk of disease outbreak. Increasing rates of undervaccinated children are likely due to increases in non-medical exemptions. Many parents, regardless of their vaccine hesitancy status, are concerned about vaccine safety. Vaccine hesitant parents refuse vaccines due to philosophical and religious beliefs, conspiracy theories, and safety concerns. Parents feel that providers do not adequately address their concern. Providers report not having the training to discredit parental concerns. The majority of parents describe their child’s pediatrician as their most trusted source of vaccine information. Parents who receive vaccine information from a provider are more likely to comply with the recommended childhood vaccine schedule. The most efficient way to discuss vaccines with parents has yet to be determined. PROPOSED PROJECT: This is a proposed QI research project for the Pediatric Clinic at Boston Medical Center. Providers would be trained in motivational interviewing during several sessions that included lectures and small group practice sessions with systematic feedback. During the intervention, parents who refuse vaccines for their child, aged 0-6 years old, will receive motivational interviewing from the provider. The proportion of the vaccine hesitant parents who accept the offered vaccine after will be analyzed. The pre and post intervention vaccination rates for the entire clinic will also be assessed. Data collection will be preformed through retrospective chart review. The project aims to increase provider confidence on vaccine counseling, educate providers on reasons for hesitancy, and improve compliance with the CDC recommended vaccine schedule. CONCLUSION: While most Americans continue to vaccinate their children according to the CDC’s recommended schedule, constant vigilance is required to maintain high immunization rates to protect our communities. Motivational interviewing is goal-oriented to alter a specific behavior and would allow providers to engage in an open, persuasive dialogue about parental vaccine concerns.

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This dissertation is an examination of trust in vaccine science, with a focus on ideas about vaccination outside the scientific consensus. It is grounded in empirical research, including 35 interviews and a review of publicly available documents, books, and academic articles. Theoretically, it is informed by theories in the sociology of science, social movements, and the sociology of expertise. In substantive chapters, it investigates the origins of the modern ‘anti-vaccine’ movement, the spread of the movement's ideas in different sociocultural and political contexts, and the perspectives and personal experiences of those who are part of the movement. Overall, it contributes to a growing body of literature that aims to change the conversation around vaccine hesitancy from an information-deficit problem to an issue about trust in institutions. The dissertation is organized into three main papers. The first is an analysis of a specific historic episode, namely the 1998 MMR (measles, mumps, rubella) vaccine-autism controversy. I find that institutional incentive structures unintentionally circulated misinformation about the MMR vaccine by former medical doctor Andrew Wakefield and posit the role that academic reward structures have in fostering public trust. The second paper examines vaccine hesitancy with a social movement lens, specifically focusing on the strategies used by the anti-vaccine movement to organize and frame their message. I introduce the concept of an ‘anti-scientific intellectual movement’ to understand the increasing trend of social groups opposing science as a set of institutions. The third paper is a study of the lived experiences of participants who were interviewed in 2019 about their views on vaccination and how their individual experiences and meaning-making activities impacted their trust in vaccine science. I find strong distrust in scientific institutions, a desire for open dialogue and debate, and dissatisfaction with the ‘anti-vaccine’ label which participants felt erased the nuance in their perspectives. Altogether, this dissertation makes significant contributions to ongoing discussions about the public face of science and how to effectively engage with public audiences to build trust. / Dissertation / Candidate in Philosophy

Objective: Little is known about the parental perception of usage and delivery of Vaccine Information Statements (VISs), the timing of VIS delivery, parent opportunity to read VISs, and time for discussing content of VISs with providers. Parental reports of dissemination and use of VISs are explored in this study, including parental use, experience, and perceptions. Method: Data for this pilot cross-sectional descriptive study were collected via an online survey. The instrument consisted of 21questions including five demographic questions, 11 questions about VIS distribution, four questions about parental use and understanding of VISs, and one open-ended question about finding information about immunizations (see appendix A). The questionnaire was available in both English and Spanish. Results: Responses from 130 parents in one school district were used for analysis. Most participants (67.7%) reported getting vaccine information from a pediatric healthcare provider. A large majority of participants (71.5%) said VISs were included as part of the vaccination process and that they received a paper copy (64.6%). About a third of participants (37.7%) said they read some or all of the VIS before their child was vaccinated and over half (59.3%) said they read some or all of the VIS after their child was vaccinated. Discussion: While it is promising that many parents reported receiving the federally mandated vaccine information, over a quarter of parents reported they did not receive a VIS. Similar to findings in the literature, a majority of parents read all or part of the VIS after an immunization appointment. Limited time to read and understand the information on the VIS before an immunization was administered may lead to limited parental understanding. Although some parents reported struggling to understand VISs, more than half of the parents in our study said that VISs were helpful and would read another in the future. Nursing Implications: Without appropriate use of VISs and other vaccine education material, providers miss the opportunity to educate parents on the risks and benefits of vaccinating their children. Conclusion: Since their implementation in 1986, there has been little research on VIS use for vaccine education and parental perception. Providers must be aware of literacy levels and vaccine attitudes and create appropriate opportunities for parents to read and learn about vaccines. VISs are a valuable tool to educate patients and parents on the benefits and risks of vaccines. Improvements are needed to improve the clarity of the VIS messaging and dissemination practices.

At the beginning of 2020, the SARS-CoV-2 virus, known more commonly as COVID-19, created a pandemic. To slow its spread, healthcare workers were heavily encouraged to vaccinate themselves. However, nurses have been less likely to be vaccinated against COVID-19 than physicians. Four common themes have been associated with vaccine hesitancy among nurses, namely certain demographic variables (e.g., younger age and female sex), fears of the vaccine, conspiracy theories and news sources, and medical and psychological histories that pertain to receiving the COVID-19 vaccine. Thus, this study aimed to identify whether these factors apply to Florida nurses' decisions to get vaccinated after the height of the pandemic. To approach this problem, sixty-five participants were surveyed through a Qualtrics cross-sectional questionnaire. The results revealed that approximately 18.5% of participants were not vaccinated. Trends in the data revealed that older age and a postgraduate education level were associated with receiving the vaccine. Non-vaccinated participants had less confidence in the vaccine's ability to reduce the risk of hospitalization, death, and infection, and they had a stronger fear of side effects and the vaccine's rapid development. Several vaccinated and non-vaccinated participants also believed vaccine conspiracy theories, such as that vaccine safety data is falsified. Many non-vaccinated nurses also received SARS-CoV-2 information from social media or their patients, whereas many vaccinated nurses received information from government news sources or physicians. Non-vaccinated nurses also tended to have more discomfort towards hypodermic injections than vaccinated nurses. These conclusions are generalizable to the nurses of this study and may not be generalizable to all nurses. However, because nurses are on the frontlines of the healthcare field and have an essential role in informing the public about health, the results of this study can help inform vaccine education interventions should a future pandemic occur.